AED - Lumps and Bumps I & II - Week 2 Flashcards
What are two general causes of a lump or bump (5)?
Increased cellular (hyperplasia) or extracellular mass (fluid/fat)
Tissue enlargement/growth/invasion
List 14 possible causes of a lump or bump and categorise by the general two causes.
Increased cellular mass
-hyperplasia
-hypertrophy
-dysplasia
-metaplasia
-neoplasia
Other
-inflammation
-cellular product deposition
-vesicle
-cyst
-duct/vessel blockage
-foreign body
-oedema
-haemorrhage
-microorganism proliferation
List the two types of neoplasia. How can they be distinguished (3)?
Benign
Malignant
This is based on appearance, rate of growth, invasiveness etc
What can a benign tumour result from (4)? Is such growth typically normal? hat happens on removal of the stimulus?
Hyperplasia
Metaplasia
Dysplasia
Hypertrophy
Such growth is a normal celllar adaptation, it ceases or is reversible with stimulus removal
How does a malignant tumour compare to a benign one?
Uncontrolled growth and spread results in the formation of a malignant tumour
Benign tumours are non-cancerous
What are malignant tumours often called?
Neoplasia
Where do pterygia originate from and in response to what? What is the end result? Are the common or rare?
They originate from limbal stem cells exposed to chronic UV radiation
This causes an overgrowth of normal tissue
They are common
Describe the tistology of pterigium progression in 3 steps.
Epithelial proliferation
Goblet cell hyperplasia
Angiogenesis sustaining growth
What are malignant tumours comprised of (2)?
Abnormal tissue with excess growth that is uncoordinated
Defects in normal cellular functions as a result of gene mutations
True or false
Viral infections cannot cause cancer
False
What do defects found in malignant tumours allow them to do (3)?
Divide uncontrollably
Invade surrounding tissue
Spread via lymphatic or vascular systems - metastasis
List 5 possivle risk factors for cancer.
Genetics
Smoking
Diet (saturated fat, food preservatives)
Occupation/environment (UV)
Infectious agents (viruses alter DNA)
List the 6 major histological categories of neoplasia, and the tissue type involved.
Carcinoma
-epithelial tissue (internal and external)
Sarcoma
-supportive/connective tissue
Lymphoma
-glands or lymph nodes
Myeloma
-plasma cells of bone marrow
Leukaemia
-haematopoietic stem cells
Mixed
List 5 types of specific tissue that can result in a sarcoma.
Bones
Tendons
Cartilage
Muscle
Fat
What type of tissue is lymphoma common to (3)?
Stomach
breast
Brain
What is most breast cancer a result of (which tissue specifically)?
Ductal carcinoma
What type of cancer accounts for most cancers, and what percentage?
Carcinoma accounts for 80-90% of all cancers
How do medical professionals refer to cancers vs the public?
Medical professionals refer based on their histological type, the public use the primary site of cancer
Can benign tumours be expansile?
Yes
Are benign tumours encapsulated?
Often, yesd
Do benign tumours have a fast or slow growth rate?
Slow
Do benign tumours show any tendency to spread to other tissue?
No
Do benign tumours have the potential to become malignant?
Yes
Are primary brain tumours generally benign or malignant?
Mostly benign
List two ways a malignant tumour can spread to other tissue.
Invasion of surrounding tissue
Metastatic seeding via body fluids
which malignant tumours especially show rapid growth?
Brain tumours
Do malignant tumours have complete or incomplete differentiation of cells?
Incomplete - atypia
Of all brain tumours, which are more common: benign or malignant?
Malignant
What are the most common sources for metastasis to the brain with malignant tumours (2)?
Breast and lung cancer
Define differentiation histologically, and compare benign and malignant tumours under this definition.
The extent to which cells resemble their precursors
Benign growths contain cells that resemble their precursor
Malignant growths show variation in cell growth structure
Define dermoid. What do they often have on their surfaces?
