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Oncologie Flashcards

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1
Q

Comment fonctionne la chimiothx?

A

Disruption of DNA synthesis at S phase (carboplatin, etoposide, 5-FU)
Inhibition of Mitosis at M phase (vincrisitine)

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2
Q

Mécanismes et types de radiothérapie

A

Mécanismes
- Direct damage of tumour DNA
- Indirect damage of DNA through ionization of H2O –> free radicals

Types :
- Teletherapy
- Brachytherapy

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3
Q

Ddx des eyelid epidermal tumours

A

Benign epidermal tumours
- Squamous Papilloma
- Seborrheic Keratosis
- Keratacanthoma

Malignant Epidermal Tumours
- Basal Cell Carcinoma
- Squamous Cell Carcinoma

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4
Q

Caractéristiques du BCC (types de morphologie, FdR, localisation)

A

Morphological types :
- Nodular
- Ulcerative
- Pigmented
- Morpheaform
- Rarement : Cystic or Multicenteric

FdR : high solar exposure

Localisation :
- Lower eyelid majoritairement
- Medial canthus (25%) : deep invasion, lacrimal obstruction, recurrence

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5
Q

2 types de Eyelid Sebaceous Tumors

A

Sebaceous adenoma
Sebaceous gland carcinoma

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6
Q

Caractéristiques du Sebaceous Adenoma

A

Lobulated mass
Commonly of Meibomiam origin
Carries NO malignant potential

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7
Q

Caractéristiques d’un Sebaceous Gland Carcinoma

A

Meibomian, Zeis or carancle origin
Circumscribed mass (mime un chalazion) or Diffuse
Intraepithelial spread (chronic conjunctivitis unilatérale)

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8
Q

3 types de eyelid neural tumors

A

Neurofibroma
Schwannoma
Merkel cell tumor

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9
Q

Caractéristiques du neurofibrome (¢ prolifératives, types)

A

Neurofibroma : Proliferation of axons, Schwann cells & endoneural fibroblasts

Types :
- Plexiform Neufibroma : Pathognomonic NF1, trends to recur
- Multiple Neurofibromata : Mostly associated with NF1
- Solitary Neurofibroma : Not associated with NF1

Signes NF1 : Lisch nodules, café au lat Patches

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10
Q

Ddx Eyelid Vascular Tumors

A

Congenital capillary hemangioma
Acquired capillary hemangioma
Cavernous hemangioma
Lymphangioma
Diffuse Angioma (Nevus Fammeus)
Vascular malformations
Hemangioendothelioma

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11
Q

Congenital Capillary Hemangioma : types, évolution et Tx

A

Types :
- Cutaneous (le plus fréquent)
- Subcutaneous
- Diffuse (rare)
- Orbital

Évolution :
- Involution 50% by fifth year, 70% by seventh year

Tx :
- PROPANOLOL
- Steroids
- Surgical
- Interferon

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12
Q

À quelle malformation vasculaire est associée le Sturge-Weber?

A

Diffuse Angioma (Nevus Fammeus)

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13
Q

Types de Bx pour une lésion diffuse eyelid (x2)

A

Incision Bx
Punch Bx
(Include adjacent normal tissu in the Bx)

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14
Q

Types de Bx pour une lésion circonscrite eyelid (x2)

A

Excision Bx
Shave Bx

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15
Q

Non-surgical Tx of Eyelid Tumours

A

Radiothérapie
Cryothérapie (for small lesion, may cause skin depigmentation)
Steroids (intra-lesional, systemic for capillary hemangioma)
Interferon alpha-2
Propanolol
Sclerosing agents
Chemotherapy
Immunotherapy (Imiquod 5% cream for BCC, BRAF inhibitors in melanoma)

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16
Q

Cible de l’immunothérapie utilisé pour certains mélanomes

A

BRAF inhibitors

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17
Q

Définition, indication et complications de l’orthovoltage X-Ray Radiotherapy

A

Orthovoltage : Type of radiation therapy
- X-rays used are strong enough to kill cancer cells but do not penetrate more than few mm beyond the surface of the skin
- Effective treatment for very superficial, small tumours (ex. skin cancer)

Indication : Malignant eyelid tumours ≤ 10 mm depth

Provides 95% tumour control

Complications :
- Loss of lashes
- Skin telangiectasia
- Dry eye/Epiphora

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18
Q

Most common ocular surface neoplasia

A

Epithelial tumors :
- Squamous Papilloma
- Conjunctival Intraepithelial Neoplasia (CIN)
- Squamous cell carcinoma

