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Ocular Neoplasia Flashcards

1
Q

Name the most common eyelid tumour?

A

Basal cell and squamous cell PAPILLOMA

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2
Q

What cell type is affected in papillomas of skin/conjuctiva?

A

Benign epithelial cell tumours

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3
Q

What organisms are associated with papillomas?

A

HPV (mostly)

Poxvirus (molluscom c) - causes benign squamous proliferation

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4
Q

Where are lid/conjuctival tumours usually derived from?

A

Glands

e.g. sweat glands, hair follicles, sebaceous glands

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5
Q

What is the most common ocular malignant tumour seen?

A

BCC lids

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6
Q

What % of eyelid tumours are BCC?

A

90%

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7
Q

What are RFs for BCC?

A

Age >50
Whites
UV exposure

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8
Q

Is BCC more common in the lower or upper lid?

A

Lower lid

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9
Q

Describe the characteristics of the NODULAR histological subtype of BCC

A

Well circumscribed islands of proliferating basal cells
Many mitotic figures

Edge of the tumour cells are arranged in a palisade

Surgical excision usually successful

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10
Q

Describe the characteristics of the SUPERFICIAL histological subtype of BCC

A

Presents as more scaly plaque

Small nests of tumour cells bud from the undersurface of the epidermis as far as the superficial dermis

Surgical excision difficult as there are gaps between nests of cells

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11
Q

Describe the characteristics of the INFILTRATIVE histological subtype of BCC

A

More aggressive

Tumour cells grow in small strands and are embedded in fibrous stroma

Poor border - making excision hard

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12
Q

Describe the characteristics of the MICRONODULAR histological subtype of BCC

A

More aggressive

Tumour forms small nodular aggregates of basaloid cells

Excision may be difficult as some nodules may not be clinically visualised

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13
Q

What cell type do SCCs affect?

A

Epithelial cells

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14
Q

What % of eyelid tumours are SCC?

A

1-5%

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15
Q

What are RFs for SCC?

A
  • Immunosuppression
  • UV exposure
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16
Q

How does SCC metastasise?

A

Via lymphatics

Upper lid - preauricular nodes
Lower lid - Submandibular nodes

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17
Q

How are SCCs classified histologically?

A

Well differentiated - Glassy, pink cytoplasm and intercellular bridges with keratin pearls
Poorly differentiated - Lose the above. Spindle cell morphology is sometimes seen and is more aggressive

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18
Q

What % of eyelid tumous are sebaceous gland carcinomas?

A

1-5%

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19
Q

Which demographic are more likely to have sebaceous gland carcinomas?

A

Older women

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20
Q

Where do sebaceous gland carcinomas most commonly originate from?

A

Meibomian glands

But can also arise from Glands of Zeiss or other sebaceous glands of the lids

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21
Q

Is the prognosis good or poor for sebaceous gland carcinomas?

A

Poor - due to the diffuse nature of the tumours

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22
Q

Name the histological subtypes of sebaceous gland carcinomas?

A
  • Nodular: lobules of tumour cells with foamy or vacuolated cytoplasm
  • Diffuse: individual tumour cells spreading within the surface epithelium (pagetoid) and adnexal structures.
23
Q

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

A

Pleomorphic adenoma of the lacrimal gland (it is benign)

24
Q

Is Pleomorphic adenoma of the lacrimal gland slow or fast growing?

A

Slow growing and it is pseudo-encapsulated

25
What is seen histologically in Pleomorphic adenoma of the lacrimal gland
Epithelial and mesenchymal elemnents e.g. myxoid tissue, cartilage, fat, bone
26
Why is it important to excise Pleomorphic adenoma of the lacrimal gland adequately?
They can undergo malignant change to produce pleomorphic carcinoma
27
How can Adenoid cystic carcinoma of the lacrimal gland present?
Repidly growing tumour Invasion of the orbit --> Diplopia, proptosis, pain, parasthaesia
28
What is most commonly seen hisologically in Adenoid cystic carcinoma of the lacrimal gland
Cribriform or swiss cheese appearance
29
Are orbital teratomas mostly benign or malignant?
Benign
30
What age is associated with Orbital teratomas?
Neonates
31
Where are orbital teratomas derived from?
Derived from totipotent germ cells and can occur at any site on the midline where germ cells have stopped on their migration to the gonads
32
How do orbital teratomas present?
Proptosis
33
What is seen on histology in orbital teratomas?
Tissue derived from 3 embryonic germ cell layers e.g. resp/gastro epithelium, stroma containing fat, cartilage, bone, neuroectodermal tissues
34
How can conjunctival melanoma develop?
- From primary acqured melanosis - From a pre-existing naevus - De novo
35
What is the clinical appearance of primary acquired melanosis?
Unilateral or bilateral diffuse flat areas of conjunctival pigmentation in middle aged or older patients - May be with (premalignant) or without (not premalignant) atypia
36
What is the clinical presentation of conjunctival melanoma?
Raised, pigmented or fleshy conjunctival lesion
37
Where can conjunctival melanoma metastasise to?
LN, brain, other organs
38
What are poor prognostic features of conjunctival melanoma?
Tumours >5mm Fornix tumours
39
What is the treatment for conjunctival melanoma?
Complete excision with or without topical chemo e.g. MMC
40
What is the most common Uveal melanoma?
Choroidal melanoma - 80% (most common melanoma of the eye as well)
41
Where do uveal melanomas usually metastasise to? and after how long?
Liver within 2-3 years
42
Are iris melanomas slow or fast growing?
Slow growing
43
What is an ocular complication that can arise from iris melanomas?
secondary glaucoma - can spread diffusely around the AC angle and infiltrate the TM
44
What is seen on histology in iris melanoma?
Spindle shaped cells with surface or stromal invasion
45
What are the forms of ciliary body and choroidal melanomas?
- Ovoid - Nodular - Mushroom shape
46
Why does the mushroom shape of ciliary body/choroidal melanomas arise?
Tumour spread into the subretinal space after breaching Bruch's membrane
47
What may happen to large tumours in ciliary body/choroidal melanomas?
Spontaneous necrosis
48
How do ciliary body/choroidal melanomas spread and how?
Haematogenous spread can be via collector channels, vortex veins, short ciliary vessels
49
How can ciliary body/choroidal melanomas be classified histologically?
- Epitheliod - Spindle - Mixed
50
Which is the most common histological cell type in ciliary body/choroidal melanomas?
Mixed
51
How can vascular patterns of tissue in ciliary body/choroidal melanomas be assessed?
Periodic acid Schiff stain
52
Give examples of patterns seen on PAS stain in ciliary body/choroidal melanomas
- Parallel - Parallel with cross linking - Closed vascular loops
53
What may immunohistochemistry be positive for in ciliary body/choroidal melanomas?
- S100 - HMB45 - Melan A
54

Pathology (15 decks)

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