Orbital Tumors Flashcards
Bony orbit
2 bony orbits are quadrangular truncated pyramids located between the _______________ superiorly and the ______________ inferiorly (_______-shaped & ________ is the stalk 25)
anterior cranial fossa
maxillary sinuses
Pear; Optic N
Bony orbit
2 medial walls are _______ to each other & are closely related to the ________ and ________ sinuses that separate the orbits from the nasal cavities
2 lateral walls are _______ to each other & each medial wall is _______ from the corresponding lateral wall.
parallel ; ethmoid; sphenoid
90°
45°
Some causes of oculo-orbital tumours Ocular tumours
_____________
________________
__________ tumours
Orbital tumours
_______________
___________ tumours
____________
______________
Retinoblastoma; Choroidal melanoma
Metastatic; Rhabdomyosarcoma
Lacrimal gland
Optic nerve glioma
Optic nerve meningioma
RETINOBLASTOMA
Average age at diagnosis in other clime ________ with bilateral cases seen earlier at _______ compare to ________ in unilateral patients.
90% cases are diagnosed within __________.
18 months
12 months
24 months
3 years
Retinoblastoma
Clinical diagnosis in four stages:-
___________ stage
___________ ___________ stage
___________ ___________ stage
___________ ___________ stage.
quiet stage
secondary glaucoma stage
extraocular extension stage
systemic metastases stage.
Differential diagnosis of retinoblastoma :-
__________ (metastatic endophthalmitis)
___________ of ___________
persistent hyperplastic vitreous
__________
retinal astrocytoma
_______’ disease
__________ of the disc
__________________
Norrie’s disease.
viterous abscess
retinopathy of prematurity
toxocariasis
Coats
coloboma
Congenital cataract
‘Antioncogenes’ or ‘cancer suppressor’ 13q14.
Deletion of the ______ arm of chromosome 13 leads to retinoblastoma in about ____%
long
4
Retinoblastoma
Modalities of treatment :- _________,__________,_____________ , exenteration, ___________,_________ , genetic counselling
enucleation, cryotheraphy, laser photocoagulation
radiotherapy, chemotheraphy
Uveal melanoma
It relatively uncommon in the __________ race.
Incidence is 6 cases per million population in USA, Canada, Finland, Denmark, Norway, Alberta.
Negroid
_________ is the Most common primary intraocular tumours in adults in the USA & Europe.
Uveal melanoma
Uveal melanoma
Risk factors:
a) Race: 90% of all eye cancers in _________ are ocular melanomas. ________ have lower incidence than ________ (White: Black - ___:__)
b) Commonly seen in the _____ decade. It is very rare below ____ years with median age at diagnosis of ____ years.
c) slight (male or female?) preponderance
Whites
American Blacks ; white
8:1
6th; 20; 55; male
Uveal melanoma
Symptoms include _______ vision, ______ defects, ________, photopsia & _______.
blurred ; field
floaters
Pain
Uveal Melanoma
Clinical picture: A)_____________ in colour, _________ (25%), small posterior uveal - slightly raised, ______ or ______ shape (most challenging diagnostic group).
B) Larger tumour (solid mass:– ______ or _______ -shaped (ruptured __________) / Flat, diffuse (rare variant) –____ melanoma (worse prognosis).______ tumours (poorer prognosis)
C) Advanced stages : extraocular extension, optic nerve invasion, glaucoma, uveitis, phthisis bulbi, orbital invasion & metastasis.
Light to medium grey
amelanocytic; round or oval
dome or mushroom
Bruch’s membrane; ring; Ciliary
Uveal melanoma
Diagnosis: _______ , ______________ Angiography, ________ , _______________ test, transillumination.
Clinical
Fundus Fluourescein
Ultrasound; 32P radiouptake
Modes of spread of uveal melanoma
________ vein
_______________ canals
_________ infiltration
________ and ________ invasion
Melanocytic _______
Vortex; Scleral emissary
Vitreous
Optic nerve & orbital
glaucoma
Treatment modalities of uveal melanoma
___________
______________
_______________
Local __________
___________
Exentenration
Chemotherapy/immunotherapy
Photocoagulation
Brachytherapy; EBR
resection; Enucleation
Sites of metastasis of uveal melanoma
_______ 56%
_______________ 24%
_________ 7%
___________ 7%
________ 2%
Median survival: ________
Liver
Subcutaneous nodules
Pulmonary; Vertebral; CNS
18 months
Metastatic tumors
Important group of oculo-orbital space occupying lesions due to spread from other parts of the body settling more commonly to the _________ 8-9 times than to the _______.
uveal tract; orbit
Metastatic Tumors
30-61% of patients with orbital metastasis develop __________ prior to the diagnosis of the ______________.
