Flashcards in Block 16 Tumors Deck (134):
An abnormal growth of tissue that exceeds and is uncoordinated with the tissues around it is called a ______?
A tumor that does not grow uncontrollably, invade neighboring tissues or spread throughout body is ______?
A tumor that grows uncontrollably, invades nearby tissues and may spread throughout the body is _____?
A benign neoplasm of RPE cells is known as _____?
What does CHRPE stand for?
Congenital hypertrophy of the RPE
Is CHRPE benign or malignant?
Which form of CHRPE is unilateral? (2 Answers)
Typical Solitary and Typical Grouped
What systemic condition is associated with Typical CHRPE?
What systemic condition is associated with Atypical CHRPE?
Familial Adenomatous Polyposis (FAP)
What condition has fundus lesions described as "bear tracks"? Are the lesions pigmented or non-pigmented?
- Grouped CHRPE
Which benign tumor is associated with precancerous colorectal polyps in teenagers?
What are two terms that describe the different appearances of multifocal lesions in the more common form of benign neoplasms of RPE cells?
- Bear tracks (pigmented)
- Polar bear tracks (non-pigmented)
What do the lesions look like in Atypical CHRPE?
Where are these commonly found on the retina?
- Elongated oval lesions with a depigmented tail on one end
- Multiple scattered throughout the retina
What are the common sizes of lesions found in both Solitary CHRPE and Grouped CHRPE?
Solitary: 1-6 mm (Average is 4-6)
Grouped: 0.1-2 mm
What condition is described as having hypopigmented halos and lacunae scattered within the lesion as it matures?
What percent of patients with Familial Adenomatous Polyposis have characteristic fundus lesions present at birth?
When discovering multiple comma-shaped lesions with depigmentation on one end scattered throughout the retina, what is the role of an optometrist?
1. Differentiate from other pigmented fundus lesions
2. Refer to GI specialist for colonoscopy and to examine relatives
How should typical CHRPE be managed?
1. Differentiate from other pigmented fundus lesions
2. Document and monitor
What type of cells exhibit abnormal growth in an choroidal nevus?
Choroidal melanocytes (pigment-containing cells)
What is the most common symptom of a choroidal nevus?
Asymptomatic (incidental finding)
When does the growth of a choroidal nevus typically occur?
What two factors could affect the macula cause vision impairment with a choroidal nevus?
1. The lesion itself
2. Subretinal fluid
What does "amelanotic" mean when referring to a choroidal nevus?
Is a choroidal nevus more commonly pigmented or amelanotic?
What type of borders are seen on choroidal nevi?
What additional sign is seen when a choroidal nevus is chronic?
What examination technique can be used to differentiate a choroidal nevus from a CHRPE?
Red-free filter (green light) to confirm choroidal location for nevus (CHRPE is RPE cells) - Red free filter will diminish appearance of choroidal nevus. A red filter will increase visibility of choroidal nevus.
Why is it important to document and monitor a choroidal nevus?
To identify any malignant transformation
List 4 suspicious findings on a choroidal nevus that point to possible malignant transformation?
1. Increase in size or thickness beyond puberty
2. Subretinal fluid
3. Lipofuscin (orange pigment)
What benign tumor could be a variant of a choroidal nevus?
What area of the retina does a choroidal nevus typically favor?
What area of the retina is a choroidal melanocytoma commonly found?
At or near optic nerve head
Who is more commonly affected by a choroidal nevus vs a choroidal melanocytoma?
Choroidal nevus: Caucasians
Choroidal melanocytoma: Darkly pigmented individuals
What benign tumor may have an associated RAPD?
The retinal lesion from a benign congenital tumor composed of various cell types form both the retina and RPE is often located ____?
What condition is this called?
- Near optic disc
- Combined Hamartoma of the Retina and RPE
What can cause visual distortion in Combined Hamartoma of Retina and RPE cells?
Dragging of macula or disc
If Combined Hamartoma of Retina and RPE cells becomes symptomatic, what is the best treatment?
Vitrectomy with membrane peeling
A benign choroidal tumor consisting of varying-sized vascular channels is often diagnosed in what age group?
Children or young adults
Is a choroidal hemangioma benign or malignant?
Is a choroidal melanocytoma being or malignant?
What diagnostic test can best show tumor vessels in circumscribed choroidal hemangioma?
In a case where a choroidal hemangioma is not asymptomatic, what may be the cause of the impaired vision?