Melanocytic tumors :
- Nevus
- Melanosis (racial, PAM, subepithelial)
- Melanoma

Lymphoproliferative tumors

Vascular : lymphangioma, hemangioma

Others : pyogenic granuloma, dermoid…

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19
Q

Caractéristiques et Tx Conjunctival Intraepithelial Neoplasia (CIN)

A

Flat/Sessile mass
Translucent/gray/fleshy
Starts at the limbus → empiète sur la cornée
NO basement membrane invasion → NO metastasis
Tx :
- Surgical excision
- Interferon
- MMC (topical mitomycin C)
- 5-FU eyedrops

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20
Q

Caractéristique et Tx Squamous Cell Carcinoma

A

THE MOST common conjunctival malignancy
CIN → invades basement membrane
Arise de novo, at the limbus or fornix
Examine for local lymph nodes (if suspicious → MRI)
Tx :
- Excision + margin cryotherapy +/- PO local chemo
- If scleral invasion on UDM → Brachytherapy

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21
Q

Quel est the most common benign conjunctival tumour?

A

Nevus

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22
Q

Quel est la caractéristique typique des Nevus conjonctivaux?

A

Clear cyst are characteristic

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23
Q

Caractéristiques d’un Nevus a/n conjonctive

A

The most common benign conjunctival tumour
Early adulthood
Bulbar conjunctiva, Plica or Caruncle, very rarely Palpebral
Color : melanotic to amelanotic
Clear cyst are characteristic
Tx : periodic observation with photographs, or excision

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24
Q

2 types de melanosis

A

Complexion (racial)
Primary Acquired Melanosis (PAM)

