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OD2 - Applied Clinical Training & Research Studies in Vision and Optometry > AED - Lumps and Bumps I & II - Week 2 > Flashcards

AED - Lumps and Bumps I & II - Week 2 Flashcards

1
Q

What are two general causes of a lump or bump (5)?

A 
Increased cellular (hyperplasia) or extracellular mass (fluid/fat)
Tissue enlargement/growth/invasion
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2
Q

List 14 possible causes of a lump or bump and categorise by the general two causes.

A 
Increased cellular mass
-hyperplasia
-hypertrophy
-dysplasia
-metaplasia
-neoplasia
Other
-inflammation
-cellular product deposition
-vesicle
-cyst
-duct/vessel blockage
-foreign body
-oedema
-haemorrhage
-microorganism proliferation
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3
Q

List the two types of neoplasia. How can they be distinguished (3)?

A

Benign
Malignant
This is based on appearance, rate of growth, invasiveness etc

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4
Q

What can a benign tumour result from (4)? Is such growth typically normal? hat happens on removal of the stimulus?

A 
Hyperplasia
Metaplasia
Dysplasia
Hypertrophy
Such growth is a normal celllar adaptation, it ceases or is reversible with stimulus removal
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5
Q

How does a malignant tumour compare to a benign one?

A

Uncontrolled growth and spread results in the formation of a malignant tumour
Benign tumours are non-cancerous

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6
Q

What are malignant tumours often called?

A

Neoplasia

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7
Q

Where do pterygia originate from and in response to what? What is the end result? Are the common or rare?

A

They originate from limbal stem cells exposed to chronic UV radiation
This causes an overgrowth of normal tissue
They are common

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8
Q

Describe the tistology of pterigium progression in 3 steps.

A

Epithelial proliferation
Goblet cell hyperplasia
Angiogenesis sustaining growth

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9
Q

What are malignant tumours comprised of (2)?

A

Abnormal tissue with excess growth that is uncoordinated

Defects in normal cellular functions as a result of gene mutations

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10
Q

True or false

Viral infections cannot cause cancer

A

False

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11
Q

What do defects found in malignant tumours allow them to do (3)?

A

Divide uncontrollably
Invade surrounding tissue
Spread via lymphatic or vascular systems - metastasis

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12
Q

List 5 possivle risk factors for cancer.

A 
Genetics
Smoking
Diet (saturated fat, food preservatives)
Occupation/environment (UV)
Infectious agents (viruses alter DNA)
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13
Q

List the 6 major histological categories of neoplasia, and the tissue type involved.

A 
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
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14
Q

List 5 types of specific tissue that can result in a sarcoma.

A 
Bones
Tendons
Cartilage
Muscle
Fat
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15
Q

What type of tissue is lymphoma common to (3)?

A

Stomach
breast
Brain

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16
Q

What is most breast cancer a result of (which tissue specifically)?

A

Ductal carcinoma

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17
Q

What type of cancer accounts for most cancers, and what percentage?

A

Carcinoma accounts for 80-90% of all cancers

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18
Q

How do medical professionals refer to cancers vs the public?

A

Medical professionals refer based on their histological type, the public use the primary site of cancer

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19
Q

Can benign tumours be expansile?

A

Yes

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20
Q

Are benign tumours encapsulated?

A

Often, yesd

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21
Q

Do benign tumours have a fast or slow growth rate?

A

Slow

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22
Q

Do benign tumours show any tendency to spread to other tissue?

A

No

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23
Q

Do benign tumours have the potential to become malignant?

A

Yes

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24
Q

Are primary brain tumours generally benign or malignant?

A

Mostly benign

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25
Q

List two ways a malignant tumour can spread to other tissue.

A

Invasion of surrounding tissue

Metastatic seeding via body fluids

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26
Q

which malignant tumours especially show rapid growth?

A

Brain tumours

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27
Q

Do malignant tumours have complete or incomplete differentiation of cells?

A

Incomplete - atypia

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28
Q

Of all brain tumours, which are more common: benign or malignant?

A

Malignant

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29
Q

What are the most common sources for metastasis to the brain with malignant tumours (2)?

A

Breast and lung cancer

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30
Q

Define differentiation histologically, and compare benign and malignant tumours under this definition.

A

The extent to which cells resemble their precursors
Benign growths contain cells that resemble their precursor
Malignant growths show variation in cell growth structure

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31
Q

Define dermoid. What do they often have on their surfaces?

