Lumps & Bumps: Vascular Tumors of Eyelid & Conjunctiva Flashcards
vascular tumor caused by disorganized overgrowth of mature capillary tissues due to endothelial cell proliferation
- one of the most common tumors of infancy
capillary hemangioma
characteristics:
- strawberry birthmarks in infants
- becomes more elevated for 3-6 mo after dx
- stable by 12-18 mo, then involutes
- usually regresses completely
- main complication: amblyopia & strabismus
- lesion blanches on pressure & can swell when crying
capillary hemangioma
management of capillary hemangioma
- careful assessment of VA & refraction
- topical beta-blockers (timolol) - first-line therapy for superficial lesions
- oral propranolol for deeper lesions
- intralesional steroid injection for lesions with amblyogenic potential
vascular tumor caused by congenital vascular malformation within superficial dermis
nevus flammeus (port-wine stain)
characteristics:
- present at birth & enlarges with time
- upper eyelid involvement
- follows cutaneous distribution of CN V
- sharply demarcated pinkish-purplish patch (doesn’t blanch with pressure)
- most frequently located on face
- associated with soft tissue hypertrophy
nevus flammeus (port-wine stain)
when nevus flammeus has upper lid involvement, what is it indicative of
strong indication for glaucoma development
nevus flammeus is often associated with what condition
Sturge-Weber syndrome
capillary hemangioma & nevus flammeus are ____ vascular tumors of the eyelid
benign
what vascular tumor is caused by multiple lesions that usually begin in lower extremeties & spread to other parts of skin & visceral organs
kaposi sarcoma
characteristics:
- eyelid lesions PATHOGNOMONIC for AIDS
- present as red, purple, brown, or blue subcutaneous lesions
kaposi sarcoma
what treatments are used for karposi sarcoma
chemotherapy for extensive lesions
radiotherapy for small lesions
karposi sarcoma is a _____ vascular tumor
malignant
what lesion is caused by choristoma (benign tumorous malformation composed of histologically normal tissue at an abnormal location)
conjunctival dermoid
characteristics:
- variably sized yellow-white limbal mass (usually inferotemporal)
- lined with squamous epithelium & filled with sweat glands, fat & cilia
- large ones can cause irritation, astigmatism & inadequate eyelid closure
conjunctival dermoid
is treatment needed for conjunctival dermoids
surgical removal indicated if dermoid results in amblyopia from astigmatism or dellen formation
what conjunctival lesion presents as part of a systemic syndrome
goldenhar syndrome
characteristics:
- hypoplasia of malar, maxillary & mandibular regions*
- macrostomia: wide mouth*
- microtia: underdeveloped pinna of the ear
- preauricular & facial skin tags*
- mental handicap
- hemivertebrae (wedge-shaped vertebrae that can result in scoliosis)
goldenhar syndrome
what conjunctival lesion is caused by fibrovascular proliferative response to a physical insult
pyogenic granuloma
characteristics:
- consists of granulation tissue, proliferation of small blood vessels & inflammatory cells
- a misnomar because lesion is neither pyogenic (pus-producing) nor granulomatous
pyogenic granuloma
treatments for pyogenic granuloma
- surgical removal indicated if dermoid results in amblyopia, astigmatism, dellen formation
- topical steroids or excision if steroids don’t work
the most common conjunctival melanocytic lesion that is initially noticed in first/second decade of life
conjunctival nevus
characteristics:
- solitary lesion, flat/slightly elevated
- mobile over underlying sclera
- plica, fornix & caruncle are uncommon locations
- stable size & pigmentation over time
- frequently contains cystic components
conjunctival nevus
what lesion is caused by presence of excess melanin within the basal layer of the conjunctival epithelial melanocytes (melanocyte count is normal)
racial melanosis
characteristics:
- bilateral (can be asymmetric) diffuse flat pigmentation of conjunctiva → pigmented epithelium moves freely over the underlying sclera
- appears during first few years of life & becomes static in early adulthood
- may have protective effect against neoplasia
- benign conjunctival epithelial melanosis
- usually concentrated around limbus & perforating branches of vessels or nerves as they enter the sclera
- small cysts can be present with pigmentation
racial melanosis
conjunctival dermoid, goldenhar syndrome, pyogenic granuloma, conjunctival nevus & racial melanosis are all what kind of conjunctival lesions
benign conjunctival lesions
conjunctival lesion caused by pre-cancerous squamous cell neoplasia of the conjunctival epithelium
intraepithelial neoplasia
characteristics:
- usually confined to epithelium, but can progress to invasive SCC
- unilateral in fair-skinned middle-aged & older patients
- fleshly sessile lesion near limbus or interpalpebral fissure
intraepithelial neoplasia
conjunctival lesion caused by acquired pigmentation of conjunctiva due to increase in melanocyte numbers in the basal layers of the epithelium
primary acquired melanosis (conjunctival melanocytic intraepithelial neoplasia)
characteristics:
- gradual onset in middle-age
- typically unilateral, noncystic patches on the conjunctiva & peripheral cornea
- can be solitary, diffuse, or multifocal
primary acquired melanosis (conjunctival melanocytic intraepithelial neoplasia)
management for primary acquired melanosis
long-term f/u
if suspicious → exicion biopsy & mitomycin C
intraepithelial neoplasia & primary acquired melanosis are what kind of conjunctival lesions
pre-malignant conjunctival lesions
conjunctival lesion that arises from primary acquired melanosis (PAM) in 75% of patients & from pre-existing nevi in 20-25%
malignant melanoma
characteristics:
- usually located on bulbar conjunctiva near the limbus
- can recur locally & exhibit regional metastasis to preauricular & submandibular nodes
malignant melanoma
conjunctival lesion caused by conjunctival intraepithelial neoplasia (CIN) that has breached basement membrane of the conjunctival epithelium & invaded the underlying tissues
squamous cell carcinoma (SCC)
characteristics:
- much less common than CIN but difficult to differentiate from CIN clinically
- large conjunctival feeder vessels usually present
- locally invasive, but only 1-2% metastasize
SCC
management of SCC
complete surgical excision, topical mitomycin-C, 5-fluorouracil, cidofovira
conjunctival lesion caused by reactive lymphoid hyperplasia
conjunctival lymphoma
characteristics:
- unilateral tumors → 17% chance of systemic lymphoma
- bilateral tuomors → 47% change of systemic lymphoma
- diffuse, slightly elevated, fleshy pink mass
- usually occurs in fornices or bulbar conjunctiva
- symptoms: gradual, painless swelling, redness, irritation
conjunctival lymphoma
malignant melanoma, SCC, & conjunctival lymphoma are what type of conjunctival lesions
malignant conjunctival lesions
management of conjunctival lymphoma
excision for small lesions
excision + radiotherapy for larger lesions
