eye tumor full
TRANSCRIPT
Introduction
•Eye Tumors can :▫Be live threatening▫Reduce vision▫Cause cosmetic problems
Eye Tumor Classification
•External : on palpebra, conjunctiva, cornea and lacrimal sac.
•Intraocular
•Orbital
Benign External Eye Tumor
•Dermoid cyst and dermoid tumor•Xanthelasma•Millium•Papilloma•Nevus•Verruca vulgaris = Common wart•Molluscum contagiosum
Malignant External Tumor
•Carsinoma in situ•Basal cell carcinoma •Squamous cell carcinoma •Aquired melanosis •Lacrimal sac tumor
Intraocular Eye Tumor
•Malignant melanoma.
•Retinoblastoma.
•Uveal metastatic tumor.
Orbital Tumor (1)
•Hemangioma•Neurogenic Tumor :Optical nerve
glioma•Meningioma •Neurofibroma •Rhabdomysarcoma
Orbital Tumor (2)
•Lacrimal gland tumor : Benign mixed tumor
Adenoid cystic carcinoma•Metastatic tumor•Malignant lymphoma•Idiopathic orbital inflammatory desease•Dysthyroid ophthalmopathy
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
Dermoid Cysts
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
Dermoid Tumor
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
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
Nevus = Benign Melanoma
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.
Verruca vulgaris•Not a true tumor
•Etiology : viral
•Shape : various
•T/ : excision
Molluscum Contagiosum•Etiology : a pox viral
•Signs : small, pale, waxy, umbilicated nodule
•T/ : excision
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
Carsinoma in situ
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
Therapy for Basal Cell Carsinoma:
•Wide excision with 2 mm safety margin, controlled by frozen section
•Radiotherapy
•Cryotherapy•Mohs’ Chemosurgery•Curetage and electrodessication
Basal Cell Carsinoma
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
Squamous cell carcinoma
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
Lacrimal Sac Tumor
•Rarely found•45 % benign : papiloma•55% malignant : carcinoma•Sign : tumor mass +
epiphora •Treatment : total excision
and irradiation
Intraocular Malignant Melanoma
•Iris Melanoma : 6-8%
•Uveal melanoma : 9%
•Choroidal Melanoma : 85%
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
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
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
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
Metastatic tumor to Uvea
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
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
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
Retinoblastoma
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
Retinoblastoma Special Investigations
•Ultrasonography
•CT-Scan : to detect calsification
•MRI : to detect optic nerve infiltration
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
Retinoblastoma Treatment
Retinoblastoma Prognosis
•Optic nerve : * uninvolved : 8%
mortality rate * involved : 65 % mortality rate
•The tumor involves the lamina cribosa : 15% mortality rate
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
Capillary Hemangioma
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
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
Rhabdomyosarcoma
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
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
Metastatic Tumor in Children
•The most common metastatic tumor in children is :
* Neuroblastoma * Ewing Sarcoma
* Leukemia•T/ : Palliative local irradiation
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
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
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
Dysthyroid Ophthalmopathy
•D/ : Blood T4,T3
•USG and CT
•T/ : High dose of steroid
Disthyroid Ophthalmopathy
Evisceration
Excenteration