A

A cyst with an entrapment of fat cells

Often have hairs on its surface

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32
Q

What is pleomorphism an early sign of?

A

Cancer

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33
Q

How do pleomorphic cells appear histologically?

A

Exhibit marked variation in size and shape

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34
Q

Define anaplasia and describe how anaplasic cells appear histologically (3).

A

Poor cellular differentiation, resulting in:

  • large nuclei
  • unusual shapes
  • little cytoplasm
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35
Q

What can be said of the blood supply in neoplasia?

A

Neoplasic tissue demands rich blood supply to sustain rapid growth, which is evident by feeder vessels

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36
Q

What do feeder vessels indicate?

A

Active and fast growth

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37
Q

How does local invasion in benign tumours (2) compare to malignant tumours (2)?

A 
Benign
-localised to a single tissue
-shows well demarcated edges
Malignant
-invade surrounding tissue
-show irregular borders
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38
Q

Do all malignancies metastasise? Explain (2).

A

No, some cancers grow slowly

Often show a halo (invasion zone)

39
Q

What is some advice if any unusual or unexpected growth is seen on the eye or adnexa (3)?

A

Consider speed of development/spread
If unsure, photograph and wait (6-12 months)
Refer for biopsy as needed

40
Q

Can a tumour grow fast and not be malignant? What is indicated if it grows fast, is pleomorphic, highly vascularised, and invasive?

A

It can grow fast and not be malignant

Fast growth, pleomorphism, vascularisation, and invasion are all indicative of malignancy

41
Q

What should be done clinically if there are any unusual/unexpected lesions inside the eye (3)?

A

Dilated fundus exam
+CFP +OCT or ultrasound
Consider the possibility that it is secondary
Vision + visual function, especially visual field

42
Q

What is a common ocular site of metastasis and from what four other regions of the body?

A

Choroid - from the breast, lung, GI tract, and liver

43
Q

Describe how intra-peritoneal seeding occurs (2).

A

Local invasion by neoplasic cells that detach due to local inflammation
Cavity fluid carries cells to distal sites in the cavity

44
Q

How can cysts arise?

A

From secreting epithelium that become trapped at a deeper location

45
Q

Define vesicle (not the organelle).

A

A container of fluid within a natural clevage of skin layers

46
Q

How are vesicles the more superficial they are? What are they sometimes called?

A

The more superficial, the more flaccid

Sometimes called blisters

47
Q

How do cysts feel on palpation and why?

A

Hard due to internal pressure

48
Q

How do vesicles feel on palpation and why?

A

A kind of softness, because they are non-secreting sacs

49
Q

Do cysts and vesicles enlarge with time?

A

Cysts do, vesicles do not

50
Q

What is the middle of a cyst filled with (2)?

A

Secretions and epithelial cells

51
Q

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)?

A

Sometimes called a dermoid

Forms at birth from entrapped dermis in the orbit, lids, or limus

52
Q

What can dermoid cysts have on their surface?

A

Lashes/hair

53
Q

What is the dermoid cyst lining?

A

Normal skin surface

54
Q

What do dermoid cysts contain, what is their growth rate, and what does this result in?

A

Contains keratin, so hard slow growing lump - usually noted late teens

55
Q

What is a lipodermoid similar to, and where can it be found (2)? What additional compound does it include?

A

It is similar to a dermoid cyst and can be found at the nasal or temporal margins
It includes collagen

56
Q

In what three cases would a referral be considered for a cyst (3)?

A

Becomes painful or inflammed
Grows rapidly or changes colour
When removal is desired for cosmetic reasons

57
Q

Define lymphangiectasia. How does it appear?

A

Focal blockage of conjunctival lymphatic vessels

Appears as multiple bubbles on the conjunctiva

58
Q

What is lymphangiectasia often secondary to (2)?

A

Trauma or inflammation

59
Q

What is a chalazion? What does it caue and how?

A

A blocked duct that causes a local swelling of the gland.

Leakage of oils into surrounding tissue causes inflammation

60
Q

What happens in which two possible glands in a chalazion, and in response to what?

A

Inflammation in the Meibomian or Zeis gland in response to the denatured secretions

61
Q

What kind of inflammation occurs in a chalazion?

A

Granulomatous inflammation

62
Q

Are chalazions painful? Explain.

