ocular tumours Flashcards
what does neoplasia mean
new growth
what is a tumour known as
a swelling
what suffix is attached to a tumour
oma
define a neoplasm
is an abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change
what three things do all tumours that are benign or malignant consist of
- Clonal Neoplastic cells that constitute the parenchyma
ie. The cells from which the tumour derives - Reactive stroma: made up of blood vessels and connective tissue
All tumours need blood supply and connective tissue to grow. - Significant cross talk between the parenchyma and reactive stroma
name the 6 types of tumours of epithelial origin
- stratified squamous
- basal cells of skin or adnexa
- epithelial lining of glands or ducts
- respiratory passages
- renal epithelium
- liver cells
name the benign and malignant version of a stratified squamous epithelial tumour
benign: squamous cell papilloma
malignant: squamous cell carcinoma
what is a basal cell carcinoma a tumour of
malignant tumour of basal cells of skin or adnexa
name the benign and malignant version of the epithelial lining of glands or ducts, epithelial tumour
Glands:
benign: adenoma papilloma
malignant: adenocarcinoma papillary carcinoma
Ducts:
benign: cystadenoma
malignant: cystadenocarcinoma
name the benign and malignant version of a tumour of the respiratory passages, epithelial tumour
benign: bronchial adenoma
malignant: bronchogenic carcinoma
name the benign and malignant version of a renal epithelium tumour
benign: renal tubular adenoma
malignant: renal cell carcinoma
name the benign and malignant version of liver cells, epithelial tumour
benign: liver cell adenoma
malignant: hepatocellular carcinoma
name the benign and malignant version of tumours of melanocytes
benign: nevus
malignant: malignant melanoma
what are the 4 things you would differentiate on a basis of a benign tumour form a malignant tumour
- Differentiation & Anaplasia
- Rate of Growth
- Local Invasion
- Metastasis
how would you classify the differentiation between a benign and a malignant tumour
how different does the neoplastic tissue differ from the parenchyma
how would you differentiate the rate of growth between a benign and malignant tumour
a malignant tumour has a fast/high growth rate
how would you differentiate local invasion between a benign and malignant tumour
malignant tumours tend to metastasise and that tells you it is more aggressive and malignant
what is anaplasia
the degree to which the parenchyma does not resemble the clonal cell
what two types of differentiation can malignant tumours be
poor or well differentiated
what is a sign of malignancy i.e. undifferentiated cells
the level of anaplasia i.e. degree to which the parenchyma does not resemble the clonal cell
how does the rate of growth define malignancy
the doubling time of the cell population:
- cell cycle becomes deranged
- usually the higher the growth rate, the more malignant
what sign marks a tumour as malignant
metastasising (tumours in other parts of the body) - which makes them hard to treat
what can cause a normal cell to transform and become a tumour
uv
what happens to the cells in a proliferative pool and what can they become within a tumour
they divide
they can go into the non-proliferative pool and can either differentiate (some into a more malignant form) or die
what happens to a differentiated cell within the non-proliferated pool in a tumour
some can differentiate into a more malignant form i.e. malignant cells that are produced don’t resemble with the original tumour that it derived from, and become anaplastic so they are not the same as when it derived from the original parenchyma
which tumour is the most common malignancy
basal cell carcinoma
out of all skin cancers, how much does a basal cell carcinoma account for
two thirds of all skin cancers
what is the growth rate of a basal cell carcinoma
slow, over months or years
what does the incident rates increase with a basal cell carcinoma
increases with age, however BCC can occur in people in their 20s
how much % of squamous cell carcinomas metastasise
20%
how many % of eyelid tumours do squamous cell carcinomas account for
5-10%
what causes an increase in developing a squamous cell carcinoma
immunocompromised
how many % of skin cancers does squamous cell carcinoma account for
one-third of skin cancers
what is the growth rate of a squamous cell carcinoma
quickly over several months
what age group is squamous cell carcinomas found most frequently in
40’s and incidents increases with age
on which part of the body do squamous cell carcinomas have a high risk of spreading
if its on the lips and ears
what are squamous cell carcinomas not as dangerous as
melanomas
what can happen if a squamous cell carcinoma is left untreated
spread to other parts of the body
what is the least common but most aggressive form of skin cancer
melanoma
what is the growth rate of a melanoma
rapid and spread rapidly
where can a melanoma start from
normal skin, a mole or a freckle
which part of the body does a melanoma usually grow
anywhere in the body, not just parts exposed to the sun
how many % of melanomas can be cured if treated
95%
what does the histology of a melanoma show
shows large atypical melanocytes within the dermis.
what is a DDX of a nodular melanoma on the eyelid
karposi sarcoma
when will you suspect malignancy of a choroidal naevus
if it grows in adulthood
which type of people is a choroidal naevus very rare in
dark skinned people
how many % of caucasians does a choroidal naevus present in
5-10%
when will a choroidal naevus be symptomatic
only when on the macula (otherwise asymptomatic)
list 3 DDX of a choroidal melanoma
- Congenital Hypertrophy of RPE (CHRPE)
- Melanocytoma of Choroid – can’t tell difference from large naevus
- Small melanoma associated with serous detachment and orange lipofuscin
in which type of people are iris melanomas more common in, and by a factor of how much
3x more common in, blue/grey eyed people
which age group does a iris melanoma develop
40s or 50s
what two types of iris melanomas are there
pigmented or non pigmented
how large is an iris melanoma
> 3mm in diameter and >1mm thick
what is an iris melanoma always associated with
pupil distortion/ectropian uveae
cataract may be present
also with naevi
list the 8 features alerting a clinician to an ocular melanoma, and explain each feature
- Melanoma visible externally: shadow or blob on the eye
- Eccentric visual phenomena: flashing lights or distortion, as the melanoma is growing on the choroid
- Lens abnormalities: cataract in periphery
- Afferent pupillary defect: tumours of retro bulbar or optic nerve
- No optical correction: distortion of retina and can’t correct va’s
- Ocular hypertension: high IOP if tumour affects aqueous outflow in iris
- Melanocytes: difference in colour of iris i.e. iris naevus
- Asymmetric episcleral vessels: blood supply going into tumour beneath the globe
how many % of patient’s who has a choroidal melanoma, complain of blurred vision
20-30%
how many % of eyes end up enucleated if a choroidal melanoma is undetected by an optometrist
45% end up enucleated
how many % of eye end up enucleated if a choroidal melanoma is DETECTED by an optometrist
30% end up enucleated
