mata & ocular adnexa ( bahan kuliah kedokteran

BAGIAN PATOLOGI ANATOMIBAGIAN PATOLOGI ANATOMIFAKULTAS KEDOKTERANFAKULTAS KEDOKTERAN

USU – MEDANUSU – MEDAN20072007

NORMAL ANATOMYNORMAL ANATOMY

PalpebraePalpebraeConjunctivaConjunctivaCorneaCorneaLensLensUvea tractUvea tractRetinaRetinaVitreous humorVitreous humorNerveNerveGlandGlandMuscleMuscleBlood vesselsBlood vessels

NORMAL ANATOMYNORMAL ANATOMY

A - A - Vitreous humorVitreous humor

B - B - LensLens

C - C - CorneaCornea

D - D - PupilPupil

E - E - IrisIris

F - F - ScleraSclera

G - G - Optic NerveOptic Nerve

H - H - RetinaRetina

CHOROIDCHOROID

CHOROID = MIDDLE CHOROID = MIDDLE LAYER EYE LAYER EYE

CONTAINS :CONTAINS :• BLOOD VESSELS &BLOOD VESSELS &• CONNECTIVE TISSUE CONNECTIVE TISSUE

• SUPPLIES NUTRIENTS SUPPLIES NUTRIENTS TO INNER PORTION OF TO INNER PORTION OF EYEEYE

CILIARY BODY CILIARY BODY CILIARY BODYCILIARY BODY = ring of = ring of

tissue tissue encircles the lens. encircles the lens.

Contains : Contains : • smooth muscle fibers smooth muscle fibers

(ciliary muscles)(ciliary muscles)

• control the shape of the control the shape of the lens. lens.

Posterior surface lens Posterior surface lens (CILIARY PROCESSES)(CILIARY PROCESSES)

Contain : capillaries Contain : capillaries

• Secrete fluid (vitreous Secrete fluid (vitreous humor) humor) into the anterior into the anterior segment of the eyeball. segment of the eyeball.

LACRIMAL SYSTEMLACRIMAL SYSTEM

LARGELY : SEROUS TYPE

MINOR MUCINOUS

DISORDER OF EYEDISORDER OF EYE

MICRO ORGANISMS *MICRO ORGANISMS * ANTIGEN *ANTIGEN * TOXIC CHEMICAL *TOXIC CHEMICAL * SOLAR RADIATION *SOLAR RADIATION * SYSTEMIC DISEASE *SYSTEMIC DISEASE *

* * BLINDNESS BLINDNESS

CONGENITAL ANOMALICONGENITAL ANOMALI

RARELY : RARELY : - ANOPTHTHALMOS- ANOPTHTHALMOS

- EYE’S (-)- EYE’S (-)- MICROPHTHALMOS- MICROPHTHALMOS

- MEDIAN EYE- MEDIAN EYE- HYPOPLASIA EYE’S- HYPOPLASIA EYE’S- COLOBOMA- COLOBOMA- CONGENITAL CATARACTS- CONGENITAL CATARACTS

- COLOR BLIND- COLOR BLIND

COLOBOMACOLOBOMA ((Defect in iris)Defect in iris)

Appear : black notch Appear : black notch pupil : irregular (shape) pupil : irregular (shape) May be associated with :May be associated with :

• Hereditary conditionsHereditary conditions• Trauma to the eye, or Trauma to the eye, or • Eye surgeryEye surgery

CONGENITAL CATARACTSCONGENITAL CATARACTS The number of people born with cataracts is low. The number of people born with cataracts is low.