A

Not painful, but red due to inflammation

63
Q

How can chalazions be managed (4)?

A

Warm compresses
Massage
Steroid injection
Surgical removal

64
Q

What is a papilloma? What cell layer does it concern?

A

A benign mass of conjunctiva

It is an overgrowth of epithelial cells

65
Q

Are papillomas invasive or non-invasive?

A

Non-invasive

66
Q

Do papillomas have blood vessel growth?

A

Modest blood vessels

67
Q

Are blood vessel capillaries the main feature of papillomas?

A

No

68
Q

Does the conjunctiva have a dense lymphatic network?

A

Yes

69
Q

List and describe the three divisions of the conjunctiva.

A

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

70
Q

What are palisades of Vogt and where can they be found?

A

Radial ridges found at the limbus within the bulbar conjunctiva

71
Q

Which region of the conjunctiva is attached to Tenon’s capsule, and is this tight or loose (2)?

A

The bulbar conjunctiva is loosely attached to Tenon’s capsule except at the limbus, where the two layers fuse

72
Q

Define OSSN, and list the two types (3).

A 
Ocular surface squamous neoplasia
Benign - two types
-papilloma
-conjunctival intra-epithelial neoplasia (CIN)
Malignant conjunctival neoplasia
-squamous cell neoplasia (SCN)
73
Q

Which type of OSSN is considered pre-malignant?

A

Conjunctival intra-epithelial neoplasia

74
Q

Consider the benign types of OSSN. What tissue does it involve only, and does it invade the cornea?

A

Only involves the conjunctival squamous epithelium

Doesnt invade the cornea

75
Q

How does squamous cell neoplasia compare to the benign types of OSSN? Give a difference (2).

A

Is similar to the benign types of OSSN, but will also invade the cornea and substantia propria

76
Q

Define OSSN: conjunctival papilloma.

A

Local conjunctival epithelial overgrowth (>8 layers)

77
Q

What can OSSN: conjunctival papilloma be triggered by (2)?

A 
Human papilloma virus infection
Excess UV (at the limbus)
78
Q

Do conjunctival papillomas have modest or rich blood vessel supply?

A

Modest

79
Q

What would appear on a biopsy of conjunctival papilloma (5)?

A

Normal cells
No metaplasia, anaplasia, or pleomorphism
No stroma invasion

80
Q

List four differences between conjunctival papillomas and malignancy.

A

Papillomas have:

  • less red colour
  • non-invasive of the cornea
  • motile over the sclera
  • fewer feeders
81
Q

Do conjunctival papillomas have a high or low chance of malignancy?

A

Low

82
Q

Can conjunctival papillomas be surgically removed or is this advised against?

A

Yes

83
Q

What would appear on a biopsy of conjunctival intra-epithelial neoplasia (3)?

A

Metaplasia
Pleomorphism
Non-invasive to the stroma

84
Q

Compare blood vessels in conjunctival intra-epithelial neoplasia and papillomas (2).

A

Blood vessel strawberry spots more marked than papillomas

Feeder vessel supply are more richer than papillomas

85
Q

Can corneal intra-epithelial neoplasia invade into the cornea?

A

Yes, lateral spread

86
Q

What happens when a conjunctival intra-epithelial neoplasia brewaks through the basement membrane and invades the underlying substantia propria (stroma)?

A

Squamous cell neoplasia

87
Q

How does squamous cell neoplasia appear histologically?

A

Same as in corneal intra-epithelial neoplasia, but invades well into the cornea, and is non-motile - it is anchored by the stroma.

88
Q

How do blood vessels appear with squamous cell neoplasia and what is a common occurence as a result?

A

Has a rich blood supply, haemorrhages are common

89
Q

What compound is present with a squamous cell neoplasia biopsy?

A

Keratin

90
Q

What tool is useful in differentially diagnosing squamous cell neoplasia?

A

OCT

91
Q

Should conjunctival intra-epithelial neoplasia and squamous cell neoplasia be surgically removed, or will it make things worse?

A

Yes

92
Q

List three OCT characteristics of malignant neoplasia that a healthcare professional shouldnt miss.

A

Presence of keratinisation
Thickening/dense growth of tissue layer
Spread to involve other layers (stroma)

93
Q

How does keratin appear on an OCT scan?

A

White

OD2 - Applied Clinical Training & Research Studies in Vision and Optometry (174 decks)

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