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25
Caractéristiques d'un complexion (racial) melanosis
Dark-skinned races Inter-palpebral on bulbar conductive and around limbus Malignant transformation is exceedingly RARE NO Tx is needed
26
Caractéristiques d'un Primary Acquired Melanosis (PAM)
Fair-skinned Involved any area of the conjunctiva PAM with severe atypia → significant nuclear change → 35% develop melanoma Tx : - Clinically mild : observation - Suspicious : Bx + cryothx - Extensive : topical anti-mitotic + cryothx + excise residue
27
Mélanome de la conjonctive (origine, localisation, caractéristiques à l'E/P, sites de métastases, Tx)
Arise de novo, from PAM or very rarely a nevus (<7%) Any area of the conjunctiva Fleshy elevated, with feeder vessels Early metastasis : lymph nodes, brain, other sites Tx : - Localized : excision + brachytherapy - Extensive : exenteration
28
Signe caractéristique d'un tumeur lymphoproliférative (ocular surface neoplasia)
Salmon patch (all grades)
29
Type de ¢ le plus souvent impliqué dans tumeur lymphoproliférative (ocular surface neoplasia)
Lymphoma is mostly non-Hodgkin's SMALL B-cell type
30
Caractéristiques de lymphome (ocular surface neoplasia)
Spectrum : low grade (ex. MALT) ad high grade (ex. Mantle cell) Clinically : Salmon patch (all grades) Lymphoma is mostly non-Hodgkin's SMALL B-cell type Treatment : - Localized : excision bx + systemic staging - Diffuse : incision bx + systemic stating
31
Ix pour le staging du lymphoma (ocular surface neoplasia) et CAT
Lymphoproliferative Systemic Staging - MRI of head and neck - Bx and pathological grading - Whole body CT scans - Referral to radiation/medical oncologist Tx : - Radiotherapy (20-40Gy) - Chemotherapy - Interferon - Rituximab (Anti-CD 20 antibodies)
32
Caractéristiques d'un lymphangiome
Vascular Tumor Multiple small cysts filled with clear fluid and/or blood Eyelid involvement is mostly associated with conjunctival lymphangioma Episodic swelling due to bouts of hemorrhage (crises d'hémorragie) and/or local infections Associated with buccal or labial lymphangioma NO involution with age CAT : - Poor response to steroids - Observation - CO2 laser-aided debulking - Complete excision in selected cases - For deeper, extensive lymphangiomas : intralesional sclerosing agents
33
2 type of Treatment for Conjunctival Tumors
SURGICAL excision TOPICAL treatment for Conjunctival
34
SURGICAL excision of Conjunctival Tumour
SURGICAL excision - Alcool (absolute 70%) corneal epitheliectomy - Total tumour excision from cornea and conjunctiva - Cryotherapy of the conjunctival margins
35
TOPICAL treatment of Conjunctival Tumour (Rx, indications et complications)
TOPICAL treatment for Conjunctival Tumors - Mitomycin-C (MMC) 0,02-0,004% - 5-Flourouracil 1% (5-FU) - Interferon alpha 2a Indications : - CIN; superficial SCC = Interferon - PAM = MMC - Intra-epithelial spread of Sebaceous Cell carcinoma Complications : - MMC = Severe epithelial toxicity - Lacrimal drainage scarring - Resistance/Recurrence
36
Clinical Manifestations of Orbital Tumors (Les Ps)
Proptosis : direction, constancy, positional change Pain : with inflammation, malignancy Progression Palpation : orbital rim, lacrima fossa Pulsations : vascular fistula, NF1, meningocele Peri-orbital changes : salmon patches, ecchymosis
37
Clinical classification of Orbital Tumours
Classification à partir du CT scan - CT scan = gold standard Lacrimal gland mass Circumscribed orbital mass Diffuse orbital mass Orbital cysts Optic nerve mass Paediatric orbital mass
38
Ddx d'une lacrimal gland mass
Lymphoproliferative/chronic inflammation Acute dacryoadenitis Pleomorphic adenoma (le plus fréquent) Adenoid cystic carnoma
39
Caractéristiques du lymphoproliferative/chronic inflammation (lacrimal gland mass)
+/- bilateral Painless Moulds to orbital structures
40
Caractéristiques de l'Acute dacryoadenitis (lacrimal gland mass)
Acute dacryoadenitis +/- bilateral Rapid course Painful Oblong swelling
41
Caractéristiques du Pleomorphic adenoma (lacrimal gland mass)
Pleomorphic adenoma = le plus fréquent - Unilateral - Slow growth - Spherical mass - Indents bone (ne cause pas d'érosion des os)
42
Caractéristiques de l'Adenoid cystic carnoma (lacrimal gland mass)
Unilateral Rapid growth Painful Irregular mass +/- bone erosion
43
Ddx circumscribed orbital mass
Cavernous hemangioma Haemangiopericytoma Neurofibrom Schwannoma/Neurilemmona Fibrous histiocytoma Rare : solitary fibrous tumor, thromboses varix, ectopic meningioma
