wk2: AED - Lumps+Bumps 1

Question 1

Name some situations that could result in increased cellular/extracellular mass (name 7 for example)

Answer 1

Cellular mass: Hyperplasia, Hypertrophy, Dysplasia, Metaplasia, Neoplasia,
Extracellular mass: Inflammation, FB, Oedema, Haemorrhage, Cellular product depostion, Vesicle, Cyst, Duct/Vesicle Blockage, Microorganism prolfieration

Question 2

What is Neoplasia?

Answer 2

A tumour. Can be benign or malignant

Question 3

How is benign vs malignancy determined for a tumour? (6)

Answer 3

Based on appearance: e.g. degree of differentiation, rate of growth, invasiveness, tendency to metastasise, blood supply, cellular origin, etc.

Question 4

What do benign tumours result from? (4)

Answer 4

Hyperplasia, Metaplasia, Dysplasia, or Hypertrophy

Question 5

When is a tumour considered cancer? (2)

Answer 5

When the cells show uncontrolled growth and spread, which leads to a malignant tumour

Question 6

What is Pterygium?

Answer 6

A fleshy overgrowth (hyperplastic tumour) of the conjunctiva occurring in response to excessive UV exposure and subsequent damage

Question 7

In terms of ocular surface lesions, how common is pterygium?

Answer 7

Common

Question 8

Where does pterygium originate from?

Answer 8

limbal stem cells exposed to chronic UV irritation

Question 9

What 3 histology characteristics does Pterygium present with?

Answer 9

Epithelial proliferation
Goblet cell hyperplasia
Angiogenesis

Question 10

What causes the defect in cancer cells?

Answer 10

Genetic mutations - sometimes caused by infectious viruses or env. factors (e.g. sunlight)

Question 11

What does the defect in cancer cells allow them to do? (3)

Answer 11

Divide uncontrollably
Invade surrounding tissue
Metastasise

Question 12

How do cancer cells metastasise? (2)

Answer 12

They spread via the vascular and/or lymphatic systems

Question 13

Name 5 risk factors for cancer

Answer 13

Genetics
Smoking
Diet (saturated fat, food preservatives)
Occupation/environment (sunlight, UV)
Infectious agents (viruses after DNA)

Question 14

Name the 6 major histological classes of cancers

Answer 14

Carcinoma
Sarcoma
Myeloma
Leukemia
Lymphoma
Mixed

Question 15

Which histological classes of cancer can affect the eyes/eyelids? (3)

Answer 15

Carcinoma
Sarcoma
Lymphoma

Question 16

What does carcinoma affect? (2)

Answer 16

Epithelial tissues: internal or external linings

Question 17

What proportion of cancers are carcinomas? Why is this?

Answer 17

80-90%. It’s common because epithelial tissue is common throughout the body

Question 18

Where do Sarcomas occur? (5)

Answer 18

Cancers of supportive or connective tissues: bones, tendons, cartilage, muscle and fat

Question 19

Where do Myelomas occur? (1)

Answer 19

cancers of plasma cells of bone marrow

Question 20

Where does Leukemia occur? (2)

Answer 20

cancers of bone marrow that affects WBCs or RBCs

Question 21

What do lymphomas affect? (2)

Answer 21

cancers of glands or nodes of lymphatic system (solid masses)

Question 22

Where do lymphomas commonly occur? (3)

Answer 22

Stomach
Breast
Brain

Question 23

What are the 2 potential causes of a lump/bump?

Answer 23

Increased cellular or extracellular mass (e.g. fluid in cyst)
Tissue enlargement/displacement due to unregulated growth/invasion

Question 24

How does the general public classify cancer?

Answer 24

Based on the primary site of cancer (e.g. skin, breast)

Question 25

Do primary brain tumours metastasise?

Answer 25

No. However, the brain is a common site for metastasis

Question 26

Describe the following characteristics for benign tumours: A: Are they encapsulated? B: How fast is their growth rate

Answer 26

A: Yes. They are encapsulated B: Slow growth rate

Question 27

Describe cellular differentiation in the context of biopsy

Answer 27

the extent to which cells resemble their forebears

Question 28

How do malignant cells vary under biopsy? (2)

Answer 28

vary in size and shape irregular cells called pleomorphism &/or anaplasia

Question 29

What histological cellular change is an early sign of cancer?

