Lecture 41 - Ophthalmic Pathology

Question 1

Sebaceous glands are more numerous in the ______ (upper or lower?) eyelid. So what does this mean for the prevalence of Sebaceous cell carcinoma in the eyelids?

Answer 1

Upper

This means Sebaceous cell carcinoma is more prevalent in the upper eyelid.

Question 2

______ cell carcinoma is the most common primary tumor of the Eye.

Answer 2

Basal

Question 3

Sebaceous cell carcinoma (aka Meibomian gland carcinoma) most often affect ______ (old or young?) patients. It often presents with loss of ______, though it may appear as a nodule under or on the edge of the eyelid. It is highly ______.

Answer 3

Old

Eyelashes

Malignant

Question 4

Stye (aka Hordeolum) may appear red and like early Sebaceous cell carcinoma, but what can differentiate it?

It is most commonly caused by _____ ______.

Answer 4

Stye will be painful, as it is an infection with inflammation; Sebaceous cell carcinoma will not be painful.

Staph aureus

Question 5

________ is a hard, painless (unlike Stye) lump under the eyelid. It is caused by ______ inflammation of a sebaceous gland –> keep in mind this is NOT infection. Sebum extravasates into the ECF.

Answer 5

Chalazion

Granulommatous inflammation

Question 6

Chlamydia trachomatis can cause Trachoma in newborns, which is among the leading causes of ________ in developing countries (so look for immigrants in question stem). It is an infection of the _______, which will have a cobblestone appearance due to hyperplasia and underlying lymphoid ______.

Answer 6

Blindness

Conjunctiva

Lymphoid follicels

Question 7

Both Pinguecula and Pterygium are membranous growths of the ______ conjunctiva, but one stops at the scleral-corneal junction. Which one?

These form from _____ exposure.

Answer 7

Bulbar (the part on the eyeball - keep in mind the paplibrar is on the underside of the eyelid)

Pinguecula stops at the scleral-corneal junction (does not invade the cornea)

UV exposure

Question 8

Conjunctival Papiloma has characteristic pin-point redness, and it is associated with HPV ___ and ___ (the ____ risk strains).

Answer 8

HPV 6 and 11 (low risk)

Question 9

______ _______ are typical manifestations of the healing process in the conjunctiva, so look for patients with hx of trauma, surgery, or infection in the eye.

Answer 9

Pyogenic Granulomas

Question 10

How is Conjunctival Nevus differentiated from Melanoma?

Answer 10

Manipulate the conjunctiva overlying the sclera –> if the spot moves, it’s a Nevus. Melnoma penetrates into the sclera and will not move.

Question 11

Conjunctiva-Squamous cell Carcinoma most often occurs in ________ patients (e.g. HIV+, transplant, etc.), and it is also associated with UV radiation or infection with HPV ___ and ___ (High risk strains). These are _____ (fast or slow?) growing, so look for a patient to say it wasn’t there a few months ago.

Histologically, these will have characteristic _______ pearls and _______ bridges.

Answer 11

Immunocompromised patients

HPV 16 and 18

Fast growing

Keratin Pearls

Intercellular bridges

Question 12

______ ______ is an accumulation of lipids in the limbus (scleral-corneal junction).

Answer 12

Arcus Senilis

Question 13

Kayser-Fleischer ring is the formation of a golden-brown ring at the limbus due to accumulation of _______ (Wilson’s disease) –> it deposits in Descemet’s membrane (endothelial lining under the corneal stromal layer).

Answer 13

Copper

Question 14

The most common pathogens of Corneal Fungal infections are ______ and ______.

Answer 14

Asergillus and Candida

Question 15

The Neurosensory Retina is a derivative of the ______, while the Rentinal Pigmented Epithelium (RPE) is a derivative of the Primary ______ vessel.

Answer 15

Diencephalon

Primary Optic Vessel

Question 16

The normal Macula of the eye is a cup-shaped spot in the retina adjacent to the Optic disc. It contains ONLY ______ (rods or cones?).

Answer 16

Cones (color vision and high res)

Question 17

Age related Macular Degeneraton occurs from lipid accumulation between the ______ and ______. These accumulations are called Drusen.

Where will the vision loss be in Macular Degeneration?

What is the difference between Dry and Wet Macular degen?

Answer 17

RPE and Choroid

Centrally

Dry –> Drusen

Wet –> neovascularization of Drusen from Choroid, leading to hemorrhage.

Question 18

Retinoblastoma arises from a loss-of-function defect in Rb (tumor suppressor gene) on chromosome ______q14.

If it is congenital, patients can develop soft tissue and ______ malignancies later in life, so they require life-long follow-up. Also look for presencce of Rb in ______ gland.

________ seen on imaging are pathognomonic of Rb.

Answer 18

13q14

Soft tissue and Bone

Pineal gland

Calcifications

Question 19

Malignant Melanoma is the most common Primary malignancy of the eye in Caucasian ______ (adults or children?). It occurs in the Uveal tract, most commonly in the ______. There are 2 types: ______ or ______ (though can be a combo). Which is most common?

Prognosis is poor when the tumor arises from the ______ body or _____.

Bc there aren’t any lymphatics in the eye, spread is hematogenous, and most commonly metastasizes to the ______.

Answer 19

Caucasian Adults

Choroid

Spindle

Epithelial

Spindle is most common

Cilliary body or Choroid

Liver

Question 20

Most common Malignancies of the eye are Mets. They frequently arise in the Uveal tract, which consists of the _____ body, _____, and _____. Mets from breast, lung, and prostate are common.

Answer 20

Cilliary body, Iris, and Choroid