44
Caractéristiques Cavernous hemangioma
Most commun Very slow growth Progression per-grossesse
45
Caractéristiques Haemangiopericytoma
Injection conjonctive Récurrence Malignancy
46
Caractéristiques Neurofibrom
Solitary Can be multiple or extensive in NF1
47
Caractéristiques du Schwannoma/Neurilemmona
Along a peripheral nerve Antoni A&B 1% malignant
48
Caractéristiques Fibrous histiocytoma
Superonasal quadrant Middle age Benign or malignant
49
Ddx diffuse orbital mass in Adult
Lymphoproliferative/leukemia Metastasis Idiopathic/Granulomatous inflammation Cellulitis/Subperiosteal abcess
50
Caractéristiques Lymphoproliferative/leukemia
+/- Bilateral Painless Slow
51
Caractéristiques Metastasis
+/- history of cancer Painless Rapid Unilateral
52
Caractéristiques Idiopathic/Granulomatous inflammation
Rapid Painful Recurrent Responsive to steroids
53
Caractéristiques Cellulitis/Subperiosteal abcess
Rapid Painful Fever Motility limitation Sinusitis
54
Ddx des Orbital cysts
Dermoid cyst/Teratoma Epithelial cyst Parasitic cyst Hemorrhagic cyst Sinus Mucocele Meningocele/Encephalocele Colobomatous cyst Cyst inside a solid tumour (Fluide = très bright à l'IRM)
55
Ddx des optic nerves tumours
Optic nerve sheath meningioma Optic nerve glioma Secondary (ex. RB) Les 2 premiers sont les plus fréquents
56
Caractéristiques du Optic nerve sheath meningioma
Middle aged female Minimal proptosis Gaze evoked amaurosis Central scotoma Disc swelling or atrophy Retino-choroidal shunts on the disc Tram track sign : calcification au CT
57
Qu'est que le Tram track sign et à quelle pathologie est-il associé?
Tram track sign : calcification in CT scan Optic nerve sheath meningioma (Tram track sign: parallel thickening and enhancement around the optic nerve)
58
Caractéristiques du Optic nerve glioma
Slow, progressive proptosis in the first 2 decades +/- Vision loss +/- Involuntary eye mvt Chronic dis swelling Retinal vascular turtuosity 50% have NF1 Tx : - Observation - Chemotherapy - Radiothx - Surgery (optic canal invasion)
59
Ddx Paediatric orbital Mass
Dermoid/Teratoma Capillary Haemangioma Rhabdomyosarcoma (le plus fréquent) Lymphangioma Orbital Cellulitis Optic nerve glioma Metastatic (Neuroblastoma, Ewing's, Wilms'...) Leukemic metastasis Fibrous dysplasia (Albright's syndrome) Histiocytosis (Rosai-Dorfman syndrome)
60
Présentation typique et Tx du Rhabdomyosarcome
Typical presentation - Rapid (orbital cellulitis-like) proptosis - First 2 decades of life Tx - Bx then - Radiothx + Chemothx (excellent response)
61
Clinical signs suspicious of malignant transformation of an iris nevus?
Documented rapid growth Increasing tumour vascularity Satellite lesions +/- pigment dispersion Secondary glaucoma
62
Incidence et Tx du Iris Melanoma
Incidence : 5% of all uveal melanoma Treatment modalities - Iridocyclectomy - Brachytherapy - Proton beam radiotherapy - Enucleation
63
Caractéristiques d'un Ciliary Body Melanoma (incidence, clinical clues)
10% of all uveal melanoma 85% asx → Delayed Dx (because of their hidden position) Clinical Clues : - Sentinel vessels - Iris bulge - Sector cataract - Pigmented nodule at iris root - Episceral pigmentation
64
Anterior Segment Ultrasonography (UBM versus B-scan)
Ultrasound Biomicroscopy (UBM) - Measures iris and ciliary body tumour < 4 mm - Ciliary body involvement in peripheral tumours - Circumferential extension - Internal echogenicity (cysts, necrosis...) B-scan - Anterior tumours > 4 mm thickness - Less accurate, less resolution
65
Incidence et risque de transformation maligne d'un choroidal nevus
Incidence : 5-10% of the population The risk of malignant transformation : 1: 8000 of typical naevi
66
Imaging of choroidal melanoma
A-scan : - Low internal reflectivity - Angle-kappa (Decrescendo pattern) B-scan : - Acoustic hollowness - Choroidal Excavation - +/- Orbital Shadowing Posterior Segment Ultrasonography : - Measures apical height - Tumour profile (dome, mushroom, flat...) - Presence of sub retinal fluid - Differentiates melanoma from other choroidal masses (in case of opaque media, non-pigmented tumour...) Fluorescein Angiography : - Dual-circulation sign - Subretinal haemorrhage - Hot Spots sign - Delineation fo tumour margins
67
Caractéristique Choroidal Melanoma (demographics and most common sites for metastasis)
Demographics : - Peaks 55-70 ans - No sex predilection - Fair-skinned individuals Most common sites for metastasis : - Liver > 90% - Lung - Subcutaneous, GIT, renal...
68
