Week 1 Pathology

Question 1

Hypertensive Retinopathy

- Features (5)

Answer 1

• AV Nicking via Arteriolar Narrowing: Copper + Silver threads
• Flame shaped Hemorrhages via burst vessel
• Cotton Wool Spots: swollen axons with cytoplasmic bodies via ischemia
• Edema of optic Disk
• Star exudates

Question 2

Diabetic Retinopathy

• Features (10)
• Complications (2)
• Detail with Type 1 vs Type 2 Diabetes

Answer 2

• Glomerulosclerosis
• Necrotizing papillitis (tips of renal papillae)
• Increased luminal narrowing w/ chance of atheroma formation
• Gangrene ulcers
• Diabetic Neuropathy/Nephropathy
• Microaneurysms + hemorrhaging
• Exudates
• Proliferative Diabetic Retinopathy w/ scarring

Complications

• Cataracts (via increased sorbitol + fructose content of lens)
• Glaucoma (vascular changes lead to obstruction of flow of vitreous humor)

Type 1 vs Type 2
- Virtually all Type 1 and many type II develop some degree of retinopathy within 5-15 years (depends on glycemic control)

Question 3

“Mushroom shaped mass + invades Bruch’s membrane” refers to…

Answer 3

Choroidal melanomas

Question 4

“Dark spots on the sclera” refers to…

Answer 4

Ciliary body melanomas

Question 5

Most common primary intraocular malignancy + treatment

Answer 5

Ocular melanoma
- TX: Enucleation of the eye or radiotherapy with local excision
Note: more than half the patients survive 15 years after enucleation.

Question 6

Most common intraocular malignant tumor of childhood. Is it usually unilateral or bilateral?

Answer 6

Retinoblastomas

Question 7

Retinoblastomas: Genetic mutation + related malignancies

Answer 7

Retinoblastoma tumor supressor gene located on long arm of chromosome 13
- Osteosarcomas and Ewing Sarcoma

Question 8

“Flexner-Wintersteiner rossettes” refers to…

Answer 8

Retinoblastoma

Question 9

Gross pathologic characteristics of Retinoplastoma…

Answer 9

• Cream colored tumors that contain chalky-white, calcified flecks within yellow necrotic zone.
  Note: calcified therefore can be detected radiographically

Question 10

Metastasize of Malignant Melanoma vs Retinoblastoma

Answer 10

Malignant Melanoma
- hematogenous route or traverse the sclera to enter the surrounding orbital tissue.

Retinoblastoma

• hematogenous route
• Extend into the optic nerve and spread intracranially

Question 11

Tumors that metastasize to the eye

Answer 11

• Leukemias = to posterior choroid
• Breast and Lung cancer = the posterior choroid
• Neuroblastoma from adrenal gland = to orbit
  Note: Orbit can be invaded by malignant tumors of the eyelid conjunctiva, nose, nasopharynx, and intracranial cavity (close vicinity)