Ocular Neoplasia Flashcards
Secondary neoplasia can occur in the eye due to metastasis. This is relatively rare except for what cancer type
Lymphoma
Where can ocular neoplasia develop
1) Orbital Neoplasia
2) Eyelid Neoplasia
3) Third eyelid and eyelid margin neoplasia
4) Corneal Neoplasia
5) AnteriorUveal Neoplasia
6) Choroidal Neoplasia
What do you need to differentiate orbial neoplasia from
orbital abscess
What are the clinical signs of orbital neoplasia
1) Exophthalmos (decreased retropulsion) - eye is bulging out
2) Third eyelid elevation
3) Generally non-painful
4) Generally chronic rather than acute
5) Generally older patients
+/- strabismus (eye misaligned to one side)
+/- lagophthalmos (eyelid cant close completely over cornea)
a condition where the eyeball protrudes abnormally from its socket.
globe is in front of the eyelids
Proptosis
where the eyelid cant close completely over the cornea
Lagophthalmos
Prognosis of orbital neoplasia depends on
neoplasia type and tissue involvement
What are your primary differentials for an animal with exophthalmos + third eyelid elevation
1) Cellulitis - painful, generally young, acute
2) Abscess - painful +/- fever, acute
3) Salivary gland sialocele
4) Neoplasia
Glaucoma makes your eye _____ while orbital neoplasia makes it ________
Glaucoma: Buphthalmic
Orbital Neoplasia: Exophthalmic
How can you differentiate orbital / retrobulbar tumors from abscesses
abscesses are really painful (especially when opening the mouth as ramus pushes on it)
neoplasia is generally not until the patient gets to a late stage (also older patients and slower progression)
How do you differentiate orbital neoplasia from
1) Cellulitis - painful, generally young, acute
2) Abscess - painful +/- fever, acute
3) Salivary gland sialocele
1) Ocular ultrasound
2) CT/MRI (best diagnostic- tells where and what it is)
3) +/- FNA
4) +/- Biopsy
5) +/- culture
What are the type of orbital neoplasias
1) Adenocarcinoma (various glandular sources)
2) Fibroma / Fibrosarcoma
3) Osteosarcoma
4) Meningioma
5) Lymphosarcoma
6) Nasal carcinoma (esp cats)
need a biopsy +/- FNA
How do you treat orbital neoplasia
Depends on the type of neoplasia and extent of involvement
-Exenteration indicated depending on size of mass
-Orbitotomy (eye sparing procedures) in some
eye removal as well as the tissue around the eye
Exenteration
removal of a mass in the orbital / retrobulbar area without removing the eye
Orbitotomy
What are common eyelid neoplasias in dogs
1) Meibomian gland adenoma (very common)
2) Fibropapilloma
3) Melanoma
4) Squamous Cell Carcinoma (rare in dogs)
T/F: it is rare for dogs to get a malignant eyelid tumor
True- even mast cell tumors on the eyelid can be removed with dirty margins and still be curative
Squamous cell carcinoma of the eyelid typically affects what species
Feline
Bovine
Equine
these are malignant
Rare in dogs
Most common primary eyelid tumor in dogs
Meibomian gland adenoma
What is the appearance of meubomian gland adenomas in dogs
papilloma like projection from / near meibomian glands
friable/ multilobulated
T/F: meibomian gland adenomas are almost always benign
True - can be locally invasive and will efface eyelid margin if left to grow
What might be a negative effect of meibomian gland adenoma
can be locally invasive and will efface eyelid margin if left to grow
could potentially cause corneal ulceration and be locally invasive
What diagnostics can you do for meibomian gland adenoma
Clinical signs
Excisional Biopsy
Histopathology
How do you treat meibomian gland adenoma
1) Debulking with cryoablation (80-90% success)
can often be done awake or with light sedation
higher risk for regrowth
2) Wedge resection surgery under general anesthesia
Can safely take 30% of lid without complex reconstruction
Why might you send an eyelid mass into histopathology
if looks different, already comes back. might be best to send in
similar to meibomian gland adenoma
papilloma-appearing projection
often pedunculated
generally not on eyelid margin
less friable than meibomian gland adenoma
Fibro-papilloma
You can resect _____% of the eyelid without complex reconstruction
30%
How do you treat fibro-papilloma
same as meibomian gland adenoma
local anesthesia +/- sedation for debulking
-adjunctive cryoptherapy
-wedge excision (general anesthesia)
1) Debulking with cryoablation (80-90% success)
can often be done awake or with light sedation
higher risk for regrowth
2) Wedge resection surgery under general anesthesia
Can safely take 30% of lid without complex reconstruction
What are the clinical signs of benign eyelid melanoma in dogs
1) Darkly pigmented mass
2) Growing from the eyelid margin
3) Older animal
4) Vizsla, Weimaraner common
What dog breeds are benign eyelid melanoma common in
Vizsla, Weimaraner (liver-coated dogs)
How do you diagnose benign eyelid melanoma in dogs
Clinical signs
Histopathology
How do you treat benign eyelid melanoma in dogs
Cryotherapy +/- debulk- these tend to be hard to curette
Wedge excision to get clean margins
What kinds of animals does eyelid SCC typically effect
1) Lightly pigmented cats and horses
2) IV radiation exposure
What is the most common primary eyelid tumor in cats
SCC
What is a potential result of eyelid SCC in cats and horses
Metastasis, particularly late in disease
SCC is an ulcerative lesion that is most common in what eyelid
the lower lid
How do you diagnose eyelid SCC
Biopsy with histopathology
How do you treat eyelid SCC