Clinical Risk Factors for Growth Intraocular Melanotic Lesions (To Find Small Ocular Melanoma Ultimately without Delay!)
To Find Small Ocular Melanoma Ultimately without Delay! Thickness > 2 mm Subretinal Fluid Symptoms Orange pigments Margin near optic disc Ultrasound hollowness Absence of drusens
69
Treatment of Uveal Melanoma
Radiation therapy - Brachytherapy - Teletherapy Thermotherapy/PDT Surgical Resection Enucleation No effective : Chemotherapy, Cryotherapy, Immunotherapy
70
Isotopes de la brachytherapy
Ruthenium 106 Iodine 125 Autres : Palladium 103 Iridium 192 Strontium 90 Gold 198 Cobalt 60
71
Complications/ES de la radiothérapie
Cataractes Glaucome néovx Radiation retinopathy Radiation papillopathy
72
Indications de la trans pupillary thermotherapy (TTT)
Mechanism is unknown Indications : Tumour edge recurrence post radiotherapy Adjuvant treatment with decentred plaques Sandwich Technique with Ruthenium plaques
73
Caractéristiques d'un Optic Disc Melanocytoma
Melanotic lesion Histology : - « Magnocellular Nevus » - Plump Polyhedral cells with numerous melanosomes Px : - Subtle growth in 10% of cases - Enlarged blind spot - Arcuate field defect - CRVO/CRAO - Melanoma transformation : 2% of cases
74
Caractéristiques d'un CHRPE (Congenital Hypertrophy of The Retinal Pigment Epithelium)
Melanotic lesion Anomalie congénitale qui arrive in early age Pigment souvent darker Unique ou multiple Lésion habituellement bien délimitée No risks Slow growth in 50% of cases Small scotoma Gardner syndrome : - AD adenomatous colonic polyposis - CHRPE-like lesions : lésions qui ressemblent plus à un poisson, bear tracks (lorsque mutiple lesions) - Extracolonic benign tumours (osteoma, fibroma...)
75
Caractéristiques Choroidal Metastases
Amelanotic Lesion 25% of cases with NO history of primary Most common site of origin : lung cancer, breast cancer, GU cancers Most common presentation : unilateral, unifocal and amelanotic lesion CAT : - Chemotherapy of the primary cancer - Low dose external radiotherapy - Plaque radiotherapy for a recurrent unifocal metastasis
76
Choroidal Metastasis versus Amelanotic Melanoma (surface, growth rate, echogenecity, profile, intrinsic vessels)
Choroidal METASTASIS - Surface : Leopard skin - Growth rate : Significantly faster - Echogenecity : Medium-high - Profile : Irregular, diffuse, dome - Intrinsic vessels : Absent (avasculaire) Amelanotic MELANOMA - Surface : +/- subtle intrinsic pigmentation - Growth rate : Relatively slower - Echogenecity : Medium-low - Profile : Dome, diffuse, collar-button - Intrinsic vessels : +/- Present
77
Caractéristiques intraocular lymphoma
Non-Hodgkin's LARGE B-cell lymphoma Corticosteroids-resistant vitritis +/- patchy retinal infiltration 80% of PIOL will develop PCNSL 20% of PCNSL will develop PIOL PIOL : Primary intraocular lymphoma PCNSL : Primary CNS lymphoma
78
Caractéristiques Uveal +/- Adnexal Lymphoma
May have intraocular and extra-ocular components Non-Hodgkin's SMALL B-cell lymphoma (Mostly MALT) Choroidal unifocal or multifocal infiltrates Ultrasound : uveal thickening +/- extra ocular thickening OCT : sea sick appearance Tx : ocular irradiation Px depends on lymphoma type : - MALT & Follicular lymphoma : ocular, good Px - Mantle cell & DLBC lymphoma : systemic, poor Px
79
Caractéristiques d'un Choroidal Granuloma
Irregular margins with clumps of cells Satellites +/- vitiritis +/- anterior uveitis Etiology : TB, sarcoïdose, idiopathique... Management : - Posterior uveitis work-up - If negative : Bx (pour démontrer que c'est idiopathique, et non pas une néo)
80
Caractéristique circumscribed choroidal haemangioma
DD from uveal melanoma - Orange color - US : solid, high internal reflectivity - FA : intense fluorescence (mid and late phases) CAT: - Observation (peripheral, dormant, no fluid) - PDT - Radiotherapy - External irradiation
81
Pathologie associée à un diffuse choroidal haemangioma
Sturge-Weber Syndrome Risks : glaucoma, neurological sx CAT of diffuse choroidal haemagioma - Low dose external irradiation (20-30 Gys) - Photodynamic therapy
82
Ddx lésion intraoculaire
Melanotic Lesions a. Iris Nevus b. Iris Melanoma c. Ciliary Body Melanoma d. Iris Epithelial Cyst e. Choroidal Nevus f. Choroidal Melanoma g. Other Melanotic Lesions : Optic Disc Melanocytoma, Congenital Hypertrophy of the Retinal Pigment Epithelium (CHRPE) Amelanotic Lesions a. Choroidal Metastases b. Amelanotic choroidal melanoma c. Intraocular lymphoma d. Choroidal granuloma Vascular Lesions a. Circumscribed Choroidal Haemangioma b. Diffuse Choroidal Haemangioma c. Retinal Capillary Haemangioblastoma Calcific Lesions a. Choroidal Osteoma b. Retinal Astrocytic Hamartoma 5. Retinoblastoma
