Lecture 9 Flashcards
Choroidal Melanoma is the most common ___
Primary malignant intraocular tumor in adults
Choroidal melanoma
Metastasis occurs in __%
90% metastasize to the ____
50%
Liver
Types of radiation for the eye
Iodine plaque Bachytherapy- Prob will lose vision/damage ON. More common. ( to save vision, could try using oil to block radiation to the rest of the eye)
Gamma knife radiotherapy- Focused through the skin. No incisions. Kills abnormal cells.
Pt with choroidal melanoma. Any difference in survival when doing radiation then enucleation vs enucleation alone
No difference
How to know that a nevus has progressed to choroidal melanoma?
Greater than 2mm thickness Subretinal fluid Orange patches Tumor margin near optic disc Hollow on ultrasound No drusen (drusen on 80% of nevi) No surrounding halo Larger than 6DD
Retinoblastoma is the most common
Intraocular malignancy in children
Retinoblastoma is bilateral in how many cases?
30%
3 patterns of retinoblastoma growth
- Endophytic- tumor grows from the retina into the vitreous and causes seeding.
- Exophytic- tumor expands into sub retinal space.
- Diffuse infiltrating
Avg age of dx of retinoblastoma. All are dx by age ___
Dx usually by 18 months, all by age 5
Evolution of retinoblastoma if inherited vs not inherited
Inherited- Bilateral and more aggressive. Long term systemic f/u with oncologist.
Tx of retinoblastoma
Enucleation to save a life
To save an eye, must do local chemo + focal consolidation therapy or external beam radiation. Chemo alone is not enough
Focal consolidation therapy options- Cryo, laser, plaque.
External beam radiation should be avoided if less than 1 year old.
Bilateral tumor presentation? Think
Metastatic, secondary to the eye.
malignant melanoma originates from what cells
Pigmented cells in the Uvea or may transform from nevus
Risk of metastasis of choroidal melanoma is associated with 2 things
- Tumor size
2. Monosomy 3. Genetic marker in tissue. can determine by fine needle biopsy.
Tx options of choroidal melanoma
- Save a life- enucleation
- Save the eye- plaque or gamma knife radiotherapy
- Save vision- Oil with plaque.
COMS Trials (Collab ocular melanoma study group)
Found characteristics associated with growth: Lack of drusen, absence of RPE changes, thickness changes, lipofuscin.
Enucleation vs radiotherapy + enucleation had no difference in survival.
Retinoblastoma appearance
Leukocoria Strab Cellulitis like appearance White/pinkk Associated serous RD Calcific/cottage cheese/white
retinocytoma appearance
Similar presentation to successfully treated retinoblastoma, common in kids.
Relatively benign but 4% progress to retinoblastoma.
Clear retinal mass.
What closely resembles that of a successfully treated retinoblastoma
Retinocytoma (clear retinal mass)
Inheritance pattern of retinocytoma
Autosomal Dominant, usually caucasian pts.
How to dx retinocytoma with IVFA
No increase in vascularization of lesion
Colors that metastatic uveal carcinoma ca be
yellow (96%)
Orange (3%)
Brown-gray (3%)
Metastatic uveal carcinoma is secondary to where in females and males
Breast in females
Lung in males
In 34%, choroidal metastasis precedes systemic dx of cancer
3 common systemic symptoms in rhabdo
HA, sinitus, Nosebleeds
