Ocular Neoplasia

Question 1

What are the most common tumours of the eyelid?

Answer 1

Basal cell and squamous cell papilloma

Question 2

What are papillomas associated with

Answer 2

HPV

Can be associated with poxvirus (molluscum contagiosum) - benign squamous proliferation

Question 3

What is the most common form of malignant eye tumour/

Answer 3

Basal cell carcinoma of lids

Question 4

What is classical appearance of BCC

Answer 4

Central ulcer
Rolled edge

Question 5

How is BCC trated

Answer 5

Locally aggressive, even more so in recurrence

Wide local excision to prevent recurrence or extension into orbit

Question 6

What are SCC associated with

Answer 6

UV exposure
Immunosuppression

Question 7

What is appearance of SCC

Answer 7

More rapidly growing nodular ulcer
Papillomatous with overlying keratinous horn

Question 8

How can SCC spread?

Answer 8

Lymphatic to preauricular nodes (upper lids)

submandibular nodes (lower lids)

Question 9

Where do sebaceous gland tumours most commonly originate?

Answer 9

Meibomian glands

Question 10

What are histological subtypes of sebaceous gland tumours?

Answer 10

Nodular - lobules of tumour cells with foamy or vacuolated cytoplasm

Diffuse - individual tumour cells spreading within the surface epithelium and adnexal structures

Question 11

What is the most common epithelial cell tumour of the lacrimal gland?

Answer 11

Pleomorphic adenoma

Epithelial cells and mesenchymal elements - myxoid tissue, cartilage fat, bone

CAn undergo malignanct changes

Question 12

What is adenoid cystic carcinoma of lacrimal gland?

Answer 12

Epithelial neoplasm of lacrimal gland
Rapid growing, proptosis, pain, paraesthesia, diplopia

Cribriform/swiss cheese appearance

Question 13

What are teratomas derived from

Answer 13

Germ cells
Can occur at any site along midline where germ cells have stopped on migration to gonads

Question 14

How do orbital teratomas present

Answer 14

Proptosis in neonates

Question 15

What is seen on histology of teratoma

Answer 15

Tissue derived from three embryonic germ cell layers - resp, GI, stroma with fat, cartilage, bone, neuroectodermal tissue

Question 16

What is primary acquired melanosis?

Answer 16

Unilateral or bialteral diffuse flat areas of conjucntival pigmentation in middle age/older patients

May be with atypia (premalignant) or without

Question 17

How does conjunctival melanoma present

Answer 17

Raised, pigmented, fleshy conj lesion

Can met to regional lymph nodes, brain, organs

Thicker than 5mm or located in fornix = poor prognosis

Question 18

Where is the most common site for melanoma?

Answer 18

Choroidal

Question 19

Where do uveal melanomas spread to?

Answer 19

Liver within 2-3 years

Question 20

What is seen on histology of iris melanoma?

Answer 20

Small, spindle shaped cells with sruface or stromal invasion

Question 21

What are types of choroidal tumour?

Answer 21

Ovoid
Nodular
Mushroom - due to spread in subretinal space after breaching Bruch’s

Question 22

How do choroidal melanomas spread?

Answer 22

Haematogenous via vortex veins, short ciliary vessels

Question 23

How can vascular patterns of choroidal melanoma be assessed?

Answer 23

Periodic acid Schiff stain

Question 24

What are prognostic markers for uveal melanoma

Answer 24

Older age
LArger size
Ciliary body worse location
Epitheliod cell type worse than spindle cell type
Closed loop vascular pattern on PAS

Question 25

What are neurofibromas derived from?

Answer 25

Endoneurium

Question 26

What is histology of neurofibromas?

Answer 26

Spindle cells with wavy nuclei and collagen

Question 27

What are histology of schwannoma?

Answer 27

Palisaded arrangement of spindle cells (Antoni A) and myxoid (antoni B) areas May contain melanin

Question 28

Where is most common place for optic nerve glioma

Answer 28

Orbital potion of optic nerve

Question 29

What is seen on histology of optic nerve glioma

Answer 29

Myxoid degeneraiton and eosinophilic masses Modified process of astrocyte - Rosenthal fibres

Question 30

What is seen on histology of optic nerve meningioma

Answer 30

Psamoma bodies Transitional pattern

Question 31

What isthe finding in RB

Answer 31

Leucocoria - white red reflex

Question 32

What are differentials for leucocoria?

Answer 32

Coats' disease - telangiectatic neovascular disease Astrocytic hamartoma REtinoapthy of prematurity PErsistent hyperplastic primary vitreous Endophthalmitiis Toxocara, toxoplasma reitnitis

Question 33

What is macroscopic appearance of RB

Answer 33

Smooth surfaced white mass that can show endophytic growth into vitroeus or exophytic greowth into subretinal space Yellow areas of necrosis or flecks of calcification

Question 34

What is seen on histology of RB

Answer 34

Small cells with scanty cytoplasm High mitotic rate with prominent apoptosis and necrosis - high cell turnover

Question 35

What are the stages of differentiation in RB

Answer 35

Homer-Wright rosettes - multi-layered circle of nuclei surrounding eosinophilic fibrillar material Flexner-Wintersteiner rosettes - circle of cells limited by continuous membrane Fleurettes: primitive photoreceptor bodies

Question 36

What are prognostic markers in RB

Answer 36

Tumour size Degree of differentiation CHoroidal invasion Optic nerve invasion

Question 37

What are associated risks of RB

Answer 37

Pineal tumour Soft tissue and osteogenic sarcoma Carcinoma in later life

Question 38

How is RB treated

Answer 38

Irradiation, chemo Enucleation cure rate of 90%

Question 39

What is a common muscle malignancy in child hood?

Answer 39

Rhabdomyosarcoma - striated muscle tumour of eyelid/orbit

Question 40

What is the most common occular lymphoma?

Answer 40

Extranodal maginal zone lymphoma - Low grade B cell lymphoma derived from mucosal associated lymphoid tissue

Question 41

Which tumours metastasize to uveal tract? Which childhood tumours have orbital involvement

Answer 41

Breast Prostate Lung GI In children: Neuroblastoma Ewing sarcoma Wilm's Rhabdomyosarcoma