83
Complication of retinal hemangioblastoma
Exudative retinal detachment (grand risque de décollement rétine 2nd vx) CAT: - Observation - Photocoagulation, PDT - Cryothx - Plaque Radiotherapy
84
Caractéristiques Choroidal Ostéome (typical patient, complications, CAT, Px)
Typical patient : - Young female - Unilateral - Asx or +/- metamorphopsia (si présent sur la macula) Complications : - SRNVM (subretinal neovascular membrane) - Central vision loss or field defects CAT of SRNVM in osteoma : - PDT - Anti-angiogenic injections - Laser photocoagulation less efficient (RPE atrophy) Px : gradual loss of vision from retinal atrophy or SRNVM
85
Caractéristiques Astrocytic Hamartoma
Cell of origin : undifferentiated neuroglial cells Morphologic Types : 1. Round semi translucent lesion 2. Calcified mulberry lesion 3. Mixed, translucent with calcific center
86
Pathologie associée à Astrocytic Hamartoma
Sclérose tubéreuse - Sporadic or AD chromosome 9q - 40% Astrocytic Hamartoma - Mental retardation, epilepsy, skin lesions
87
Incidence et 2 sx les plus fréquents du Retinoblastoma
Incidence of 1 : 12 000-18 000 live births Sx : - Leukocoria (55%) - Strabismus (25%) Obstetric Ultrasonography : large RB at 33 weeks of gestation
88
Mutation et chromosome impliqué dans le Retinoblastoma
Chromosome 13 Mutation of the 2 alleles (AD) of the tumour-suppressor gene RB1 - « Knudson two-hit hypothesis »
89
Acquisition du Retinoblastoma
SPORADIC (No family Hx) - Non-Heritable (60%) : two somatic mutations in a progenitor retina cell → lésion unilaterale, unifocale - Heritable (30%) : Germline mutation started in early embryogenesis of the proband → bilateral/multifocal FAMILIAL (10%) : germline mutation inherited an affected parent → bilateral/multifocal
90
Grouping and staging of Retinoblastoma
Group A : - Tumors < 3 mm - >1 Disc Diameter (DD) from optic disc - > 2 DD from fovea Group B : - Tumors < 3 mm - Any location - No vitreous seeds - Subretinal fluid (SRF) within 5 mm Group C : - Vitreous/SRF seeds within 3 mm from tumour - SRF within one quadrant Group D : - Diffuse large vitreous/subretinal seeds > 3 mm from tumor - SRF > one quadrant Group E : - Anterior segment - NVG - Massive Hg - Diffuse infiltrating Vitreous seeds : tumor cells floating within the vitreous cavity
91
Initial Assessment for Retinoblastoma
Fx Hx and Pedigree drawing IRM > CT tête et orbites Examination under anesthesia (EUA) with bilateral Retcam imaging B-scan and UBM Fluorescein angiography Blood sample for gene mutation testing Group E or orbital tumor : CSF cytology Treatment planning according to IIRC and TNM staging
92
Ddx d'une leukocoria
Cataract Uveitis/Toxocariasis PHPV (persistance système vasculaire hyaloïde) Astrocytoma (from endophytic RB) ROP Retinal dysplasia/coloboma Coat's disease Différencier exophytic RB from Coat's disease : - Yellowish fundus color - Unilateral - Male - Course of retinal vessels
93
Tx of Retinoblastoma
Systemic chemotherapy - Chemoreduction followed by focal therapy for bilateral RB (group B-D) - Vincristine + Etoposide + Carboplatin - Toxicity : ototoxicity, nephrotoxicity, myelodysplasia, acute myeloid leukemia (AML) Focal therapy - Focal laser : Group A-B, posterior location, minimal SRF - Cryothx : peripheral tumours = prior to chemo - Brachythx : post chemo, unifocal, medium External Beam Radiothx - Failed to Chemothx + Focal Thx in an eye with vision potentials - Risks : secondary cancer (38% at 50 ys), orbital bone deformities (avoid be4 age of 12 months) Enucleation Indications : - Any Group E tumor - Advanced Group D tumor (if other eye has vision potential) - Recurrent : if other Tx failed - Evidence of optic nerve, anterior segment or extraocular invasion Intra-Arterial Chemothx (IAC) - Femoral artery catheterization - Melphalan, Topotecan, Carboplain... - Variable control rates - Advantages : fewer systemic side effects than IV chemo - Disadvantages : specific serious complications (sectoral choroidal occlusive vasculopathy, retinal arteriolar embolization, cataractogenic radiation dose from fluoroscopy) Intravitreal chemothx - Intravitreal Melphalan - Best current Tx for VITREOUS SEEDS - Cryo at injection site be4 withdrawing - Toxicity : salt and pepper fundus, reduced ERG response

TORIC (17 decks)

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