Questions and Answers
What percentage of patients with metastatic cancer may present with ocular metastasis?
Which primary cancers are the most common causes of ocular metastasis?
What is the most common location for ocular metastasis?
Approximately what percentage of ocular metastases are located in the choroid?
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Which mechanism of metastasis involves the spread of cancer cells to adjacent tissues?
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What is the most common ocular site for metastatic tumors?
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What percentage of patients with ocular metastasis have no known history of primary cancer at the time of diagnosis?
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What feature is commonly associated with choroidal metastasis?
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Which symptom is NOT commonly associated with metastatic tumors?
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Which of the following primary cancers has the lowest incidence of causing ocular metastasis?
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Which type of metastatic tumor is often characterized by difficulty in visualization?
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What is the approximate percentage of ocular metastatic lesions located in the iris?
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What condition might iris and ciliary body metastases simulate?
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What is a potential consequence of choroidal metastasis?
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In what condition do optic disc metastases usually occur?
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What unusual feature can be seen in iris metastasis?
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Which diagnostic test is NOT mentioned for evaluating Primary Intraocular Lymphoma?
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What is the treatment strategy for the vitreoretinal form of Primary Intraocular Lymphoma?
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What signifies a poor prognosis for long-term survival in Primary Intraocular Lymphoma?
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Intraocular leukemia is primarily associated with which condition in children?
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Which characteristic of Primary Intraocular Lymphoma demonstrates variability in its outcome?
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What treatment is recommended for the uveal form of Primary Intraocular Lymphoma when systemic involvement is absent?
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Which of the following statements regarding the prognosis of Primary Intraocular Lymphoma and AIDS is accurate?
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Which ocular structure is NOT listed as potentially involved in Intraocular Leukemia?
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Which statement correctly describes the vascularization of metastatic tumors compared to melanomas?
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Which diagnostic test is least utilized for ocular purposes?
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What is the primary characteristic of the A-scan in ultrasonography of metastatic tumors?
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What does OCT reveal in cases of metastatic tumors?
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In the context of serous retinal detachment and choroidal melanoma, what is true about the mass size?
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Which treatment is typically considered for metastatic tumors when vision is not threatened?
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Which of the following is NOT a management option for metastatic tumors?
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What distinguishes ICG angiography in showing tumors?
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What is a common clinical feature of intraocular leukemia?
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Which of the following pathological findings is typical in intraocular leukemia?
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What role does fine needle aspiration biopsy play in the diagnosis of intraocular leukemia?
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What is the expected outcome if intraocular leukemia is untreated?
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Which of the following statements about ocular irradiation is true in the context of intraocular leukemia management?
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What diagnostic feature is commonly noted with fluorescein angiography (FA) and ultrasonography in cases of intraocular leukemia?
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Which ocular manifestation in intraocular leukemia indicates a poor prognosis?
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What is the primary function of systemic chemotherapy in the management of intraocular leukemia?
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Study Notes
Metastatic Tumors
- Up to 10% of metastatic cancer patients may develop ocular metastasis.
- Approximately 30% of patients present with ocular metastasis without a documented primary cancer history.
- Most common primary sources of ocular metastasis are breast (37%) and lung (26%) cancers.
- The posterior choroid is the most frequent site for ocular metastasis.
- Lesions can occur bilaterally and may be multifocal.
Mechanisms of Metastasis
- Seeding: Involves the spread of cancer cells to adjacent tissues.
- Blood circulation can distribute cancer cells to distant sites.
- Lymphatic drainage facilitates the spread of malignancies through the lymphatic system.
- The vascular supply, particularly in the choroid, is often affected by metastasis.
Intraocular Locations for Metastasis
- Approximately 88% of ocular metastases occur in the choroid.
- The iris is involved in about 9% of cases, while ciliary body involvement is around 2%.
- Retinal metastasis is very rare.
Symptoms
- Symptoms may be absent; many patients are asymptomatic.
- Potential symptoms include decreased or distorted vision, flashes of light, floaters, diplopia, photophobia, and pain.
Iris and Ciliary Body Metastases
- Less common than choroidal metastasis, characterized by a loosely-cohesive creamy or pink mass.
- May mimic conditions like iridocyclitis or endophthalmitis.
- Can cause secondary glaucoma and present with pseudohypopyon or hyphema.
Choroidal Metastasis
- Represent the most common site for eye metastasis, typically appearing as diffuse, plateau-shaped lesions.
- Characterized by creamy yellow masses; exceptions include melanoma and certain renal/thyroid cancers.
- Can lead to extensive retinal detachment and often grows rapidly.
Optic Disc Metastasis
- Usually an extension from underlying choroidal metastasis.
- May occur solely at the optic disc without choroidal involvement, presenting as a swollen disc.
Diagnostic Tests
- Fluorescein angiography and indocyanine green angiography.
- Ultrasonography and optical coherence tomography (OCT) used for evaluation.
- CT and MRI not commonly utilized for ocular diagnostics.
- Fine needle aspiration biopsy may assist in diagnosis.
Management of Metastatic Tumors
- Chemotherapy is utilized for systemic disease.
- Observation may be chosen if the vision is not compromised.
- Treatment options include external beam radiation, photodynamic therapy, and intravitreal anti-VEGF injections.
Primary Intraocular Lymphoma
- Diagnostic methods involve vitreal/retinal/uveal biopsy and CNS evaluation.
- Ocular irradiation for vitreoretinal forms; systemic chemotherapy for uveal forms with systemic involvement.
- Outcomes are highly variable, potentially leading to blindness or aggressive progression.
Intraocular Leukemia
- Commonly seen during relapse, often in children with leukemia.
- Involves various ocular structures including the iris, ciliary body, and retina.
- Characterized by solitary masses, spontaneous hyphema, and extensive retinal hemorrhage.
Diagnostic and Management Approaches for Intraocular Leukemia
- Diagnosis based on clinical presentation and history of leukemia, supported by fine needle aspiration biopsy.
- Treatment involves systemic chemotherapy and ocular irradiation; careful monitoring is crucial due to poor prognosis if untreated.
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Description
This quiz covers the key aspects of ocular metastasis, including its prevalence among patients with metastatic cancer and the most common primary cancers associated with this condition. It highlights the significance of the posterior choroid as a frequent site for ocular lesions and discusses the nature of these lesions in terms of their multifocality. Test your understanding of these critical concepts in metastatic tumors.
