Orbital Tumors

Question 1

Bony orbit

2 bony orbits are quadrangular truncated pyramids located between the _______________ superiorly and the ______________ inferiorly (_______-shaped & ________ is the stalk 25)

Answer 1

anterior cranial fossa

maxillary sinuses

Pear; Optic N

Question 2

Bony orbit

2 medial walls are _______ to each other & are closely related to the ________ and ________ sinuses that separate the orbits from the nasal cavities

2 lateral walls are _______ to each other & each medial wall is _______ from the corresponding lateral wall.

Answer 2

parallel ; ethmoid; sphenoid

90°

45°

Question 3

Some causes of oculo-orbital tumours Ocular tumours
_____________
________________
__________ tumours

Orbital tumours
_______________
___________ tumours
____________
______________

Answer 3

Retinoblastoma; Choroidal melanoma

Metastatic; Rhabdomyosarcoma

Lacrimal gland

Optic nerve glioma
Optic nerve meningioma

Question 4

RETINOBLASTOMA

Average age at diagnosis in other clime ________ with bilateral cases seen earlier at _______ compare to ________ in unilateral patients.

90% cases are diagnosed within __________.

Answer 4

18 months

12 months

24 months

3 years

Question 5

Retinoblastoma

Clinical diagnosis in four stages:-
___________ stage
___________ ___________ stage
___________ ___________ stage
___________ ___________ stage.

Answer 5

quiet stage
secondary glaucoma stage
extraocular extension stage
systemic metastases stage.

Question 6

Differential diagnosis of retinoblastoma :-

__________ (metastatic endophthalmitis)
___________ of ___________
persistent hyperplastic vitreous
__________
retinal astrocytoma
_______’ disease
__________ of the disc
__________________
Norrie’s disease.

Answer 6

viterous abscess
retinopathy of prematurity

toxocariasis
Coats

coloboma
Congenital cataract

Question 7

‘Antioncogenes’ or ‘cancer suppressor’ 13q14.

Deletion of the ______ arm of chromosome 13 leads to retinoblastoma in about ____%

Answer 7

long

4

Question 8

Retinoblastoma

Modalities of treatment :- _________,__________,_____________ , exenteration, ___________,_________ , genetic counselling

Answer 8

enucleation, cryotheraphy, laser photocoagulation

radiotherapy, chemotheraphy

Question 9

Uveal melanoma
It relatively uncommon in the __________ race.
Incidence is 6 cases per million population in USA, Canada, Finland, Denmark, Norway, Alberta.

Answer 9

Negroid

Question 10

_________ is the Most common primary intraocular tumours in adults in the USA & Europe.

Answer 10

Uveal melanoma

Question 11

Uveal melanoma

Risk factors:
a) Race: 90% of all eye cancers in _________ are ocular melanomas. ________ have lower incidence than ________ (White: Black - ___:__)

b) Commonly seen in the _____ decade. It is very rare below ____ years with median age at diagnosis of ____ years.

c) slight (male or female?) preponderance

Answer 11

Whites

American Blacks ; white

8:1

6th; 20; 55; male

Question 12

Uveal melanoma

Symptoms include _______ vision, ______ defects, ________, photopsia & _______.

Answer 12

blurred ; field

floaters

Pain

Question 13

Uveal Melanoma

Clinical picture: A)_____________ in colour, _________ (25%), small posterior uveal - slightly raised, ______ or ______ shape (most challenging diagnostic group).

B) Larger tumour (solid mass:– ______ or _______ -shaped (ruptured __________) / Flat, diffuse (rare variant) –____ melanoma (worse prognosis).______ tumours (poorer prognosis)

C) Advanced stages : extraocular extension, optic nerve invasion, glaucoma, uveitis, phthisis bulbi, orbital invasion & metastasis.

Answer 13

Light to medium grey

amelanocytic; round or oval

dome or mushroom

Bruch’s membrane; ring; Ciliary

Question 14

Uveal melanoma

Diagnosis: _______ , ______________ Angiography, ________ , _______________ test, transillumination.

Answer 14

Clinical

Fundus Fluourescein

Ultrasound; 32P radiouptake

Question 15

Modes of spread of uveal melanoma

________ vein
_______________ canals
_________ infiltration
________ and ________ invasion
Melanocytic _______

Answer 15

Vortex; Scleral emissary

Vitreous

Optic nerve & orbital

glaucoma

Question 16

Treatment modalities of uveal melanoma

___________
______________
_______________
Local __________
___________
Exentenration
Chemotherapy/immunotherapy

Answer 16

Photocoagulation

Brachytherapy; EBR

resection; Enucleation

Question 17

Sites of metastasis of uveal melanoma
_______ 56%
_______________ 24%
_________ 7%
___________ 7%
________ 2%

Median survival: ________

Answer 17

Liver

Subcutaneous nodules

Pulmonary; Vertebral; CNS

18 months

Question 18

Metastatic tumors

Important group of oculo-orbital space occupying lesions due to spread from other parts of the body settling more commonly to the _________ 8-9 times than to the _______.

Answer 18

uveal tract; orbit

Question 19

Metastatic Tumors
30-61% of patients with orbital metastasis develop __________ prior to the diagnosis of the ______________.