Macular distortion due to the tumor itself or a exudative retinal detachment
A benign choroidal vascular tumor found in a patient with Sturge-Weber Syndrome is most likely ____?
Diffuse Choroidal Hemangioma
A benign choroidal vascular tumor found in a patient with no systemic association is most likely ____?
Circumscribed Choroidal Hemangioma
A benign vascular tumor of retinal capillary bed is most commonly associated with what systemic condition?
von Hippel-Lindau (VHL)
60% of patients with VHL display what type of tumor that has sight and light threatening complications?
Dilation and tortuosity of the supplying artery and draining vein extending from the optic disc is associated with which ocular tumor? Is it benign or malignant?
Are lesions typically nasal or temporal to the optic disc in a capillary hemangioma?
A "bunch of grapes" on the surface of the retina describes which ocular tumor? Is it benign or malignant?
Retinal Cavernous Hemangioma
What gives a retinal cavernous hemangioma its "bunch of grapes" appearance?
Clusters of retinal venous aneurysms
A congenital arterio-venous malformation of retinal vasculature is sometimes accompanied by similar lesions in what 2 locations?
Direct communication between enlarged and tortuous retinal veins and arteries is caused by ___?
Why should imaging be done when discovering a Racemose Hemangioma?
To rule out non-ocular arterio-venous malformation
Is racemose hemangioma commonly unilateral or bilateral?
What symptoms are most often associated with Racemose Hemangioma?
1. What type of lesion is a retinal vasoproliferative tumor?
2. Benign or malignant?
1. Glio-vascular lesion
Are most retinal vasoproliferative tumors primary or secondary?
Are retinal vasoproliferative tumors that are secondary to another condition unilateral or bilateral?
Are most retinal vasoproliferative tumors unilateral or bilateral?
Where are lesions from retinal vasoproliferative tumors most often found? Are they most often single or multifocal?
- Infero-temporal periphery
When is there a single lesion vs multifocal lesions due to a retinal vasoproliferative tumor?
Single lesion: Primary VPT (most common)
Multifocal: Secondary VPT (20%)
What are 3 ways a mass is different when the retinal vasoproliferative tumor is secondary to another condition (rather than primary)?
3. Posterior to equator
What are 4 examples of conditions that a retinal vasoproliferative tumor could be secondary to?
1. Retinitis pigmentosa
2. Pars planitis
3. Coat's disease
4. Retinal detachment repair
A retinal astrocytoma is composed of what kind of cells?
Retinal glial cells
When does a retinal astrocytoma typically appear?
Congenital (born with it)
What systemic association is commonly associated with a benign congenital tumor or retinal glial cells?
Tuberous sclerosis (Bourneville Disease)
How is Tuberous sclerosis (Bourneville Disease) often characterized?
Skin, CNS and visceral tumors causing seizures and mental retardation
What is the common ocular treatment for Retinal Astrocytoma?
Not typically required
What may be a reason ocular treatment is needed in Retinal Astrocytoma?
A tumor consisting of mature bone within the choroid and atrophied RPE above it describes ______?
Benign or malignant?
- Choroidal Osteoma
How often is a Choroidal Osteoma unilateral?
A Choroidal Osteoma is commonly seen in ____?
Otherwise healthy young women
What color do lesions initially appear on a choroidal osteoma? What color do they become?
- Initially: Orange
- Become yellow/white
Describe the borders seen on a Choroidal osteoma?
Well-defined scalloped margins
When would treatment be required in a choroidal osteoma?
If choroidal neovascularization (CNV) is present
What 3 things describes a malignant tumor?
1. Grows uncontrollably
2. Invades nearby tissues
3. May spread throughout body
The most common childhood eye malignancy is ___?
Retinoblastoma (1 in 18,000 infants)
Is Retinoblastoma malignant or benign?
What is the most likely outcome of Retinoblastoma if left untreated? Why?
- Direct spread into brain
What is the most common presentation of Retinoblastoma?
Leukocoria (white pupil)
Is retinoblastoma unilateral or bilateral?
Can be either. If bilateral, it is often multifocal
Why does strabismus often develop in Retinoblastoma?
No sensory information is being received by affected eye, so the eye turns from lack of use
How does the affected retina appear in Retinoblastoma?
White dome-shaped mass
In Retinoblastoma, what is it called if the white mass extends into the vitreous?
In Retinoblastoma, what is it called if the white mass extends beneath the retina?
What type of testing is required to diagnose Retinoblastoma?
Dilated fundus exam - usually done with anesthesia
What type of testing is used as a screening for Retinoblastoma?
