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Pathology and Tumors > Vitreous/Retina/Uvea > Flashcards

Vitreous/Retina/Uvea Flashcards

1
Q

The vitreous attaches most firmly where?

A

Vitreous base - extends more posteriorly with advancing age.

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2
Q

What is the primary vitreous?

A

Fibrillar material, meschymal cells, and vascular components: the hyaloid artery, vasa hyaloidea propria, and tunica vasculosa lentos.

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3
Q

What is secondary vitreous?

A

Begins to form at the nineth week destine to become the MAIN portion of the vitreous in the adult eye.

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4
Q

What is teritary vitreous?

A

zonular fibers

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5
Q

Asteriod bodies stain with what and are made up of what?

A

Neutral fat, phospholipids, calcium; alcian blue, metachromatic and exhibit bifringence. Asteriod bodies can be surrounded by a foreign body giant cell.

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6
Q

Where is the water shed area of the retina?

A

Inner nuclear layer

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7
Q

What does retina blood supply?

A

Up to the inner 2/3 of the inner nuclear layer

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8
Q

What does choroidal circulation supply?

A

Outer 1/3 of the inner nuclear layer

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9
Q

What are the 8 functions of the RPE?

A
  1. Vit A metabolism
  2. Formation of the basal lamina of the inner portion of Bruch’s membrane
  3. Production of the mucopolyscarride matrix that surrounds the photoreceptor outer segments
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10
Q

In oculocutaneous albinism what is seen on histology?

A

Amount of melanin in each melanosome is reduced

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11
Q

In ocular albinism what is seen on histology?

A

The number of mealosomes is reduced

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12
Q

Mylinated NFL is a/w what?

A
  1. Myopia
  2. Amblyopia
  3. Strabismus
  4. Nystagmus
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13
Q

Where is reticular peripheral cystoid degeneration found ?

A

NFL and more posterior to areas of TPCD - typical periphearl cystoid degeneration

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14
Q

What are some histological characteristics for Lattice degeneration?

A
  1. Discontinuity of the ILM
  2. Sclerosed vessels that remain PATENT
  3. Variable degrees of atrophy of the INNER layers of the retina.
  4. RD as a result of vitreous adhesions at the MARGIN of LD
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15
Q

In Pavingstone degeneration what do you see?

A

Inner nuclear layer is adherent to Bruch’s membrane b/c occlusion of the choriocapillaris can lead to loss of the outer retinal layers and RPE.

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16
Q

What are cystoid bodies?

A

Localized accumulations of axoplasmic material that are present in ischemic infarcts of the NFL (ischemic damage to the nerve fibers of the ganglion cells)

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17
Q

CWS take how long to resolve?

A

4-12 weeks.

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18
Q

Henle’s layer is where?

A

Outer plexiform layer of the macula

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19
Q

Chronic retinal ischemia leads to architectural changes in the retina. Adjacent to acellular capillaries, what forms?

A

Dilated irregular vascular channels = IRMA and microaneurysms often appear.

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20
Q

What is a micro aneurysm histologically?

A

Hyalinized hypocelluar ma’s

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21
Q

Carotid vascular dx forms what type of plaque?

A

Hollenhorst - cholesterol emboli

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22
Q

Cardiac vascular dx causes what type of plaque?

A

calcific emboli

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23
Q

Thromboembolism forms what type of plaque?

A

platelet-fibrin emboli

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24
Q

What are histoloical changes seen in DR?

A
  1. Thickening of the retinal capillary BM
  2. SELECTIVE loss of pericytes compared with retinal capillary endothelial cells
  3. CORNEAL epithelial BM is thickened.
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25
Q

What histologically does NOT develop in ROP?

A

Retinal edema and exudates

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26
Q

What are the 5 AREDS vitamins?

A
  1. Vit C
  2. Vit E
  3. Beta cartone
  4. Zinc
  5. Copper
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27
Q

Type 1 CNV is located where and a/w what?

A

Within Bruch’s membrane in the sub-RPE space; more characteristic of AMD

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28
Q

Type 2 CNV is located where and a/w what?

A

Sub retinal and a/w ocular histoplasmosis

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29
Q

The ABCA4 gene is Stargardts codes what?

A

RIM protein which helps in ATPase binding.

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30
Q

What is the most common mutation a/w pattern dystrophies?