Possible causes :Possible causes :• GalactosemiaGalactosemia • Chondrodysplasia syndrome Chondrodysplasia syndrome • Congenital Congenital rubellarubella syndrome syndrome • Down syndromeDown syndrome (trisomy 21) (trisomy 21) • Pierre-Robin syndrome Pierre-Robin syndrome • Familial congenital cataracts Familial congenital cataracts • Hallerman-Streiff syndrome Hallerman-Streiff syndrome • Lowe syndrome Lowe syndrome • TrisomyTrisomy 13 13 • Conradi syndrome Conradi syndrome • EctodermalEctodermal dysplasiadysplasia syndrome syndrome • Marinesco-Sjogren syndrome Marinesco-Sjogren syndrome

CONGENITAL CATARACTS CONGENITAL CATARACTS

PIGMENTATIONPIGMENTATION

EXOGENEXOGEN ENDOGENENDOGEN

ALBUMIN ALBUMIN MELANOSIS MELANOSIS

MELANINMELANIN

HEMOSIDERINE HEMOSIDERINE

I.O.HI.O.H

IRONIRONCOPPER COPPER SILVERSILVER

PIGMENTATIONPIGMENTATION

KAYSER - FLEISCHER RINGKAYSER - FLEISCHER RING WILSON’S DISEASE (HEPATOLENTIWILSON’S DISEASE (HEPATOLENTI CULAR DEGENERATION)CULAR DEGENERATION)

DEPIGMENTATIONDEPIGMENTATION

VITILIGOVITILIGO

PHYSICAL & CHEMICAL INJURIESPHYSICAL & CHEMICAL INJURIES

TRAUMA : ECCHYMOSISTRAUMA : ECCHYMOSIS SUP.FICIAL :SUP.FICIAL :

• CONTACT LENSCONTACT LENS• FOREIGN BODIESFOREIGN BODIES• ULTRA VIOLETULTRA VIOLET

CAUSTIC CHEMICALCAUSTIC CHEMICAL BLUNT TRAUMA BLUNT TRAUMA FRACTURE OF BONE FRACTURE OF BONE

SKIN APPENDAGES OF EYELIDSSKIN APPENDAGES OF EYELIDS

1.1. SEBACEOUS GLANDS SEBACEOUS GLANDS (ZEIS & MEIBOMIAN)(ZEIS & MEIBOMIAN)

2.2. APOCRINE GLANDS APOCRINE GLANDS (MOLL)(MOLL)

3.3. ECCRINE SWEAT GLANDSECCRINE SWEAT GLANDS

MOLUSCUM CONTANGIOSUMMOLUSCUM CONTANGIOSUM

VIRAL INFECT VIRAL INFECT WART LIKE WART LIKE CENTRAL UMBILICAL CENTRAL UMBILICAL KERATIN KERATIN

CYSTIC LESSIONCYSTIC LESSION SUDORIFERASUDORIFERA SEBACEASEBACEA MEIBOMIANMEIBOMIAN DERMOIDDERMOID

HORDEOLUMHORDEOLUM( = STYE )( = STYE )

ZEIS GLAND (SEBACEOUS GLANDS)ZEIS GLAND (SEBACEOUS GLANDS) EXTERNAL HORDEOLUMEXTERNAL HORDEOLUM

MEIBOMIAN GLANDS MEIBOMIAN GLANDS INTERNAL INTERNAL HORDEOLUMHORDEOLUM

FOLICLE FOLICLE INFECTION STAPHYLLOCOCUS INFECTION STAPHYLLOCOCUS

CELLULITISCELLULITIS

HORDEOLUMHORDEOLUM

EXTERNAL

INTERNAL

CHALAZIONCHALAZION(MEIBOMIAN GLAND LIPOGRANULOMA)(MEIBOMIAN GLAND LIPOGRANULOMA)

