eye tumor full
TRANSCRIPT
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Introduction
•Eye Tumors can :▫Be live threatening▫Reduce vision▫Cause cosmetic problems
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Eye Tumor Classification
•External : on palpebra, conjunctiva, cornea and lacrimal sac.
•Intraocular
•Orbital
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Benign External Eye Tumor
•Dermoid cyst and dermoid tumor•Xanthelasma•Millium•Papilloma•Nevus•Verruca vulgaris = Common wart•Molluscum contagiosum
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Malignant External Tumor
•Carsinoma in situ•Basal cell carcinoma •Squamous cell carcinoma •Aquired melanosis •Lacrimal sac tumor
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Intraocular Eye Tumor
•Malignant melanoma.
•Retinoblastoma.
•Uveal metastatic tumor.
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Orbital Tumor (1)
•Hemangioma•Neurogenic Tumor :Optical nerve
glioma•Meningioma •Neurofibroma •Rhabdomysarcoma
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Orbital Tumor (2)
•Lacrimal gland tumor : Benign mixed tumor
Adenoid cystic carcinoma•Metastatic tumor•Malignant lymphoma•Idiopathic orbital inflammatory desease•Dysthyroid ophthalmopathy
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Dermoid Cysts
•Congenital tumor•The tumor wall consists of dermis and
epidermis layer•Location : supero-temporal •Tumor palpation : firm, round, and
smooth, freely mobile under the skin.•T/ : In toto excision
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Dermoid Cysts
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Dermoid Tumor
•Congenital, located at the limbus•Consists of connective tissue with hair
follicles & sebaceus gland, walled by stra- tified squamous epithelium
•Signs : solid, smooth, round, protruded mass, whitish in colour
•T/ : excision
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Dermoid Tumor
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Nevus = Benign Melanoma(1)
•Consists of pigment stained cells•Observed in children, grows during
puberty with increase pigmentation•Nevus cells can be found in the :
▫Epidermis: Junctional nevus ▫Dermis: Compound nevus ▫Whole dermic layers : Intradermal nevus
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Nevus = Benign Melanoma(2)•Malignant degeneration can happen to
junctional & intradermal nevus•Signs : slightly elevated, pigment
stained, clearly defined lesion•T/ : Excision• Excision indications :
▫Cosmetic▫irritation ▫rapid tumor’s growth
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Nevus = Benign Melanoma
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Papilloma
•Location : margo palpebra and limbus•Signs : tumor mass is cauliflower-like
and pedunculated•Large tumor size can resembles
malignancy•Has regrowth tendency•Related to viral infection.•T/ : In toto excision.
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Verruca vulgaris•Not a true tumor
•Etiology : viral
•Shape : various
•T/ : excision
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Molluscum Contagiosum•Etiology : a pox viral
•Signs : small, pale, waxy, umbilicated nodule
•T/ : excision
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Intraepithelial epithelioma = Carsinoma in situ = Bowen Desease•Location :cornea, conjungtiva,
palpebral skin•Age 60, particularly men•Signs : Diffuse lesion, elevated, hyper-
keratotic nodule•T/ : In toto excision
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Carsinoma in situ
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Basal Cell Carsinoma
•Known as Basal cell epithelioma•90-95% of malignant eyelid tumors•Age 50-55 y, particularly men•Signs : ulcerative small node, with
elevated border•Rarely cause metastasis
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Therapy for Basal Cell Carsinoma:
•Wide excision with 2 mm safety margin, controlled by frozen section
•Radiotherapy
•Cryotherapy•Mohs’ Chemosurgery•Curetage and electrodessication
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Basal Cell Carsinoma
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Squamous Cell Carsinoma•2 - 9 % of eyelid malignancies•More aggressive tumor than BCC•Slow growth•Metastasis to regional lymph nodes•Sign : plaque-like, nodular, ulcerating
tumor•T/ : similar to basal cell carcinoma
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Squamous cell carcinoma
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Acquired Melanosis• Manifestation :
Precancerous or cancerous
• Precancerous : at age 40-60 y, becomes malignant after 5-10 y
• Signs : diffuse pigmentation
• Treatment : wide conjunctivectomy with adjuvant irradiation
• Cancerous : excenteration
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Lacrimal Sac Tumor
•Rarely found•45 % benign : papiloma•55% malignant : carcinoma•Sign : tumor mass +
epiphora •Treatment : total excision
and irradiation
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Intraocular Malignant Melanoma
•Iris Melanoma : 6-8%
•Uveal melanoma : 9%
•Choroidal Melanoma : 85%
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Iris Melanoma
• Sign : pigmented or nonpigmented nodule, >3mm in diameter and >1mm in thickness
• Angle involvement, if extensive, may give rise to secondary glaucoma
• T/ : Small tumors : iridectomy Diffusely growing tumor : enucleation
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Ciliary Body Melanoma•Often recognized clinically after it
pushes the iris anteriorly•Sign: depend on the size and location
of the tumor•Extraocular extension through the
scleral emissary vessels may produce a dark epibulbar mass
•T/ : iridosiclectomy or enucleation
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Choroidal Melanoma
• Signs : elevated, subretinal, oval-shaped mass
• Frequently brown, may be amelanotic