A cyst with an entrapment of fat cells
Often have hairs on its surface
What is pleomorphism an early sign of?
Cancer
How do pleomorphic cells appear histologically?
Exhibit marked variation in size and shape
Define anaplasia and describe how anaplasic cells appear histologically (3).
Poor cellular differentiation, resulting in:
-large nuclei
-unusual shapes
-little cytoplasm
What can be said of the blood supply in neoplasia?
Neoplasic tissue demands rich blood supply to sustain rapid growth, which is evident by feeder vessels
What do feeder vessels indicate?
Active and fast growth
How does local invasion in benign tumours (2) compare to malignant tumours (2)?
Benign
-localised to a single tissue
-shows well demarcated edges
Malignant
-invade surrounding tissue
-show irregular borders
Do all malignancies metastasise? Explain (2).
No, some cancers grow slowly
Often show a halo (invasion zone)
What is some advice if any unusual or unexpected growth is seen on the eye or adnexa (3)?
Consider speed of development/spread
If unsure, photograph and wait (6-12 months)
Refer for biopsy as needed
Can a tumour grow fast and not be malignant? What is indicated if it grows fast, is pleomorphic, highly vascularised, and invasive?
It can grow fast and not be malignant
Fast growth, pleomorphism, vascularisation, and invasion are all indicative of malignancy
What should be done clinically if there are any unusual/unexpected lesions inside the eye (3)?
Dilated fundus exam
+CFP +OCT or ultrasound
Consider the possibility that it is secondary
Vision + visual function, especially visual field
What is a common ocular site of metastasis and from what four other regions of the body?
Choroid - from the breast, lung, GI tract, and liver
Describe how intra-peritoneal seeding occurs (2).
Local invasion by neoplasic cells that detach due to local inflammation
Cavity fluid carries cells to distal sites in the cavity
How can cysts arise?
From secreting epithelium that become trapped at a deeper location
Define vesicle (not the organelle).
A container of fluid within a natural clevage of skin layers
How are vesicles the more superficial they are? What are they sometimes called?
The more superficial, the more flaccid
Sometimes called blisters
How do cysts feel on palpation and why?
Hard due to internal pressure
How do vesicles feel on palpation and why?
A kind of softness, because they are non-secreting sacs
Do cysts and vesicles enlarge with time?
Cysts do, vesicles do not
What is the middle of a cyst filled with (2)?
Secretions and epithelial cells
What is a dermoid cyst and what is it sometimes called? When are they formed and what layer of the skin? Which regions of the body (3)?
Sometimes called a dermoid
Forms at birth from entrapped dermis in the orbit, lids, or limus
What can dermoid cysts have on their surface?
Lashes/hair
What is the dermoid cyst lining?
Normal skin surface
What do dermoid cysts contain, what is their growth rate, and what does this result in?
Contains keratin, so hard slow growing lump - usually noted late teens
What is a lipodermoid similar to, and where can it be found (2)? What additional compound does it include?
It is similar to a dermoid cyst and can be found at the nasal or temporal margins
It includes collagen
In what three cases would a referral be considered for a cyst (3)?
Becomes painful or inflammed
Grows rapidly or changes colour
When removal is desired for cosmetic reasons
Define lymphangiectasia. How does it appear?
Focal blockage of conjunctival lymphatic vessels
Appears as multiple bubbles on the conjunctiva
What is lymphangiectasia often secondary to (2)?
Trauma or inflammation
What is a chalazion? What does it caue and how?
A blocked duct that causes a local swelling of the gland.
Leakage of oils into surrounding tissue causes inflammation
What happens in which two possible glands in a chalazion, and in response to what?
Inflammation in the Meibomian or Zeis gland in response to the denatured secretions
What kind of inflammation occurs in a chalazion?
Granulomatous inflammation
Are chalazions painful? Explain.
Not painful, but red due to inflammation
How can chalazions be managed (4)?
