Presentation on INTRA OCULAR TUMORS.pptx

This is a short presentation on intraocular tumors

1. INTRAOCULAR TUMORS

2. Introduction Intraocular tumors can affect both children and adults. Can be unilateral or bilateral. Most common primary malignant intraocular tumor in → adults : melanoma → children : retinoblastoma

3. CLASSIFICATION Reticulum cell sarcoma originates from the reticuloendothelial system.

4. RETINOBLASTOMA

5. Most common primary intraocular malignancy in childhood occurring in 1 in 14,000 to 1 in 20,000 live births.

6. Proliferation of neural cells which have failed to evolve normally. Previously called - glioma retinae

7. Tumor is confined to infants & very young children . Frequently congenital but can remain quiescent /pass unnoticed until 5th or 6th yr of life/even later. Retinoblastoma develops when both copies of retinoblastoma gene (RB1) becomes non functional either by deletion error or by mutation. RB gene(tumor suppressor gene) location→ long arm of Chromosome 13.

8. Pathology 2 Types Glioma exophytum Grows outwards towards subretinal space separating retina from choroid Appears as retinal detachment. Retinal vessels seen over it. 2. Glioma endophytum Grows inwards towards vitreous Polypoid masses sometimes with haemorrhages on the surface. Fluffy preretinal tumor with seeding into the vitreous. TYPES CHARACTER OPHTHALMOSCOPIC APPEARENCE

9. EXOPHYTIC RETINOBLASTOMA ENDOPHYTIC RETINOBLASTOMA

10. Histopathology Retinoblastoma cells → medium sized(twice the size of lymphocyte),high nucleocytoplasmic ratio, marked apoptotic & mitotic activity & stain blue in H & E stain. The tumor cells tend to grow around a feeder vessel as a cuff. Once they outgrow vascular supply→ undergo necrosis with calcification Necrotic cells→ appear pink Calcification→ hint of violet or blue hue.

11. Flexner Wintersteiner rosettes. Homer Wright rosettes.

12. The fleurette(arrow)

13. Presentations:- Leucocoria/ amaurotic cat’s eye Squint(convergent/divergent) Cataract Buphthalmos Pseudohypopyon Proptosis

14. Clinical course The child is usually brought with Amaurotic cat’s eye reflex

15. 2. Convergent or divergent squint 3. Cataract

16. 4. Buphthalmos 5. Psudohypopyon 6. Proptosis

17. STAGES The quiescent stage ,lasting 6 months to 1 year. The glaucomatous stage - enlargement of globe with apparent or real proptosis.Associated with severe pain that relieves once the tumor bursts out through sclera The stage of extraocular extension

18. The stage of metastasis:- 1st occurs in preauricular and neighbouring lymph nodes , later in cranial & other bones. Affects optic nerve by direct extension.

19. Investigations Diagnosis of RB is mainly clinical→ based on indirect ophthalmoscopy. Imaging done to confirm the diagnosis & to stage the disease. → A Scan ultrasound: detects high echoreflective spots of calcification. → B Scan ultrasound: measure size & extent of tumor. → MRI with contrast: recommended for staging of the disease,identifies tumor extension to optic nerve, orbit, or intracranial extension

20. CT scan is avoided due to inherent risk of radiation exposure that can increase risk of secondary cancers like osteosarcoma and pinealoblastoma.

21. Management CONSERVATIVE MANAGEMENT: Systemic chemoreduction Focal consolidation with laser photocoagualtion Cryotherapy/thermotherapy External beam radiotherapy Brachytherapy

22. SURGICAL TREATMENT Enucleation

23. CHOROIDAL MELANOMA The most common primary intraocular tumor of adults. Mean age 40 - 70 yrs Gross→ 2 forms Circumscribes/pedunculated Diffuse/flat type Histopathology:- spindle cell/epithelioid cell/mixed cell.

24. Investigations USG- Collar stud configuration FFA- Dual circulation OCT Indocyanine Green Angiography- Diffuse hyperfluorescence MRI- Hyperintense lesion(T1) - Hypointense lesion(T2) PETCT

25. Biopsy- Immunohistochemistry:- MELANOMA MARKERS S100, melan A, HMB45

26. Treatment Brachytherapy External beam radiotherapy Transpupillary Thermotherapy Trans scleral local resection Enucleation

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