List 5 treatment options for Retinoblastoma.
1. Photocoagulation (laser)
2. Cryotherapy (freezing)
3. Chemotherapy (targets highly mitotic cells)
4. Various types of radiotherapy (irradiation)
What makes up the tumor in Retinoblastoma?
Incompletely differentiated retinal cells = retinoblasts
When does Retinoblastoma almost always manifest?
Within first few years of life
What does leukocoria mean?
The most common primary intraocular malignancy in adults is ____?
Choroidal melanoma is more common in what age group? What race?
What is often the result if a choroidal melanoma metastasizes from the eye to other organs?
What is frequently found on surface of a choroidal melanoma?
Lipofuscin = clumps of orange pigment
What is the common clinical appearance of a choroidal melanoma?
Pigmented, dome-shaped sub retinal elevation.
Can also be amelanotic and relatively flat
60% of choroidal melanoma's are located _____?
3mm from optic disc
If a choroidal melanoma breaks through Bruch's membrane, how is the appearance described?
What type of angiography is useful in diagnosing a choroidal melanoma?
What test can be used to aid in determining the prognosis for a choroidal melanoma?
True or false: Treatment of a choroidal melanoma is always required
Which method of irradiation is most commonly used to treat a choroidal melanoma?
Which organ does a choroidal melanoma commonly spread to (if it spreads at all)?
List 4 treatment options for a choroidal melanoma.
1. Irradiation (brachytherapy most often)
2. Transpupillary thermotherapy (TTT)
3. Resection (rare)
The most common type of intraocular malignancy almost always occurs where within the eye?
Choroid (90%) > Iris > Ciliary body
The most common type of intraocular malignancy is a primary or secondary tumor?
Secondary (primary tumor is elsewhere and travelled to eye via bloodstream)
What are the most common primary sites of metastatic tumors that spread to choroid?
Lung and breast
What portion of the macula is usually affected by choroidal metastases?
Are choroidal metastases most often solitary or multifocal?
Unilateral or bilateral?
Solitary and unilateral
Describe the typical clinical appearance of a choroidal metastases?
Creamy-white "placoid" lesion at posterior pole; relatively flat
What is often a secondary finding to choroidal metastases?
How is vision often affected by choroidal metastases?
Distorted - due to location of lesion at macula/posterior pole
2/3 of patients with choroidal metastases have a history of ____?
Primary malignant tumor
How long do most patients have to live when choroidal metastases from a primary tumor is discovered?
1 year or less
A neoplasm of immune system cells is known as ____?
A malignant proliferation of white blood cells within the eye is called _____?
Do most cases of intraocular lymphoma initially have unilateral or bilateral symptoms? What are the symptoms?
- Usually unilateral at first, and eventually becomes bilateral
- Floaters and blurred vision
Is vitritis commonly mild or severe in Intraocular Lymphoma?
Is anterior uveitis commonly mild or severe in Intraocular Lymphoma?
Mild anterior uveitis
What is a common feature of vitritis in intraocular lymphoma?
The vitritis does not clear with corticosteroids
What is often a result of severe, unremitting vitritis - but does NOT occur in intraocular lymphoma?
Cystoid macular edema
"Collar stud" appearance on the retina occurs due to _______ in the most common primary intraocular malignancy in adults?
A choroidal melanoma breaking through Bruch's membrane
Cystoid macular edema does NOT occur despite unremitting _______ in which condition?
- Unremitting vitritis
- Intraocular lymphoma
Is the appearance of a Intraocular Lymphoma on the retina multifocal or single?
Describe the appearance of intraocular lymphoma.
Multiple yellow-white sub retinal infiltrates that enlarge and coalesce.
(plus severe vitritis, mild anterior uveitis, and no CME)
What diagnosis should be considered in any elderly patient with recalcitrant posterior uveitis?
Most patients with primary intraocular lymphoma eventually develop ____ symptoms ?
_____ symptoms may precede eye involvement in an intraocular lymphoma.
Intraocular lymphoma is a subset of ____?
Primary CNS lymphoma
When attempting to diagnose intraocular lymphoma, National Eye Institute recommends to perform ________ first, before performing _______.
- Lumbar puncture (CSF evaluation) first
- Vitreous biopsy
What is the reason most patients die with primary intraocular lymphoma?
What type of treatment is often used for ophthalmic manifestations of ocular lymphoma?
What type of treatment is often used for CNS involvement of ocular lymphoma?