Podcast Beta
Questions and Answers
What thickness measurement is considered suspicious for malignant transformation in ocular conditions?
Which symptom is NOT associated with suspicious signs for melanoma?
The presence of which feature is more likely associated with melanoma rather than a nevus?
Which of the following factors is NOT typically considered when determining the treatment for choroidal melanoma?
Signup and view all the answers
What is the risk of malignant transformation within 5 years if one risk factor is present?
Signup and view all the answers
Which factor does NOT indicate a higher risk of malignant transformation?
Signup and view all the answers
Which management approach is specifically aimed at preserving vision in choroidal melanoma cases?
Signup and view all the answers
What is the significance of chromosome abnormalities in choroidal melanoma management?
Signup and view all the answers
If a patient exhibits all five risk factors for choroidal nevus transformation, what is the estimated risk of malignant transformation at 15 years?
Signup and view all the answers
Which ultrasonographic sign is most indicative of melanoma?
Signup and view all the answers
Which of the following is a common differential diagnosis for choroidal melanoma?
Signup and view all the answers
The two cell types that are most relevant in the prognostic factors for choroidal melanoma are:
Signup and view all the answers
Which of the following is not a suspicious sign for melanoma growth?
Signup and view all the answers
Which novel therapeutic approach is NOT commonly used in the management of choroidal melanoma?
Signup and view all the answers
What percentage of choroidal melanoma patients may experience metastasis within ten years?
Signup and view all the answers
Which of the following treatment options is most invasive for managing choroidal melanoma?
Signup and view all the answers
What is a primary characteristic of diffuse choroidal hemangioma associated with Sturge-Weber syndrome?
Signup and view all the answers
Which imaging technique is NOT mentioned as showing features of circumscribed and diffuse choroidal hemangioma?
Signup and view all the answers
Which of the following is a complication of choroidal hemangioma?
Signup and view all the answers
What does the late 'wash-out' phenomenon signify in ICG angiography for choroidal hemangioma?
Signup and view all the answers
Which of the following is NOT a feature observed in ultrasounds of choroidal hemangioma?
Signup and view all the answers
When is diffuse choroidal hemangioma generally diagnosed?
Signup and view all the answers
What characteristic shape is typically seen in choroidal hemangioma lesions?
Signup and view all the answers
What is typically observed in the early phase of fluorescein angiography for both forms of choroidal hemangioma?
Signup and view all the answers
What is the typical location of a choroidal hemangioma?
Signup and view all the answers
Which symptom is commonly associated with a choroidal hemangioma when it causes complications?
Signup and view all the answers
What characteristic distinguishes a circumscribed choroidal hemangioma?
Signup and view all the answers
At what stage of life is a circumscribed choroidal hemangioma usually diagnosed?
Signup and view all the answers
How is the risk of malignant transformation related to the number of risk factors?
Signup and view all the answers
Which feature is not characteristic of a choroidal hemangioma?
Signup and view all the answers
What describes the typical appearance of a choroidal hemangioma?
Signup and view all the answers
Which is not a typical symptom of choroidal hemangioma?
Signup and view all the answers
What treatment option is typically used for symptomatic choroidal hemangioma?
Signup and view all the answers
Which feature is NOT typical for choroidal osteoma?
Signup and view all the answers
What is a common complication associated with choroidal hemangioma?
Signup and view all the answers
Which diagnostic tool is used to assess choroidal osteoma?
Signup and view all the answers
Which demographic is most commonly affected by choroidal osteoma?
Signup and view all the answers
What is a characteristic of choroidal osteoma as it progresses?
Signup and view all the answers
Which therapy is least likely to be beneficial for asymptomatic choroidal hemangioma?
Signup and view all the answers
In terms of visual acuity, what percentage of choroidal hemangioma patients demonstrate a visual acuity of less than 20/40?
Signup and view all the answers
Study Notes
Choroidal Melanoma Management
- Objective: Eradicate cancer, save life, preserve eye and vision.
- Treatment determination factors: Tumor size, location, activity, potential for vision preservation, status of opposite eye, patient's age, general health, and presence of metastasis.
Conventional and Novel Treatment Approaches
- Conventional methods include observation, laser photocoagulation, transpupillary thermotherapy, various radiation therapies (plaque brachytherapy, external beam), and surgical options (local resection, enucleation, exenteration).
- Novel therapeutic methods focus on immunotherapy and gene therapy.
Prognostic Factors for Choroidal Melanoma
- Cell types include spindle A/B cells, intermediate cells, and epithelioid cells.
- Cytogenetic abnormalities often involve chromosomes 3, 6, 8, 9.
- Tumor size and growth pattern: ~1mm correlates with ~5% chance of metastasis.
- Proximity to the optic disc and extraocular extension are significant.
- Ten-year metastasis rate is ~34%, with a high overall mortality rate (30-50%) within a decade.
Differential Diagnoses
- Conditions to differentiate include choroidal nevus, melanocytoma, congenital hypertrophy of the RPE, choroidal hemangioma, choroidal metastasis, choroidal osteoma, and choroidal detachment.
Choroidal Nevus vs. Melanoma
- Suspicious indicators for malignant transformation include thickness >2mm, subretinal fluid, presence of symptoms, orange pigment, and margin <3mm from the optic disc.
- Ultrasonographic hollowness and absence of drusen are more characteristic of melanoma than nevus.
Malignant Transformation Risks from Choroidal Nevus
- 5-year malignant transformation rates based on risk factors:
- No risk factors: <3-5%
- One risk factor: 38%
- Two risk factors: 50%
- Three or more risk factors: up to 100%, depending on specific combinations.
Choroidal Hemangioma
- Described as an uncommon, benign vascular tumor, typically red-orange and disc-shaped.
- Commonly located in the posterior pole region and likely congenital, detected later in life.
- Symptoms can include blurry vision, metamorphopsia, and flashes of light.
Types of Choroidal Hemangioma
- Circumscribed form: Raised, dome-shaped, distinct margins, usually unilateral, diagnosed primarily in the 2nd to 4th decades.
- Diffuse form: Often linked to Sturge-Weber syndrome, characterized by more extensive retinal changes and generally identified earlier.
Imaging Techniques
- Fluorescein and indocyanine green angiography demonstrate similar features in both choroidal hemangioma forms.
- Ultrasonography shows high internal reflectivity and indicates solid tumor characteristics.
Complications of Choroidal Hemangioma
- May lead to fibrous metaplasia of the RPE, retinal changes, serous retinal detachment, and secondary glaucoma.
Management and Prognosis
- Observation recommended if asymptomatic; therapies include photodynamic treatment, laser photocoagulation, transpupillary thermotherapy, radiation therapy, and anti-VEGF injections.
- Generally poor prognosis due to potential complications, with over 50% of patients exhibiting visual acuity <20/40.
Choroidal Osteoma
- Classified as a benign ossifying tumor characterized by yellowish-white or orange lesions, often well-defined with scalloped edges.
- Predominantly unilateral, commonly affecting young women in their 20s and 30s, and is slowly progressive.
Diagnostic Imaging for Choroidal Osteoma
- Imaging modalities include ultrasonography, computed tomography, and fluorescein angiography, with CT showing hyperintense lesions similar to bone tissue.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz explores the management principles for choroidal melanoma, focusing on the factors that help determine the best treatment options. Key considerations include tumor characteristics, patient age, and the condition of the opposite eye. Understanding these factors is crucial for effective treatment and preserving vision.