Warm compresses
Massage
Steroid injection
Surgical removal
What is a papilloma? What cell layer does it concern?
A benign mass of conjunctiva
It is an overgrowth of epithelial cells
Are papillomas invasive or non-invasive?
Non-invasive
Do papillomas have blood vessel growth?
Modest blood vessels
Are blood vessel capillaries the main feature of papillomas?
No
Does the conjunctiva have a dense lymphatic network?
Yes
List and describe the three divisions of the conjunctiva.
Palpebral conjunctiva - starts at the junction of of the lid margins and covers under the eyelids
Forniceal conjunctiva - loose, redundant tissue in the fornix, beyond the edge of the tarsal plate
Bulbar conjunctiva - covers the sclera
What are palisades of Vogt and where can they be found?
Radial ridges found at the limbus within the bulbar conjunctiva
Which region of the conjunctiva is attached to Tenon’s capsule, and is this tight or loose (2)?
The bulbar conjunctiva is loosely attached to Tenon’s capsule except at the limbus, where the two layers fuse
Define OSSN, and list the two types (3).
Ocular surface squamous neoplasia
Benign - two types
-papilloma
-conjunctival intra-epithelial neoplasia (CIN)
Malignant conjunctival neoplasia
-squamous cell neoplasia (SCN)
Which type of OSSN is considered pre-malignant?
Conjunctival intra-epithelial neoplasia
Consider the benign types of OSSN. What tissue does it involve only, and does it invade the cornea?
Only involves the conjunctival squamous epithelium
Doesnt invade the cornea
How does squamous cell neoplasia compare to the benign types of OSSN? Give a difference (2).
Is similar to the benign types of OSSN, but will also invade the cornea and substantia propria
Define OSSN: conjunctival papilloma.
Local conjunctival epithelial overgrowth (>8 layers)
What can OSSN: conjunctival papilloma be triggered by (2)?
Human papilloma virus infection
Excess UV (at the limbus)
Do conjunctival papillomas have modest or rich blood vessel supply?
Modest
What would appear on a biopsy of conjunctival papilloma (5)?
Normal cells
No metaplasia, anaplasia, or pleomorphism
No stroma invasion
List four differences between conjunctival papillomas and malignancy.
Papillomas have:
-less red colour
-non-invasive of the cornea
-motile over the sclera
-fewer feeders
Do conjunctival papillomas have a high or low chance of malignancy?
Low
Can conjunctival papillomas be surgically removed or is this advised against?
Yes
What would appear on a biopsy of conjunctival intra-epithelial neoplasia (3)?
Metaplasia
Pleomorphism
Non-invasive to the stroma
Compare blood vessels in conjunctival intra-epithelial neoplasia and papillomas (2).
Blood vessel strawberry spots more marked than papillomas
Feeder vessel supply are more richer than papillomas
Can corneal intra-epithelial neoplasia invade into the cornea?
Yes, lateral spread
What happens when a conjunctival intra-epithelial neoplasia brewaks through the basement membrane and invades the underlying substantia propria (stroma)?
Squamous cell neoplasia
How does squamous cell neoplasia appear histologically?
Same as in corneal intra-epithelial neoplasia, but invades well into the cornea, and is non-motile - it is anchored by the stroma.
How do blood vessels appear with squamous cell neoplasia and what is a common occurence as a result?
Has a rich blood supply, haemorrhages are common
What compound is present with a squamous cell neoplasia biopsy?
Keratin
What tool is useful in differentially diagnosing squamous cell neoplasia?
OCT
Should conjunctival intra-epithelial neoplasia and squamous cell neoplasia be surgically removed, or will it make things worse?
Yes
List three OCT characteristics of malignant neoplasia that a healthcare professional shouldnt miss.
Presence of keratinisation
Thickening/dense growth of tissue layer
Spread to involve other layers (stroma)
How does keratin appear on an OCT scan?
White