A

RDS/peripherin gene

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31
Q

What is the incidence of RP?

A

1/3500

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32
Q

What type of gene is the retinoblastoma gene?

A

TUMOR SUPPRESSOR GENE

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33
Q

What are histological findings of RB?

A
  1. Tumor cells surrounding blood vessels
  2. Zones of tumor necrosis
  3. Calcium present in necrotic areas
  4. Nuclei 2x the size of lymphocytes with amount no cytoplasm.
  5. Flexner-Wintersteiner rosettes - expressions of retinal differentiation
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34
Q

What do Flexner-Wintersteiner rosettes look like?

A

Cells of rosettes surround a CENTRAL LUMEN lined by refractile structures. Refracticle lining corresponds to the EXTERNAL LIMITING MEMBRANE

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35
Q

In what 4 dx are Flexner-Wintersteiner rosettes seen in?

A
  1. RB
  2. Pinealoblastoma
  3. Medulloepithelioma
  4. Ectopic intracranial retinoblastoma
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36
Q

Where are Homer Wright rosettes seen in?

A
  1. Neuroblastoma
  2. Medulloblastoma
  3. RB
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37
Q

What are Homer Wright rosettes and what does it look like?

A

NOT RETINAL differenitaion
Filled with a tangle of eosinophilic cytoplasm
(Homer Simpson likes jelly donuts - no hole)

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38
Q

What is a fleurette?

A

Photoreceptor differentiation seen in RB. Expresses a GREATER degree of retinal differentiation than does Flexner-Wintersteriner rosettes.

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39
Q

What spreads RB via the CNS?

A

Optic nerve invasion where cells spead into the leptomeninges

40
Q

What spreads RB via hematogenous dissemination?

A

Massive uveal invasion.

41
Q

How does a retinocytoma differ from RB histologically?

A
  1. More cytoplasm and more evenly dispered nuclear chromatin. No mitoses
  2. Calcification with NO necrosis
42
Q

What does a medulloepithelimoa look like histologically?

A

Ribbon like structures with heteroplastic tissue - cartilage or smooth muscle

43
Q

What is a Fuch’s adenoma made of ?

A

Nonpigmented ciliary epithlium

44
Q

What does the color of the iris depend on?

A

The number and size of the melanin pigment granules in STROMAL melanocytes.

45
Q

In which dz is the choriocapillaris spared?

A

Sympathetic ophthalmia

46
Q

What are Dalen-Fuchs nodules made of?

A

Collections of epithelioid hisitiocytes and lymphocytes between the RPE and Bruch’s membrane

47
Q

Where do most iris melanoma occur?

A

Inferior sectors of the iris - they follow a nonaggressive clinical course compared to posterior melanomas

48
Q

What are the 3 types of uveal melanomas?

A
  1. Spindle cell (Type A and B)
  2. Epithelioid melanoma (worst prognosis)
  3. Mixed- cell type
49
Q

Where is there a propensity of uveal melanoma to metastasize ?

A

The LIVER

50
Q

All choroidal melanocytic tumors thicker than WHAT are melanomas? And diameter?

A

3mm; 10mm

51
Q

What are risk factors for a choroidal nevus to be malignant?

A
  1. Orange pigmentation
  2. Juxtapapillary location
  3. hOMOGENEITY on ultrasound
52
Q

What type of internal reflectivity does a chorodial melanoma have?

A

LOW

53
Q

How do hemorrhagic detachments look?

A

Dome shaped, involving multiple quadrants and a/w breakthrough vitreous bleeding.

54
Q

What type of internal reflectivity does a choroidal hemangioma have?

A

HIGH

55
Q

What % of RB is b/l?

A

30-40%

56
Q

If a parent has U/L RB and the first off spring is unaffected, what is the chance of the second child having RB?

A

7-15%

57
Q

If you have an unaffected parent with a first with b/l dz what is the chance that the second child gets RB?

A

5% (if parent is a carrier then 45%)

58
Q

A scan U/S measures what 3 things?

A
  1. Internal reflectivity
  2. Vascularity
  3. Height
59
Q

Vitreous amyloidosis is a/w what?

A

Peripheral neuropathy - both are a/w transthyretin abnormality

60
Q

Touton giant cells are seen in what 3 d/o’s?