Such __________ malignancies of embryonal origins like neuroblastoma, sarcoma, Ewing’s bone tumour, nephroblastoma can metastastise to the orbit

Answer 19

eye symptoms

primary tumours

childhood

Question 20

Metastatic Tumors

Orbital metastatic tumours in adult are carcinomas of _______ origin from the _______ (50%), ________ (17%), _______, gastrointestinal tract, kidney, thyroid & urinary bladder in order of importance.

Non-epithelial tumours like neuroblastoma, sarcoma, choroidal melanoma of the contralateral eye and melanoma of the skin and conjunctiva have been implicated.

Answer 20

epithelial; breast; prostate

lung

Question 21

Rhabdomyosarcoma (Embryonal sarcoma)

It is a ______ growing tumour presenting as (slowly or rapidly?) progressive _____lateral _________ seen usually in the _____ decade of life with median age of _____ years.

It originates from ___________________________ with the potential to develop into ____________ . They do not arise from ______________ as the term ‘Rhabdomyosarcoma’ connotes.

Answer 21

fast ; rapidly ; unilateral

proptosis ;first ; 7 years.

undifferentiated mesenchymal cell crests

striated muscles ; striated muscles

Question 22

______________ is the Most common primary orbital malignancies of childhood.

Answer 22

Rhabdomyosarcoma (Embryonal sarcoma)

Question 23

Rhabdomyosarcoma

Tumour is located in the _________,__________ followed by the _________ and __________ aspects of the orbit.

A _______________________ and _______ is seen in one third of the cases sometimes with injections of the overlying skin.

Answer 23

superonasal, retrobulbar

superior and inferior

palpable anterior orbital mass and ptosis

Question 24

Rhabdomyosarcoma

____________ and ____________ are the mainstay of treatment using vincristine, actinomycin & cyclophosphamide. ________ is reserved for rare recurrent or radio-resistant tumours.
Orbital tumours have ____% cure rate.

Answer 24

Radiotherapy and chemotherapy

Surgery

95

Question 25

Lacrimal gland Tumors ____crine glands located in the ____________ aspect of the _______ portion of the orbit in a concavity called _____________. It is divided into two parts: big _____ and small _______ portions. Few accessory glands of ________ and __________ are located in the conjunctiva.

Answer 25

Exo; superotemporal anterior; lacrimal fossa orbital; palpebral Krause and Wolfring

Question 26

Lacrimal Gland Tumors CLASSIFICATIONS:- __________ tumours __________ __________ tumours __________ __________ Other types of carcinoma

Answer 26

Benign mixed tumours Malignant mixed tumours Adenocystic carcinoma Other types of carcinoma

Question 27

Pleomorphic adenoma (Benign mixed tumour) Commonest lacrimal gland tumour with (painful or painless?) mass in the __________ portion of the orbit in a middle aged patient. Globe is displaced _______ward and ______. It should be excised with ______________ .

Answer 27

Painless; superotemporal down; medially intact capsule

Question 28

FNAB is contraindicated in _____________ lacrimal gland tumor

Answer 28

Benign Mixed

Question 29

Benign mixed tumor incomplete removal leads to _________ and rarely, _______________.

Answer 29

recurrence malignant transformation

Question 30

Malignant epithelial lacrimal gland tumours. Adenoid cystic carcinoma (common & infiltrative) Pleomorphic adenocarcinoma Mucoepithelial carcinoma Median age for malignant mixed tumours:____ years Adnexial cystic carcinoma median age :____ years Presentation is usually _________ displaced proptosis, some extraocular movement restriction, ptosis, hyperaemia and ______. Malignant reactive lymphoid hyperplasia (lymphoma) of the lacrimal glands can occur in adults.

Answer 30

50; 38 infero-medially pain

Question 31

Optic nerve Glioma (Common or Rare?), (slow or fast?)-growing pilocytic astrocytoma that typically affects ________ mostly in the ______ decade of life with median age ___ years. It causes ______ proptosis with fusiform enlargement of the ________ and the corresponding _________ on CT scan and plain x-ray (_______view).

Answer 31

Rare; slow ; children First; 6.5 axial; optic nerve ; optic canal Water’s

Question 32

Optic nerve Glioma Approximately, 30% of the patient have neurofibromatosis with _______ prognosis. If it occurs in adult, it is usually _______ and ______. Some tumours have indolent course while others have intracranial extension.

Answer 32

better malignant and fatal.

Question 33

Optic nerve sheath meningioma Eye is an extension of the brain with the optic nerve having it’s own _________ and covered by ______,___________, and _______ Meningothelial cells of the archnoid villi can encircle the nerve or grows along the fibrovascular pial septae.

Answer 33

subarachoid space dura, arachnoid and pia matter.

Question 34

Optic nerve sheath meningioma Commonly affects (men or women?) with the classical symptoms’ triad: A) ____________. B) ______________. C) ___________ _________ vessels(30%). As well as _____ proptosis after visual loss. Prognosis is _____ in adults but may be _____________ in children.

Answer 34

Women A) loss of vision. B) optic atrophy. C) opticociliary shunt vessels axial; good poorer and fatal