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Pathology > Ocular Neoplasia > Flashcards

Ocular Neoplasia Flashcards

1
Q

What are the most common tumours of the eyelid?

A

Basal cell and squamous cell papilloma

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2
Q

What are papillomas associated with

A

HPV

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

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3
Q

What is the most common form of malignant eye tumour/

A

Basal cell carcinoma of lids

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4
Q

What is classical appearance of BCC

A

Central ulcer
Rolled edge

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5
Q

How is BCC trated

A

Locally aggressive, even more so in recurrence

Wide local excision to prevent recurrence or extension into orbit

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6
Q

What are SCC associated with

A

UV exposure
Immunosuppression

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7
Q

What is appearance of SCC

A

More rapidly growing nodular ulcer
Papillomatous with overlying keratinous horn

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8
Q

How can SCC spread?

A

Lymphatic to preauricular nodes (upper lids)

submandibular nodes (lower lids)

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9
Q

Where do sebaceous gland tumours most commonly originate?

A

Meibomian glands

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10
Q

What are histological subtypes of sebaceous gland tumours?

A

Nodular - lobules of tumour cells with foamy or vacuolated cytoplasm

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

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11
Q

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

A

Pleomorphic adenoma

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

CAn undergo malignanct changes

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12
Q

What is adenoid cystic carcinoma of lacrimal gland?

A

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

Cribriform/swiss cheese appearance

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13
Q

What are teratomas derived from

A

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

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14
Q

How do orbital teratomas present

A

Proptosis in neonates

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15
Q

What is seen on histology of teratoma

A

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

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16
Q

What is primary acquired melanosis?

A

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

May be with atypia (premalignant) or without

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17
Q

How does conjunctival melanoma present

A

Raised, pigmented, fleshy conj lesion

Can met to regional lymph nodes, brain, organs

Thicker than 5mm or located in fornix = poor prognosis

18
Q

Where is the most common site for melanoma?

A

Choroidal

19
Q

Where do uveal melanomas spread to?

A

Liver within 2-3 years

20
Q

What is seen on histology of iris melanoma?

A

Small, spindle shaped cells with sruface or stromal invasion

21
Q

What are types of choroidal tumour?

A

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

22
Q

How do choroidal melanomas spread?

A

Haematogenous via vortex veins, short ciliary vessels

23
Q

How can vascular patterns of choroidal melanoma be assessed?

A

Periodic acid Schiff stain

24
Q

What are prognostic markers for uveal melanoma

A

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

25
Q

What are neurofibromas derived from?

A

Endoneurium

26
Q

What is histology of neurofibromas?

A

Spindle cells with wavy nuclei and collagen

27
Q

What are histology of schwannoma?

A

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

May contain melanin

28
Q

Where is most common place for optic nerve glioma

A

Orbital potion of optic nerve

29
Q

What is seen on histology of optic nerve glioma

A

Myxoid degeneraiton and eosinophilic masses

Modified process of astrocyte - Rosenthal fibres

30
Q

What is seen on histology of optic nerve meningioma

A

Psamoma bodies

Transitional pattern

31
Q

What isthe finding in RB

A

Leucocoria - white red reflex

32
Q

What are differentials for leucocoria?

A

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

33
Q

What is macroscopic appearance of RB

A

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

34
Q

What is seen on histology of RB

A

Small cells with scanty cytoplasm

High mitotic rate with prominent apoptosis and necrosis - high cell turnover

35
Q

What are the stages of differentiation in RB

A

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

36
Q

What are prognostic markers in RB

A

Tumour size
Degree of differentiation
CHoroidal invasion
Optic nerve invasion

37
Q

What are associated risks of RB

A

Pineal tumour
Soft tissue and osteogenic sarcoma
Carcinoma in later life

38
Q

How is RB treated

A

Irradiation, chemo
Enucleation

cure rate of 90%

39
Q

What is a common muscle malignancy in child hood?

A

Rhabdomyosarcoma - striated muscle tumour of eyelid/orbit

40
Q

What is the most common occular lymphoma?

A

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

41
Q

Which tumours metastasize to uveal tract?

Which childhood tumours have orbital involvement

A

Breast
Prostate
Lung
GI

In children:
Neuroblastoma
Ewing sarcoma
Wilm’s
Rhabdomyosarcoma

Pathology (15 decks)

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