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1 P Seg II > Lecture 9 > Flashcards

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
Q

Rhabdo age of dx

A

Median age is 5-7
90% before age 16
Males

26
Q

Metastatic lesion of the ONH appearance

A

Chalky white to creamy yellow
Infiltrate with sharply defined border, scalloped nodules.

associated with hemes and ONH edema.

27
Q

Mean survival time after metastasis of metastatic lesion of the ONH

28
Q

Lymphoproliferative tumors. What is it?

A

Intraocular infiltration of malignant lymphoid cells. Usually associated with systemic lymphoma.

29
Q

Appearance of lymphoproliferative tumors

A

Vitreoretinal- White, diffuse retinal infiltrates. Vitritis, anterior uveitis, KP’s, optic neuropathy

Uveal- Creamy white yellow. Single or multiple lesions.

30
Q

Radiation retinopathy can develop when

A

Anywhere from 1 month-15 years following radiation. Most commonly 6 months- 3 years.

31
Q

What increases risk of radiation retinopathy?

A

Comorbidities such as DM, HTN, pregnancy.

Higher dose radiation

32
Q

Complication of radiation retinopathy

A

Tractional retinal detachment

33
Q

Systemic work up for rhabdo

A
  1. Chest and abdomen CT
  2. Lumbar puncture
  3. Bone scan

1 P Seg II (9 decks)

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