Podcast
Questions and Answers
What thickness measurement is considered suspicious for malignant transformation in ocular conditions?
What thickness measurement is considered suspicious for malignant transformation in ocular conditions?
- Less than 1 mm
- Exactly 2 mm
- Between 3 mm and 4 mm
- Greater than 2 mm (correct)
Which symptom is NOT associated with suspicious signs for melanoma?
Which symptom is NOT associated with suspicious signs for melanoma?
- Subretinal fluid
- Loss of visual acuity of 20/50 or worse
- Presence of orange pigment
- Feeding difficulties (correct)
The presence of which feature is more likely associated with melanoma rather than a nevus?
The presence of which feature is more likely associated with melanoma rather than a nevus?
- Hollowness on B scan (correct)
- Halo presence
- Thickness less than 2 mm
- Drusen
Which of the following factors is NOT typically considered when determining the treatment for choroidal melanoma?
Which of the following factors is NOT typically considered when determining the treatment for choroidal melanoma?
What is the risk of malignant transformation within 5 years if one risk factor is present?
What is the risk of malignant transformation within 5 years if one risk factor is present?
Which factor does NOT indicate a higher risk of malignant transformation?
Which factor does NOT indicate a higher risk of malignant transformation?
Which management approach is specifically aimed at preserving vision in choroidal melanoma cases?
Which management approach is specifically aimed at preserving vision in choroidal melanoma cases?
What is the significance of chromosome abnormalities in choroidal melanoma management?
What is the significance of chromosome abnormalities in choroidal melanoma management?
If a patient exhibits all five risk factors for choroidal nevus transformation, what is the estimated risk of malignant transformation at 15 years?
If a patient exhibits all five risk factors for choroidal nevus transformation, what is the estimated risk of malignant transformation at 15 years?
Which ultrasonographic sign is most indicative of melanoma?
Which ultrasonographic sign is most indicative of melanoma?
Which of the following is a common differential diagnosis for choroidal melanoma?
Which of the following is a common differential diagnosis for choroidal melanoma?
The two cell types that are most relevant in the prognostic factors for choroidal melanoma are:
The two cell types that are most relevant in the prognostic factors for choroidal melanoma are:
Which of the following is not a suspicious sign for melanoma growth?
Which of the following is not a suspicious sign for melanoma growth?
Which novel therapeutic approach is NOT commonly used in the management of choroidal melanoma?
Which novel therapeutic approach is NOT commonly used in the management of choroidal melanoma?
What percentage of choroidal melanoma patients may experience metastasis within ten years?
What percentage of choroidal melanoma patients may experience metastasis within ten years?
Which of the following treatment options is most invasive for managing choroidal melanoma?
Which of the following treatment options is most invasive for managing choroidal melanoma?
What is a primary characteristic of diffuse choroidal hemangioma associated with Sturge-Weber syndrome?
What is a primary characteristic of diffuse choroidal hemangioma associated with Sturge-Weber syndrome?
Which imaging technique is NOT mentioned as showing features of circumscribed and diffuse choroidal hemangioma?
Which imaging technique is NOT mentioned as showing features of circumscribed and diffuse choroidal hemangioma?
Which of the following is a complication of choroidal hemangioma?
Which of the following is a complication of choroidal hemangioma?
What does the late 'wash-out' phenomenon signify in ICG angiography for choroidal hemangioma?
What does the late 'wash-out' phenomenon signify in ICG angiography for choroidal hemangioma?
Which of the following is NOT a feature observed in ultrasounds of choroidal hemangioma?
Which of the following is NOT a feature observed in ultrasounds of choroidal hemangioma?
When is diffuse choroidal hemangioma generally diagnosed?
When is diffuse choroidal hemangioma generally diagnosed?
What characteristic shape is typically seen in choroidal hemangioma lesions?
What characteristic shape is typically seen in choroidal hemangioma lesions?
What is typically observed in the early phase of fluorescein angiography for both forms of choroidal hemangioma?
What is typically observed in the early phase of fluorescein angiography for both forms of choroidal hemangioma?
What is the typical location of a choroidal hemangioma?
What is the typical location of a choroidal hemangioma?
Which symptom is commonly associated with a choroidal hemangioma when it causes complications?
Which symptom is commonly associated with a choroidal hemangioma when it causes complications?
What characteristic distinguishes a circumscribed choroidal hemangioma?
What characteristic distinguishes a circumscribed choroidal hemangioma?
At what stage of life is a circumscribed choroidal hemangioma usually diagnosed?
At what stage of life is a circumscribed choroidal hemangioma usually diagnosed?
How is the risk of malignant transformation related to the number of risk factors?
How is the risk of malignant transformation related to the number of risk factors?
Which feature is not characteristic of a choroidal hemangioma?
Which feature is not characteristic of a choroidal hemangioma?
What describes the typical appearance of a choroidal hemangioma?
What describes the typical appearance of a choroidal hemangioma?
Which is not a typical symptom of choroidal hemangioma?
Which is not a typical symptom of choroidal hemangioma?
What treatment option is typically used for symptomatic choroidal hemangioma?
What treatment option is typically used for symptomatic choroidal hemangioma?
Which feature is NOT typical for choroidal osteoma?
Which feature is NOT typical for choroidal osteoma?
What is a common complication associated with choroidal hemangioma?
What is a common complication associated with choroidal hemangioma?
Which diagnostic tool is used to assess choroidal osteoma?
Which diagnostic tool is used to assess choroidal osteoma?
Which demographic is most commonly affected by choroidal osteoma?
Which demographic is most commonly affected by choroidal osteoma?
What is a characteristic of choroidal osteoma as it progresses?
What is a characteristic of choroidal osteoma as it progresses?
Which therapy is least likely to be beneficial for asymptomatic choroidal hemangioma?
Which therapy is least likely to be beneficial for asymptomatic choroidal hemangioma?
In terms of visual acuity, what percentage of choroidal hemangioma patients demonstrate a visual acuity of less than 20/40?
In terms of visual acuity, what percentage of choroidal hemangioma patients demonstrate a visual acuity of less than 20/40?
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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.
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