Answer 29

pleomorphism

Question 30

Define anaplasia

Answer 30

loss of the mature or specialised features of a cell or tissue, as in malignant tumours

Question 31

Describe 4 features of cells that have undergone anaplasia

Answer 31

cells become immature large nuclei unusual shapes little cytoplasm (immaturity)

Question 32

What does the presence of feeder blood vessels going towards a lump indicate? (2)

Answer 32

active + fast growth suggesting it's a neoplastic growth (the feeder vessels are needed to facilitate this)

Question 33

How do Benign tumours and Malignant tumours differ in appearance? (2)

Answer 33

Benign: localised to single tissue (e.g. conjunctiva); show well demarcated edges Malignant: invade surrounding tissue; show irregular borders

Question 34

What proportion of tumours with irregular borders are metastatic at time of diagnosis?

Answer 34

20%

Question 35

Do all malignancies metastasize?

Answer 35

No

Question 36

What does a halo around a malignant tumour represent?

Answer 36

area of invasion (invasion zone)

Question 37

When looking at the eye, how do we know whether a neoplastic growth is superficial or deeper in the eye?

Answer 37

Get a cotton bud and rub the area: if it moves, it's superficial

Question 38

Which is worse? A neoplastic growth superficial on the eye or deeper in the eye?

Answer 38

Deeper is worse

Question 39

What tests can we use to determine the rate of growth/spread of a neoplastic growth? (2)

Answer 39

FAT - Family Album Test Photo and watch - 6/12months

Question 40

if a tumour grows fast does that mean it's malignant?

Answer 40

Not always

Question 41

If a tumour grows fast, is pleomorphic, highly vascularised and invasive, does that mean it's malignant?

Answer 41

Most likely

Question 42

As a clinician, what should we do if we see any unusual/unexpected lesion inside the eye? (in addition to a tumour) (3)

Answer 42

DFE + CFP + OCT or ultrasound Consider possibility that this is secondary Vision + Visual function, esp. Visual Field Test

Question 43

Does lymphatic spread happen in the CNS?

Answer 43

No

Question 44

Name the 4 most frequent secondary sites for tumour metastasis

Answer 44

Eye Breast Liver Lungs

Question 45

How do cysts arise?

Answer 45

from secreting epithelium that becomes trapped at a deeper location

Question 46

Define Vesicle

Answer 46

a container of fluid within a natural cleavage of skin layers

Question 47

Are cysts hard or soft on palpation?

Answer 47

Hard b/c of internal pressure

Question 48

Which enlarges over time? Cysts or Vesicles?

Answer 48

Cysts (vesicles do not enlarge over time)

Question 49

In regards to dermoid cysts: A) When do they form? B) Where do they form?

Answer 49

A) Form at birth from entrapped dermis in orbit, lid, limbus B) can form around and contain lashes (also forms elsewhere presumably)

Question 50

How would you describe the cyst lining?

Answer 50

normal skin surface

Question 51

What do cysts contain and how does this affect their structure?

Answer 51

Keratin - so hard, slow, growing lump

Question 52

When might you consider referral for a cyst? (3)

Answer 52

When: Becomes painful + inflamed Grows rapidly or changes colour Removal is desired for cosmetic reasons

Question 53

What is Lymphangiectasia?

Answer 53

focal blockage of conjunctival lymphatic vessels (= multiple bubbles on the conj)

Question 54

How does Lymphangiectasia present? (1)

Answer 54

Bubbles on conjunctiva

Question 55

Name 2 potential causes of lymphatic vessel blockage?

Answer 55

Trauma Inflammation

Question 56

What is a Chalazion?

Answer 56

A blocked duct causing local swelling of a gland

Question 57

How is a chalazion associated with inflammation?

Answer 57

Leakage of oils into surrounding tissues cause inflammation here

Question 58

Describe the nature of the inflammation associated with chalazion? (1)

Answer 58

Granulomatous

Question 59

How do you manage chalazion? (3)

Answer 59

Warm compresses + massage Steroid injection Surgical removal

Question 60

Are chalazions painful?

Answer 60

No

Question 61

What is a papilloma?

Answer 61

A benign overgrowth of epithelial cells (non-invasive with modest blood vessel growth (surface pink like strawberry))