wk2: AED - Lumps+Bumps 1 Flashcards
Name some situations that could result in increased cellular/extracellular mass (name 7 for example)
Cellular mass: Hyperplasia, Hypertrophy, Dysplasia, Metaplasia, Neoplasia,
Extracellular mass: Inflammation, FB, Oedema, Haemorrhage, Cellular product depostion, Vesicle, Cyst, Duct/Vesicle Blockage, Microorganism prolfieration
What is Neoplasia?
A tumour. Can be benign or malignant
How is benign vs malignancy determined for a tumour? (6)
Based on appearance: e.g. degree of differentiation, rate of growth, invasiveness, tendency to metastasise, blood supply, cellular origin, etc.
What do benign tumours result from? (4)
Hyperplasia, Metaplasia, Dysplasia, or Hypertrophy
When is a tumour considered cancer? (2)
When the cells show uncontrolled growth and spread, which leads to a malignant tumour
What is Pterygium?
A fleshy overgrowth (hyperplastic tumour) of the conjunctiva occurring in response to excessive UV exposure and subsequent damage
In terms of ocular surface lesions, how common is pterygium?
Common
Where does pterygium originate from?
limbal stem cells exposed to chronic UV irritation
What 3 histology characteristics does Pterygium present with?
Epithelial proliferation
Goblet cell hyperplasia
Angiogenesis
What causes the defect in cancer cells?
Genetic mutations - sometimes caused by infectious viruses or env. factors (e.g. sunlight)
What does the defect in cancer cells allow them to do? (3)
Divide uncontrollably
Invade surrounding tissue
Metastasise
How do cancer cells metastasise? (2)
They spread via the vascular and/or lymphatic systems
Name 5 risk factors for cancer
Genetics
Smoking
Diet (saturated fat, food preservatives)
Occupation/environment (sunlight, UV)
Infectious agents (viruses after DNA)
Name the 6 major histological classes of cancers
Carcinoma
Sarcoma
Myeloma
Leukemia
Lymphoma
Mixed
Which histological classes of cancer can affect the eyes/eyelids? (3)
Carcinoma
Sarcoma
Lymphoma
What does carcinoma affect? (2)
Epithelial tissues: internal or external linings
What proportion of cancers are carcinomas? Why is this?
80-90%. It’s common because epithelial tissue is common throughout the body
Where do Sarcomas occur? (5)
Cancers of supportive or connective tissues: bones, tendons, cartilage, muscle and fat
Where do Myelomas occur? (1)
cancers of plasma cells of bone marrow
Where does Leukemia occur? (2)
cancers of bone marrow that affects WBCs or RBCs
What do lymphomas affect? (2)
cancers of glands or nodes of lymphatic system (solid masses)
Where do lymphomas commonly occur? (3)
Stomach
Breast
Brain
What are the 2 potential causes of a lump/bump?
Increased cellular or extracellular mass (e.g. fluid in cyst)
Tissue enlargement/displacement due to unregulated growth/invasion
How does the general public classify cancer?
Based on the primary site of cancer (e.g. skin, breast)
Do primary brain tumours metastasise?
No. However, the brain is a common site for metastasis
Describe the following characteristics for benign tumours:
A: Are they encapsulated?
B: How fast is their growth rate
A: Yes. They are encapsulated
B: Slow growth rate
Describe cellular differentiation in the context of biopsy
the extent to which cells resemble their forebears
How do malignant cells vary under biopsy? (2)
vary in size and shape
irregular cells called pleomorphism &/or anaplasia
What histological cellular change is an early sign of cancer?
pleomorphism
Define anaplasia
loss of the mature or specialised features of a cell or tissue, as in malignant tumours
Describe 4 features of cells that have undergone anaplasia
cells become immature
large nuclei
unusual shapes
little cytoplasm (immaturity)
What does the presence of feeder blood vessels going towards a lump indicate? (2)
active + fast growth suggesting it’s a neoplastic growth (the feeder vessels are needed to facilitate this)
How do Benign tumours and Malignant tumours differ in appearance? (2)
Benign: localised to single tissue (e.g. conjunctiva); show well demarcated edges
Malignant: invade surrounding tissue; show irregular borders
What proportion of tumours with irregular borders are metastatic at time of diagnosis?
20%
Do all malignancies metastasize?
No
What does a halo around a malignant tumour represent?
area of invasion (invasion zone)
When looking at the eye, how do we know whether a neoplastic growth is superficial or deeper in the eye?
Get a cotton bud and rub the area: if it moves, it’s superficial
Which is worse? A neoplastic growth superficial on the eye or deeper in the eye?
Deeper is worse
What tests can we use to determine the rate of growth/spread of a neoplastic growth? (2)
FAT - Family Album Test
Photo and watch - 6/12months
if a tumour grows fast does that mean it’s malignant?
Not always
If a tumour grows fast, is pleomorphic, highly vascularised and invasive, does that mean it’s malignant?
Most likely
As a clinician, what should we do if we see any unusual/unexpected lesion inside the eye? (in addition to a tumour) (3)
DFE + CFP + OCT or ultrasound
Consider possibility that this is secondary
Vision + Visual function, esp. Visual Field Test
Does lymphatic spread happen in the CNS?
No
Name the 4 most frequent secondary sites for tumour metastasis
Eye
Breast
Liver
Lungs
How do cysts arise?
from secreting epithelium that becomes trapped at a deeper location
Define Vesicle
a container of fluid within a natural cleavage of skin layers
Are cysts hard or soft on palpation?
Hard b/c of internal pressure
Which enlarges over time? Cysts or Vesicles?
Cysts
(vesicles do not enlarge over time)
In regards to dermoid cysts:
A) When do they form?
B) Where do they form?
A) Form at birth from entrapped dermis in orbit, lid, limbus
B) can form around and contain lashes (also forms elsewhere presumably)
How would you describe the cyst lining?
normal skin surface
What do cysts contain and how does this affect their structure?
Keratin - so hard, slow, growing lump
When might you consider referral for a cyst? (3)
When:
Becomes painful + inflamed
Grows rapidly or changes colour
Removal is desired for cosmetic reasons
What is Lymphangiectasia?
focal blockage of conjunctival lymphatic vessels (= multiple bubbles on the conj)
How does Lymphangiectasia present? (1)
Bubbles on conjunctiva
Name 2 potential causes of lymphatic vessel blockage?
Trauma
Inflammation
What is a Chalazion?
A blocked duct causing local swelling of a gland
How is a chalazion associated with inflammation?
Leakage of oils into surrounding tissues cause inflammation here
Describe the nature of the inflammation associated with chalazion? (1)
Granulomatous
How do you manage chalazion? (3)
Warm compresses + massage
Steroid injection
Surgical removal
Are chalazions painful?
No
What is a papilloma?
A benign overgrowth of epithelial cells (non-invasive with modest blood vessel growth (surface pink like strawberry))
