Lecture 9 Flashcards

1
Q

Choroidal Melanoma is the most common ___

A

Primary malignant intraocular tumor in adults

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2
Q

Choroidal melanoma
Metastasis occurs in __%
90% metastasize to the ____

A

50%

Liver

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3
Q

Types of radiation for the eye

A

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.

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4
Q

Pt with choroidal melanoma. Any difference in survival when doing radiation then enucleation vs enucleation alone

A

No difference

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5
Q

How to know that a nevus has progressed to choroidal melanoma?

A
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
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6
Q

Retinoblastoma is the most common

A

Intraocular malignancy in children

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7
Q

Retinoblastoma is bilateral in how many cases?

A

30%

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8
Q

3 patterns of retinoblastoma growth

A
  1. Endophytic- tumor grows from the retina into the vitreous and causes seeding.
  2. Exophytic- tumor expands into sub retinal space.
  3. Diffuse infiltrating
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9
Q

Avg age of dx of retinoblastoma. All are dx by age ___

A

Dx usually by 18 months, all by age 5

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10
Q

Evolution of retinoblastoma if inherited vs not inherited

A

Inherited- Bilateral and more aggressive. Long term systemic f/u with oncologist.

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11
Q

Tx of retinoblastoma

A

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.

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12
Q

Bilateral tumor presentation? Think

A

Metastatic, secondary to the eye.

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13
Q

malignant melanoma originates from what cells

A

Pigmented cells in the Uvea or may transform from nevus

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14
Q

Risk of metastasis of choroidal melanoma is associated with 2 things

A
  1. Tumor size

2. Monosomy 3. Genetic marker in tissue. can determine by fine needle biopsy.

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15
Q

Tx options of choroidal melanoma

A
  1. Save a life- enucleation
  2. Save the eye- plaque or gamma knife radiotherapy
  3. Save vision- Oil with plaque.
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16
Q

COMS Trials (Collab ocular melanoma study group)

A

Found characteristics associated with growth: Lack of drusen, absence of RPE changes, thickness changes, lipofuscin.

Enucleation vs radiotherapy + enucleation had no difference in survival.

17
Q

Retinoblastoma appearance

A
Leukocoria 
Strab 
Cellulitis like appearance 
White/pinkk
Associated serous RD
Calcific/cottage cheese/white
18
Q

retinocytoma appearance

A

Similar presentation to successfully treated retinoblastoma, common in kids.

Relatively benign but 4% progress to retinoblastoma.

Clear retinal mass.

19
Q

What closely resembles that of a successfully treated retinoblastoma

A

Retinocytoma (clear retinal mass)

20
Q

Inheritance pattern of retinocytoma

A

Autosomal Dominant, usually caucasian pts.

21
Q

How to dx retinocytoma with IVFA

A

No increase in vascularization of lesion

22
Q

Colors that metastatic uveal carcinoma ca be

A

yellow (96%)
Orange (3%)
Brown-gray (3%)

23
Q

Metastatic uveal carcinoma is secondary to where in females and males

A

Breast in females
Lung in males

In 34%, choroidal metastasis precedes systemic dx of cancer

24
Q

3 common systemic symptoms in rhabdo

A

HA, sinitus, Nosebleeds

25
Rhabdo age of dx
Median age is 5-7 90% before age 16 Males
26
Metastatic lesion of the ONH appearance
Chalky white to creamy yellow Infiltrate with sharply defined border, scalloped nodules. associated with hemes and ONH edema.
27
Mean survival time after metastasis of metastatic lesion of the ONH
10 months
28
Lymphoproliferative tumors. What is it?
Intraocular infiltration of malignant lymphoid cells. Usually associated with systemic lymphoma.
29
Appearance of lymphoproliferative tumors
Vitreoretinal- White, diffuse retinal infiltrates. Vitritis, anterior uveitis, KP's, optic neuropathy Uveal- Creamy white yellow. Single or multiple lesions.
30
Radiation retinopathy can develop when
Anywhere from 1 month-15 years following radiation. Most commonly 6 months- 3 years.
31
What increases risk of radiation retinopathy?
Comorbidities such as DM, HTN, pregnancy. Higher dose radiation
32
Complication of radiation retinopathy
Tractional retinal detachment
33
Systemic work up for rhabdo
1. Chest and abdomen CT 2. Lumbar puncture 3. Bone scan