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X. Post Seg 2 > Non-Melanocytic Tumors > Flashcards

Non-Melanocytic Tumors Flashcards

1
Q

T/F: Retinoblastoma is confined to retina

A

FALSE: can also invade ON or choroid

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2
Q

Pathophysiology of Retinoblastoma

A

Believed to be undifferentiated rod/cones that metastasize

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3
Q

Color of retinoblastoma

A

Starts translucent gray/white but as it grows and calcifies, it gains “chalky white” appearance

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4
Q

Most common malignant intraocular tumor in children

A

Retinoblastoma

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5
Q

T/F: retinoblastoma is generally sporadic

A

TRUE

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6
Q

In developed countries, retinoblastoma is typically found before age

A

4 (avg: 18 months)

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7
Q

Most frequent sites of metastasis in children

A

Skull
Distal Bones
Brain
Spinal Cord
Lungs
Lymph Nodes

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8
Q

Primary workup for Retinoblastoma

A

FA + B-scan

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9
Q

Main growth patterns of Retinoblastomas

A
  1. Intraretinal —> homogenous, dome-shaped white tumor, eventually irregular w/ calcific flecks
  2. Endophytic —> grows into vitreous cavity and invades inner retina layers as white mass w/ “seeding” of tumor cells

3 Exophytic —> grows into direction of subretinal space as bi-lobed white mass —> can cause RD

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10
Q

What must be ruled out in all cases of childhood uveitis/ocular inflammation?

A

Retinoblastoma!

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11
Q

Under what conditions is there an increased risk of metastasis of Retinoblastoma?

A
  1. If tumor is advanced/large “too big”
  2. Choroidal/Retrolaminar ON invasion “too back”
  3. AS involvement “too front”
  4. Orbital spread “too far”
  5. Repeated recurrence after conservative treatments ‘too many times”
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12
Q

Uveal layer most common for metastasis? Why?

A

Choroid; rich blood supply

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13
Q

T/F: diagnosis of choroidal metastasis requires immediate treatment

A

TRUE

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14
Q

T/F: Retinoblastoma is bilateral, multifocal, and has ON involvement.

A

Actually false
Only 20% bilateral, 20% MF, and 20% ON involvement

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15
Q

Describe the appearance of choroidal metastasis

A

Indistinct margins
Elevated mildly —> Flat
Yellow/creamy
Subretinal

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16
Q

What ocular findings if other uveal tissues affected by Choroidal Metastasis? (4)

A
  1. Pseudohypopyon (tumor cells, not WBCs)
  2. Iridocyclitis (inflammatory cells)
  3. Secondary Angle Closure GLC
  4. Rubeosis iridium —> hyphema, NVG
17
Q

Diagnostic tool of choice for Choroidal Metastasis? Why?

A

Ultrasonography; tells size, shape, and excavation

18
Q

Results of Ultrasonography w/ Choroidal Metastasis?

A

A scan — moderate/high internal acoustic reflectivity

B scan — irregular placoid lesion and associated serous RD

19
Q

Symptoms of CHoroidal Metastasis

A
  1. Decreased vision
  2. VF defects
  3. Elevated IOP
  4. Photopsia (flashes)
  5. Diplopia

but may be asymptomatic

20
Q

Uveal metastasis implies

A

Poor prognosis (8-12 months to live)*

  • actual survival rate dependent on cancer type
21
Q

For what diagnosis might Brachytherapy be appropriate?

A

Retinoblastoma or Choroidal Metastasis

22
Q

Describe course if Choroidal Metastasis breaks Bruch’s Membrane

A

Develops mushroom shape
Subretinal fluid invades
Possible serous SD and RPE atrophy
Can cause VF defects and vision loss

23
Q

T/F: Choroidal Osteoma is a fast-growing benign tumor

A

Benign, but slow-growing

24
Q

Who is most susceptible to Choroidal Osteoma?

A

Females in 2nd-3rd decade of life

25
Q

T/F: Choroidal Osteoma typically unilateral

A

TRUE; 75% unilateral
If bilateral, usually not simultaneous

26
Q

Appearance of Choroidal Osteoma

A

Distinct margins
Yellow-white
Calcified
Flat —> minimally elevated

27
Q

What is commonly secondary to Choroidal Osteoma?

A

choroidal neovascularization is very common

28
Q

Longstanding Choroidal Osteoma can result in…

A

RPE atrophy/hyperplasia

29
Q

What is Choroidal Osteoma?

A

Deposits forming bony trabeculae in between choroid and choriocapillaris

30
Q

Choroidal Osteoma results in (rapid/gradual) vision loss

A

Gradual

31
Q

T/F: regression in Choroidal Osteoma is possible

A

Actually true

32
Q

Management of Choroidal Osteoma

A

Every 6 months:
DFE, OCT/OCTA

+ occasional A/B-scan

33
Q

T/F: Vision Loss associated with Choroidal Osteoma is usually treatable

A

FALSE

34
Q

Location of Choroidal Osteoma

A

Posterior Pole / Juxtapapillary

35
Q

Choroidal Osteoma CT scan shows

A

Dense plaque like opacity at choroidal level

36
Q

Choroidal Osteoma Ultrasonography shows

A

Highly reflective localized area w/ orbital shadowing

37
Q

Choroidal Osteoma FA shows

A

early irregular diffuse mottled hyperfluorescence and late staining of the tumor

X. Post Seg 2 (13 decks)

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