A
  1. Chalazion
  2. Xanthogranuloma
  3. Xanthelasma
61
Q

Why do adult medulloepitheliomas occur?

A

Usually related to trauma that are actually reactive hyperplasia of the ciliary epithelium

62
Q

Where does the sclera receive nutrition?

A
  1. Choroid
  2. Episcleral vessels.
    * It does not have its own capillary bed*
63
Q

What portion of the sclera is dervied from the mesoderm?

A

Temporal (all other parts are from the NEURAL CREST cells!!!)

64
Q

The RPE and neurosensory retina is derived from which cells?

A

Neuroectoderm

65
Q

Schlems canal is dervied from what?

A

MESODERM

66
Q

The Iris Stroma is derived from what cells?

A

Neural CREST (all other parts of the iris are dervied from the neuroectoderm)

67
Q

The trabecular meshwork is dervied from where?

A

NEURAL CREST

68
Q

The corneal stroma and endothelium is dervied from where?

A

NEURAL CREST

69
Q

In NF1 what do you see histologically in the choroid?

A

hamartoumatous infiltrate with OVOID bodies (resembles tactile corpuscle)

70
Q

What do astrocystic hamartomas look like on histology?

A

Calcospherites

71
Q

In ataxia telengectasia which Ig is deficient?

A

IgA (increased incidence of lymphoma and increased alpha feta protein)

72
Q

Blue argon laser absorbs what and does what to the retina?

A

Absorbs yellow macular pigment and DAMAGES the retina

73
Q

Green argon laser absorbs what?

A

Melanin and BLOOD

74
Q

In peripheral microcystoid degeneration what are the cyst filled with?

A

Hyaluronic acid

75
Q

A pars plana cyst is what and filled with what?

A

Splitting between pigmented and non pigmented layers of the CILIARY epithelium and contain hylauronic acid

76
Q

Gray sphere with a maltese cross makes you think of?

A

Asteriod hyalosis

77
Q

Mutant protein TRANSTHYRETIN (pre albumin) causes what?

A

Amyloidosis in vitreous

78
Q

What rarely mimic CNS lymphoma with b/l vitritis and dementia?

A

Whipples dx

79
Q

Leiomyoma are found where and in whom?

A

Young girls, amelanotic tumors found in the supraciliary space

80
Q

Where do enophytic RB arise?

A

From INNER retina and sees the vitreous

81
Q

Where does an exophytic RB arise?

A

From the OUTER retina and causes RD.

82
Q

Which dz invades the optic nerve: Uveal melanoma or RB?

A

RB

83
Q

In coats dz which part of the retina is usually affected?

A

ST

84
Q

Retinal dysplasia occurs with which trisomy usually?

A

13

85
Q

What is the pathological hallmark of Bechets?

A

Vasculitis; chronic nongranulomatous uveitis

86
Q

What is the most common ocular site for systemic sarcoid?

A

Uveal tract

87
Q

In RB what the two main tumor seen not do to radiation tx?

A
  1. Osteosarcoma

2. Maligant melanoma

88
Q

Where do cell bodies of Muller cells reside?

A

Inner nuclear layer

89
Q

What happens with a CWS?

A

THICKENING of NFL with cystoid bodies - swollen axons blocked with axoplasm

90
Q

Which dz has early trouble with acommondation and iris thickening?

A

Sympathetic ophthalmia

91
Q

What are the 4 stages of VKH?

A
  1. Prodromal stage (CSF pleocytosis, tinnitus, fever)
  2. Acute Uveitic Stage (few days after stage 1)
  3. Convalescent stage (several weeks after uveitic) - depigmentation of the choroid
  4. Chronic recurrent stage - recurrent inflm, glaucoma, subretinal fibrosis, PSC
92
Q

HLA-DR2?

A

Pars planitis (also DR51, DR17)

93
Q

Amyloid makes what teriatary structure?

A

Beta pleated sheets

94
Q

Which two metatstatic dz are a/w long survival times?

A
  1. Breast CA

2. Carcinoid tumors

95
Q

What type of pattern do u see on FA with Choroidal melanomas?

A

Double circulation pattern - where both retinal and chorodial vessels are seen in the tumor.

96
Q

Which is a more effective treatment for uveal melanoma: external beam radiation or charged particle radiation?

A

charged particle radiation

Pathology and Tumors (5 decks)

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