Such __________ malignancies of embryonal origins like neuroblastoma, sarcoma, Ewing’s bone tumour, nephroblastoma can metastastise to the orbit
eye symptoms
primary tumours
childhood
Metastatic Tumors
Orbital metastatic tumours in adult are carcinomas of _______ origin from the _______ (50%), ________ (17%), _______, gastrointestinal tract, kidney, thyroid & urinary bladder in order of importance.
Non-epithelial tumours like neuroblastoma, sarcoma, choroidal melanoma of the contralateral eye and melanoma of the skin and conjunctiva have been implicated.
epithelial; breast; prostate
lung
Rhabdomyosarcoma (Embryonal sarcoma)
It is a ______ growing tumour presenting as (slowly or rapidly?) progressive _____lateral _________ seen usually in the _____ decade of life with median age of _____ years.
It originates from ___________________________ with the potential to develop into ____________ . They do not arise from ______________ as the term ‘Rhabdomyosarcoma’ connotes.
fast ; rapidly ; unilateral
proptosis ;first ; 7 years.
undifferentiated mesenchymal cell crests
striated muscles ; striated muscles
______________ is the Most common primary orbital malignancies of childhood.
Rhabdomyosarcoma (Embryonal sarcoma)
Rhabdomyosarcoma
Tumour is located in the _________,__________ followed by the _________ and __________ aspects of the orbit.
A _______________________ and _______ is seen in one third of the cases sometimes with injections of the overlying skin.
superonasal, retrobulbar
superior and inferior
palpable anterior orbital mass and ptosis
Rhabdomyosarcoma
____________ and ____________ are the mainstay of treatment using vincristine, actinomycin & cyclophosphamide. ________ is reserved for rare recurrent or radio-resistant tumours.
Orbital tumours have ____% cure rate.
Radiotherapy and chemotherapy
Surgery
95
Lacrimal gland Tumors
____crine glands located in the ____________ aspect of the _______ portion of the orbit in a concavity called _____________.
It is divided into two parts: big _____ and small _______ portions.
Few accessory glands of ________ and __________ are located in the conjunctiva.
Exo; superotemporal
anterior; lacrimal fossa
orbital; palpebral
Krause and Wolfring
Lacrimal Gland Tumors
CLASSIFICATIONS:-
__________ tumours
__________ __________ tumours
__________ __________
Other types of carcinoma
Benign mixed tumours
Malignant mixed tumours
Adenocystic carcinoma
Other types of carcinoma
Pleomorphic adenoma (Benign mixed
tumour)
Commonest lacrimal gland tumour with
(painful or painless?) mass in the __________ portion of the orbit in a middle aged patient.
Globe is displaced _______ward and ______.
It should be excised with ______________ .
Painless; superotemporal
down; medially
intact capsule
FNAB is contraindicated in _____________ lacrimal gland tumor
Benign Mixed
Benign mixed tumor
incomplete removal leads to _________ and rarely, _______________.
recurrence
malignant transformation
Malignant epithelial lacrimal gland tumours.
Adenoid cystic carcinoma (common & infiltrative) Pleomorphic adenocarcinoma
Mucoepithelial carcinoma
Median age for malignant mixed tumours:____ years
Adnexial cystic carcinoma median age :____ years
Presentation is usually _________ displaced proptosis, some extraocular movement restriction, ptosis, hyperaemia and ______.
Malignant reactive lymphoid hyperplasia (lymphoma) of the lacrimal glands can occur in adults.
50; 38
infero-medially
pain
Optic nerve Glioma
(Common or Rare?), (slow or fast?)-growing pilocytic astrocytoma that typically affects ________ mostly in the ______ decade of life with median age ___ years.
It causes ______ proptosis with fusiform enlargement of the ________ and the corresponding _________ on CT scan and plain x-ray (_______view).
Rare; slow ; children
First; 6.5
axial; optic nerve ; optic canal
Water’s
Optic nerve Glioma
Approximately, 30% of the patient have neurofibromatosis with _______ prognosis.
If it occurs in adult, it is usually _______ and ______.
Some tumours have indolent course while others have intracranial extension.
better
malignant and fatal.
Optic nerve sheath meningioma
Eye is an extension of the brain with the optic nerve having it’s own _________ and covered by ______,___________, and _______
Meningothelial cells of the archnoid villi can encircle the nerve or grows along the fibrovascular pial septae.
subarachoid space
dura, arachnoid and pia matter.
Optic nerve sheath meningioma
Commonly affects (men or women?) with the classical symptoms’ triad:
A) ____________.
B) ______________.
C) ___________ _________ vessels(30%).
As well as _____ proptosis after visual loss.
Prognosis is _____ in adults but may be _____________ in children.
Women
A) loss of vision.
B) optic atrophy.
C) opticociliary shunt vessels
axial; good
poorer and fatal