1) Complete surgical excision (often requires blepharoplasty to reconstruct the lid)
2) Radiation therapy
3) Topical chemotherapy
4) Immune therapy (eg. interferon- not available anymore)
for eyelid neoplasia, when in doubt what should you do
biopsy for diagnosis then treat based on histopathology
SCC on the third eyelid is common in what species
Bovine
managed similalrly to eyelid SCC
What are the clinical signs of hemangioma/ hemangiosarcoma of the third eye lid
1) Raised red mass on bulbar conjuctival or 3rd eyelid
2) Delicate and bleed easily
3) Generally small
4) Middle aged to older dogs
How do you treat hemangioma/ hemangiosarcoma of the third eye lid
Diagnose:
clinical signs
excisional biopsy
Treatment:
Excise `1mm marging with adjunctive cryotherpay or radiofrequency electrocautery
these masses often send in so you can get an idea of if it will come back
Adenoma/Adenosarcoma of the gland of the third eye lid is often
well encapsulated diffuse enlargement of the third eye lid
surgical excision of the third eyelid is often curative
Corneal squamous cell carcinoma is more common in what species
Brachycephalics Dogs and UV exposed horses
What cause corneal squamous cell carcinoma
1) KCS (dogs)
2) Immune mediated of similar chronic keratitis
-Increased risk with long-term use of topical immunosuppressive medications (Tacrolimus and/or Cyclosprine)
3) UV exposure (horses)
basically chronic inflammation to the cornea (entropion, FHV-1, etc)
How do you treat corneal SCC
Keratectomy (excise mass + superficial cornea)
adjunctive cryotherapy, radiation therapy, or topical chemotherapy (because sometimes you cant get as deep)
often curative
What are the clinical signs of limbal melanoma/melanocytoma
1) Dark mass along limbus
2) Raised, protruding out and into the cornea/ bulbar conjunctiva
3) Generally unilateral
4) Age variable
5) Breeds: GSH, Labs, goldens
good prognosis for life and eye (often benign but needs to be treated
What breeds of dogs typically get limbal melanoma/melanocytoma
GSH, labs, goldens
age variable
How do you diagnose limbal melanoma/melanocytoma
Clinical signs
Differentiate limbal origin for uveal origin with ultrasound
Biopsy
How do you treat limbal melanoma/melanocytoma
Excision with cryotherapy (or cryotherapy alone)
+/- graft if scleral wall is compromised due to invasion
what is a fairly common mass that grows from anterior uvea (irus and/or cilary body)
pink, lobulated, visible in pupillary margin
Cilary body adenoma / adenocarcinoma
What are the clinical signs of Cilary body adenoma / adenocarcinoma
1) Mass growing from anterior uvea (iris and/or ciliary body)
2) Pink, lobulated, issible in pupillary margin
generally slow growing benign intraocular mass
often not detected in early stages until it causes glaucoma or syncechiae
locally problem (lead to enucleation) but never a systemic issue
How do you typically diagnose Cilary body adenoma / adenocarcinoma
Clinical Signs
Intraocular mass
Elevated IOP (glaucoma)
Uveitis
often diagnosed after enucleation because you cant get into the eye
How do you treat Cilary body adenoma / adenocarcinoma
1) Enucleate once uveitis or glaucoma develop
2) Intraocular mass removal if client motivated and its not too big
What are the clinical signs of uveal melanoma in dogs
1) Dark raised lesion on iris and/or ciliary body
2) Diffuse or local mass like
3) Melanin cells in anterior chamber
4) Secondary uveitis and/or glaucoma
often slow growing
unilateral
middle to older age dogs
T/F: uveal melanoma in dogs is benign
True
uveal melanoma in dogs treatment
laser therapy if small
once larger and causing glaucoma or uveitis = enucleation
T/F: uveal melanoma is benign in cats
false
What is the progression of uveal melanoma in cats
often starts as small nevi/freckle
cant metastasize
can grow fast
What are the clinical signs of uveal melanoma in cats
Dark brown / black diffuse pigment
+/- uveitis
+/- secondary glaucoma
How do you treat uveal melanoma in cats
Monitor and/or enucleate when progressive changes are seen
Enucleate if:
1) Iris is very abnormal
2) Glaucoma and/or uveitis
3) Rapid progression
rarely enucleate if little freckles
age is really important in deciding what to do
are uveal melanoma in cats grows what can happen
dyscoria of the pupil
When the eye is involved, lymphoma is automatically what stage
Stage V
What are the clinical signs of anterior uveal lymphoma (secondary)
1) Mostly bilateral
2) Anterior uveitis
3) +/- thickened iris
4) Secondary glaucoma
How do you diagnose anterior uveal lymphoma (secondary)
1) Lymph node aspirate
2) Chest and abdomen imaging
3) Aqueocentesis
T/F: anterior uveal lymphoma (secondary) carries a poor prognosis
True
How do you treat anterior uveal lymphoma (secondary)
1) As for systemic lymphoma - steroids, chemo
2) Treat uveitis and glaucoma as needed
-Topical nad oral steroids +/- anti glaucoma medication
What are the. clinical signs of choroidal melanoma
1) Dark raised lesion on fundic exam
2) Slowly progressive
3) Leads to retinal detachement
4) Associated with ocncurrent anterior uveal melanoma
choroidal melanoma leads to
1) retinal detachment
2) metastasis
choroidal melanoma is associated with
concurrent anterior uveal melanoma
How do you diagnose choroidal neoplasia
fundic examination
T/F: choroidal melanoma metastasis
True
do a complete systemic workup for metastasis
unlike anterior uveal melanoma this can metastasize
Does choroidal or anterior uveal melanoma metastasize
choroidal melanoma
