TUMORS OF THE EYE

Teguh Anamani

TUMORS OF THE EYE

• TUMORS OF THE EYELIDS• CONJUNCTIVAL TUMORS• INTRAOCULAR TUMORS• ORBITAL TUMORS

TUMORS OF THE EYELIDS

BENIGN LID TUMORS NEVUS PAPILLOMAS MOLLUSCUM CONTAGIOSUM XANTHELASMA KERATOACHANTOMA CYSTS HEMANGIOMA

NEVUS

• Congenital• Rarely become

malignant• Tx: surg excision

(cosmetic)

PAPILLOMAS

most common2 TYPE :• Squamous cell

papilloma (papiloma skuamosa)

• Seborheic keratoses (papiloma sel basal, veruka senilis) middle-aged and older

MOLLUSCUM CONTAGIOSUM

• Poxvirus • TYPICAL LESION : a small, flat, symmetric,

centrally umbilicated. Lid margin lesionhidden in the cilia konjungtivitis, keratitisMultiple : HIV

• Tx: cautery, excision, curettement

XANTHELASMA• Common, bilaterally near

the inner angle of the eye• Yellow plaques• Collections of lipid

containing histiocytes in the dermis of the lid

• Hiperlipidemia 2/3 N serum lipids

• Tx: cosmetic surg excision, cauterized,laser surgery

KERATOACANTHOMA

• Sun-exposed of adult• Immunodeficiency,xeroderma

pigmentosum, Muir-Torre syndr>• Elevated lesion, central crater containing

keratin,enlarged rapidly• Spontaneous involition• Th/ excisional biopsycosmetic/possibility

squamous cell ca

CYSTS

• Obstruction of pilosebaceous (milia and pilar cysts) or congenital and traumatic subepithelial implantation of surface epithelium (epidermal inclusion cysts)

• Dermoid cysts (hair follicles and sebaceous glands) congenital. Most near orbital rim superotemporally

• Hydrocystoma (sudoriferous cysts, ductal cysts) eccrin/apocrine sweat duct.

HEMANGIOMA• CAPILLARY HEMANGIOMA (strawberry nevus)– Most common congenital vascular tumor of

the eyelid– composed proliferating capillaries and

endhothelial cells– grow rapidly at or shortly after birth

(90% < 6 months), regress spontaneously over 6-7 yr,

CAPILLARY HEMANGIOMA (strawberry nevus)……

Superficial : bright red, Deeper : bluish/violetTreated block the visual axis or induces

astigmatismSecondary anisometropia, refractive amblyopia,

strabismus Tx: no treatment, corticosteroid or interferon

alfa inj, partial surgical excision

Nevus flammeus (“port wine stain”)

• Sturge-weber syndr• More purple• Composed of dilated, cavernous vascular

chanel• At birth, no grow or regress• Cosmetic th/ laser surgery

• CAVERNOUS HEMANGIOMA. Composed of large endothelium-lined vascular channels with smooth muscles in their wall Developmental , >> after first decade. Grow slowly. Women > Men. Loc : muscle cone proptosis, hyperopia. Regress spontaneously (-)

PRIMARY MALIGNANT TUMORS OF THE LIDS

CARCINOMA. Basal Cell Ca. Squamous Cell Ca

The most common malignant ocular tumorsFair complexioned individuals+sun

exposureSebaceous gland ca MALIGNANT MELANOMA

BASAL CELL CARCINOMA

• Grow slowly• Painless• Nodule or ulcer• Local invasive• Metastase (-)• 95% of lid cancer• Tx: surg excision,

radiotherapy or cryotherapy

SQUAMOUS CELL CARCINOMA

• Grow slowly• Painless• Hyperkeratotic

noduleulcerated• Local invasive• Metastase (+)• Tx: surg excision,

radiotherapy,chemotherapy

SEBACEOUS GLAND CARCINOMA

• Meibomian and zeis• 50% chalazia and cronic blepharitis• Aggressive than squamous cell ca• Extending orbit, invading lymphatics and

metastase

MALIGNANT MELANOMA

• Similar to those elsewhere in the skin

• Not all malignant melanomas are pigmented

Prognosis depth of invasion / thickness

• Tx: surg excision

CONJUNCTIVAL TUMORSPRIMARY BENIGN TUMORS OF THE CONJUNCTIVA NEVUS DERMOID TUMOR DERMOLIPOMA ANGIOMAPRIMARY MALIGNANT TUMORS OF THE BULBAR CONJUNCTIVA CARCINOMA CONJUNCTIVAL DYSPLASIA MALIGNANT MELANOMA

NEVUS• 1/3 of cases –

lack of pigment• 1/2 of cases – cystic

epithelial inclusion• Rarely become malignant• > 3rd decade – high risk to

malignant

DERMOID TUMOR• CongenitalA smooth,

rounded, yellow elevated mass, hair protruding

• Loc : inferotemporal• Tx: surg

excisioncosmetic, vision

DERMOLIPOMA

• A smoothly rounded• Loc : temporal

quadrant of the bulbar conjunctiva

• Tx: surg excision

ANGIOMA

• Isolated, circumscribed capillary hemangioma

• Pyogenic granuloma : variety palp conj over chalazia

CARCINOMA

• Loc: >> limbus, palpebral fissura

• A gelatinous surface• Leukoplakic• Slow• Invasion (-) • Metastase (-)• Tx: surg excision,

cryotherapy

CONJUNCTIVAL DYSPLASIA

• Benign • Intermediate between

conj dysplasia andmalignant ca in situ

Th/excisional biopsy

MALIGNANT MELANOMA

• Rare• Arise from a

preexisting nevus• Tx: excision,

cryotherapy,exenteration

INTRAOCULAR TUMORS

RETINOBLASTOMA• 2/3 of cases appear < 3rd year• 30% bilateral – inherited• Chromosome band 13q14• Grow endophytic or exophytic, optic nerve• Sign : leucocoria, strabismus, inflammation• Metastase (+)• Tx: enucleation, exenteration,radiotherapy,

chemotherapy

RETINOBLASTOMA

ORBITAL TUMORSPRIMARY ORBITAL TUMORS• CAPILLARY HEMANGIOMA• CAVERNOUS HEMANGIOMA• LYMPHANGIOMA• RHABDOMYOSARCOMA• NEUROFIBROMA• OPTIC NERVE GLIOMA• LACRIMAL GLAND TUMORS• LYMPHOMA

METASTATIC TUMORS

RHABDOMYOSARCOMA• Most common primary

malignant tumor orbit childhood

• Presentation < 10 yr• Rapid growth• Destroy adjacent bone

and spread into the brain

• Tx: chemotherapy, radiotherapy, exenteration

NEUROFIBROMA

• Inherited autosomal dominant• Chr 17• Iris Lisch nodules + cutaneous café au lait

spot• Optic nerve glioma, meningioma

METASTATIC TUMORS

• Hematogenous (+), limphagenous (-)• Men : lung cancer• Women : breast cancer• Childhood : neurobblastoma• Choroid > orbit• Th/ radiation, chemo,excised

SECONDARY TUMORS

• NASOPHARYNGEAL CA (> MAXILLARY SINUS), MENINGIOMA