Benign adnexal tumours and miscellaneous benign tumours

Question 1

What is a syringoma

Answer 1

Benign proliferation of the eccrine sweat glands. It is seen as small papules that are often multiple and bilateral

Question 2

What is a pilomatricoma

Answer 2

Derived from the germinal matrix cell of the hair bulb, it is the most common proliferation of the hair follicle seen by Ophthalmologists. If affects children and young adults and is more common in females

Question 3

What are the alternate names for a pilomatricoma

Answer 3

Pilomaxtricoma

Caclifying epithelioma of Malherbe

Question 4

What is the histology of a pilomatricoma

Answer 4

Iregular epithelial islands with viable basophillic cells at the periphery and degenerate cells in the centre. Calcification is frequently seen and there is often a foreign body giant cell reaction

Question 5

What are the signs of a pilomatricoma

Answer 5

Deep, dermal, purplish nodule that may be hard due to calcification

Question 6

What is the treatment of a pilomatricoma

Answer 6

Excision

Question 7

What are the types of hair follicle proflierations

Answer 7

Piloatricoma
Trichilemmoma
Trichifolliculoma
Trichiepithelioma

Question 8

What is a capillary haemangioma

Answer 8

Although rare it is the most common types of tumours of infancy and presents shortly after birth

Female to male ratio is 3:1

Question 9

Where do capillary haemangioma tend to be

Answer 9

They have a predilection for the upper lid and may have orbital extensions

They can also involve the skin of the face and they may have other strawberry naevi on other parts of the body

It is important to be aware of the association between multiple cutaneous lesions and visceral haemangiomas

Question 10

What is the histology of capillary haemangioma

Answer 10

Proliferation of varying sizes of vascular channels in the dermis and subcutaneous tissue

Question 11

What are the signs of capillary haemangioma

Answer 11

Unilateral, raised bright red lesion which blanches with pressure and may swell with crying. A large lesion can induce a mechanical ptosis

Question 12

What is a port-wine stain

Answer 12

Rare subcutaenous lesion consisting of large ectactic vessels of varying calibre.

Question 13

What are the other names of a port-wine stain

Answer 13

Cavernous haemangioma

Naevus flammeus

Question 14

Where does a port wine stain occur

Answer 14

Frequently occurs on the face
Usually unilateral and segmental
Can be bilateral

Question 15

What the histology of a port-wine stain

Answer 15

Dilated blood filled spaces separated by thin fibrous septa

Question 16

What are the signs of a port-wine stain

Answer 16

A sharply demarcated soft pink patch which does not blanch with pressure

With age the lesion does not grow but darkens to a red or purple

The overlying skin can become hypertrophied, coare, nodular and friable and may bleed or become infected

Question 17

What is the treatment of a port-wine stain

Answer 17

Treatment with laser in effective in decreasing the amount of discolouration in relatively flat or mildly hypertrophic lesions. Photodynamic therapy may be useful in resistant lesions

Question 18

What is sturge weber syndrome?

Answer 18

Congenital, sporadic phacomatosis

Question 19

What is the other name for sturge weber syndrome

Answer 19

Encephalotrigeminal angiomatosis

Question 20

What is the classification of sturge weber syndrome

Answer 20

Trisystem disease which involves the face, leptomeniniges (meninges, arachnoid and pia mater) and eyes

Bisystem disease which involves either the face and eyes or the face and leptomeninges

Question 21

What are the signs of sturge weber syndrome

Answer 21

Port wine stain affecting an area of the face corresponding to the distribution of one or two branches of the trigeminal nerve

An ipsilateral temporal or occipital haemangioma which can cause contralateral focal or generalised seizures

Ocular signs include ipsilateral glaucoma, episcleral haemangioma and diffuse choroidal haemangiomas

Question 22

What is a pyogenic granuloma

Answer 22

A fast growing vascularised proliferation of granulation tissue which is antedated by surgery, trauma or infection although it is sometimes idiopathic

Question 23

What is the histology of a pyogenic granuloma

Answer 23

Granulation tissue with thin walled dilated vascular channels and inflammatory cells infiltrating a loose stroma

Question 24

What are the signs of a pyogenic granuloma

Answer 24

Painful, rapidly growing, vascular polypoidal lesion that can bleed with relatively trivial trauma

Question 25

What is the treatment of pyogenic granuloma

Answer 25

Excision

Question 26

What is xanthelasma

Answer 26

Common, frequently bilateral condition affecting middle aged and elderly individuals

Along with corneal arcus it is associated with elevated serum cholesterol levels

Question 27

What are the signs of xanthelasma

Answer 27

Multiple yellowish subcutaneous plaques usually located at the medial aspects of the eyelids

Question 28

What is the histology of xanthelasma

Answer 28

Lipid laden histiocytes in the dermis

Question 29

What is the treatment of xanthelasma

Answer 29

Excision for cosmetic reasons
Preferable to destroy with carbon dioxide or argon laser
Recurrence is highest in those with persistently elevated cholesterol levels

Question 30

Who does neurofibromas tend to affect

Answer 30

Plexiform neurofibormas typically affect children who also have neurofibromatosis type 1. (plexiform - means network) Solitary neurofibromas affect adults, 25% of which have NF1

Question 31

What is the histology of neurofibromas

Answer 31

Proliferation of schwann cells, nerve axons and fibroblasts

Question 32

What are the signs of neurofibromas

Answer 32

Typically affects the upper lid giving rise to an s shaped deformity

Question 33

What is the treatment

Answer 33

Solitary lesions involves simple excisions but removal of plexiform lesions may be difficult as especially if they are diffuse

Question 34

What is the treatment of capillary haemangioma

Answer 34

Usually involute by the age of 5
If it is amblyogenic - then can treat with either oral propanolol, intralesional steroid or excision
The dose of propanolol is usually 2mg/kg/day and is given until the end of the proliferation period (6 months to 1 year) or until astigmatism is stabilised
It should be used in conjunction with paediatricians
The side effects of hypoglycemia and hypotension are commoner in young infants