• Mushroom-shaped appearance as it breaks through the Bruch membrane
• T/ Small tumors : observation
• Very large tumors : enucleation
• Extensive extraocular extension : excenteration
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Metastatic tumor to Uvea•The most frequent primary-tumor site is :
▫The breast in women▫The bronchus in men
•Signs : fast growing, creamy-white, placoid or oval lesion most frequently at macula
•T/ : Radiotherapy, Systemic therapy Enucleation for a painful blind
eye
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Metastatic tumor to Uvea
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Retinoblastoma•The most common primary, malignant,
intraocular tumor of childhood•Occurring in about 1:20.000 live birth•No sexual predilection•The vast majority become clinically
apparent before the age of 3 years
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Genetic Aspects of Retinoblastoma•Non heritable account for 60% of cases•The tumors arises at the somatic level in a
single retinal cell•Heritable account for 40 % of cases.•The primitive retinal cells are predisposed
to malignant transformation•Only 6% have a positive family history
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Presentation of Retinoblastoma•Leukocoria (white pupillary reflex), in
about 60% cases.•Strabismus, in 20% of cases•Secondary glaucoma•Anterior segment invasion•Orbital inflamation•Proptosis•Metastasis•Routine exam to risk patients
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Retinoblastoma
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Signs of Retinoblastoma•Early intraretinal
tumor : a flat or round white lesion
•Endophytic tumor : white mass, secondary calcification
•Exophytic tumor : Multiglobulated white mass with retinal detachment.Vitreus hemorrhage
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Retinoblastoma Special Investigations
•Ultrasonography
•CT-Scan : to detect calsification
•MRI : to detect optic nerve infiltration
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Retinoblastoma Treatment
•Unilateral cases : enucleation, including about 10 mm of optic nerve
•Bilateral cases : enucleation of the worse eye, irradiation of the fellow eye
•Extraocular growth : excenteration•Metastasis : palliative radiotherapy or
chemotherapy
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Retinoblastoma Treatment
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Retinoblastoma Prognosis
•Optic nerve : * uninvolved : 8%
mortality rate * involved : 65 % mortality rate
•The tumor involves the lamina cribosa : 15% mortality rate
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Capillary Hemangioma•Appear at the first month after birth•Strawberry birthmark on palpebral skin•1st year enlargement followed by
regression•T/ :
▫Steroid, low dosage of irradiation▫Dysfunction or marked deformity
indication of excision
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Capillary Hemangioma
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Cavernous Hemangioma•Benign orbital tumor most frequently
found in adults•Signs : slow progressive exophthalmos;
can cause strabismus, diplopia, optic nerve compression
•Age : 20-40 year•D/ : USG and CT-Scan•T/ : Extirpation
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Rhabdomyosarcoma•The most common primary orbital
malignant tumor in children.•Presentation : rapidly progressive
proptosis on children 7 year of age •Sign : A palpable mass at nasal
superior orbit•Swelling and injection of overlying skin
but the skin is not hot•D/ : USG and CT, biopsy•T/ : Irradiation and chemotherapy
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Rhabdomyosarcoma
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Pleomorphic Lacrimal Gland Adenoma (Benign Mixed Tumor)• Lacrimal gld. most
common epithelial tumor • The fifth decade of life• Painless, slowly
progressive swelling in the upper outer quadrant
• D/ : X-ray, CT• T/ : In toto surgical
excision without prior biopsy
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Lacrimal gland carsinoma (Adenoid cystic carsinoma)
•A high morbidity and mortality rare tumor
•Presentation : 40-60years of life•Tends to spread perineurally with bone
destruction•T/: Excenteration and mid-facial
resection Radiotherapy + local resection
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Metastatic Tumor in Children
•The most common metastatic tumor in children is :
* Neuroblastoma * Ewing Sarcoma
* Leukemia•T/ : Palliative local irradiation
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Malignant Lymphoma
•Location : subconjunctiva and lacrimal gland•The tumor maybe primary or disseminated•Signs : exphthalmos and vision impairment•D/ : X- ray, USG, CT, Biopsy•T/ : Irradiation for localized lesions
Chemotherapy for disseminated disease
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Idiopathic Orbital Inflammatory Disease (Orbital Pseudotumor)•Non-neoplastic and non-infectious,
space-occupying orbital lesions•Abrupt painful onset in 20-50y of
age •Signs : periorbital swelling,
chemosis and conjunctival inflammation
•Proptosis, ophthalmoplegia, optic nerve dysfunction may be present
•T/: systemic steroids
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Dysthyroid Ophthalmopathy
• Female : Male = 8 : 1• Patients’ age : 20-45 years• Clinical features :
▫Darymple’s sign▫Von Graefe’s sign▫Exophthalmos▫Diplopia▫Periorbital and lid swelling ▫Conjuctival hyperaemia
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Dysthyroid Ophthalmopathy
•D/ : Blood T4,T3
•USG and CT
•T/ : High dose of steroid
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Disthyroid Ophthalmopathy
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Evisceration
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Excenteration
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