A PAINLESS GRANULOMA A PAINLESS GRANULOMA OF THE MEIBOMIAN OF THE MEIBOMIAN GLANDS GLANDS

MEIBOMIAN GLAND MEIBOMIAN GLAND OCCLUTIONOCCLUTION

CHRONIC CHRONIC GRANULATIONGRANULATION

MICROSCOPIC MICROSCOPIC

MULTIPLE FOCI OF GRANULOMATOUS INFLAMMATIONMULTIPLE FOCI OF GRANULOMATOUS INFLAMMATION

XANTHELASMA XANTHELASMA SHARPLY DEMARCATED YELLOWISH SHARPLY DEMARCATED YELLOWISH

(COLLECTION CHOLESTEROL) -(COLLECTION CHOLESTEROL) -UNDERNEATH SKINUNDERNEATH SKIN

USUALLY : ON / AROUND EYELIDSUSUALLY : ON / AROUND EYELIDS

ASSOCIATIONS :ASSOCIATIONS :• CHOLESTEROL CHOLESTEROL ↑↑ (FAMILIAL HYPERCHOL) (FAMILIAL HYPERCHOL) • PRIMARY BILIARY CIRRHOSIS PRIMARY BILIARY CIRRHOSIS • MENOPAUSE MENOPAUSE • DIABETES DIABETES

EXOPTHALMUSEXOPTHALMUS( = PROPTOSIS )( = PROPTOSIS )

PROTUSION (EYEBALL)PROTUSION (EYEBALL)

BILATERALBILATERAL

THYROID DISEASETHYROID DISEASE

EARLY ADULT LIFE (WOMEN), 4/1EARLY ADULT LIFE (WOMEN), 4/1

+ EDEMA (EYELID, CHEMOSIS)+ EDEMA (EYELID, CHEMOSIS)

EXOPTHALMUSEXOPTHALMUS( = PROPTOSIS )( = PROPTOSIS )

PATHOLOGY:PATHOLOGY:• ORBITAL WATER >>ORBITAL WATER >>• EXT.OCULAR MUSCLE >>EXT.OCULAR MUSCLE >>

( + LYMPHOCYTES & MN )( + LYMPHOCYTES & MN )

CLINIC : CLINIC : • EXPOSURE CONJ’TIVA EXPOSURE CONJ’TIVA BLIDING, BLIDING,

ULCERATION, OPTIC NERVE ULCERATION, OPTIC NERVE COMPRESSIONCOMPRESSION

CONJUNCTIVA DISORDERCONJUNCTIVA DISORDER

HYPEREMIAHYPEREMIA HEMORRHAGEHEMORRHAGE INFLAMATIONINFLAMATION THRACHOMATHRACHOMA CHLAMYDIAL INFECTIONCHLAMYDIAL INFECTION OPHTHALMIA NEONATORUMOPHTHALMIA NEONATORUM DRY-EYE SYNDROMEDRY-EYE SYNDROME PINGUECULA & PTERYGIUMPINGUECULA & PTERYGIUM

HYPEREMIA - CONJUCTIVAHYPEREMIA - CONJUCTIVA

DILATASI BLOOD VESELDILATASI BLOOD VESEL CONJUNCTIVITISCONJUNCTIVITIS CORNEA DISEASECORNEA DISEASE IRIDOCYCLITISIRIDOCYCLITIS CORNEA DEFECTCORNEA DEFECT GLAUCOMAGLAUCOMA IRITISIRITIS

HEMORRHAGE CONJUNCTIVAHEMORRHAGE CONJUNCTIVA

TRAUMATRAUMA ANOXIAANOXIA SEVERE COUCHING SEVERE COUCHING SPONTANEUS SPONTANEUS

SUBCONJUNCTIVAL HEMORRHAGE SUBCONJUNCTIVAL HEMORRHAGE

Causes :Causes :

• Minor eye trauma Minor eye trauma • Spontaneously (venous Spontaneously (venous

press press ↑)↑) • Streneuous Exercising Streneuous Exercising • Coughing Coughing • Touching/widening eyes Touching/widening eyes • Sneezing Sneezing • Vomiting (bulimia nervosa) Vomiting (bulimia nervosa) • Severe alcohol intoxication, Severe alcohol intoxication,

blood press blood press ↑↑ • Severe hypertension Severe hypertension

CONJUNCTIVITISCONJUNCTIVITIS

MICRO-ORG MICRO-ORG CONJUNCTIVITIS CONJUNCTIVITIS

KERATITISKERATITIS

CORNEAL ULCERCORNEAL ULCER

HEMATOGEN HEMATOGEN

IATROGENIC INFECTIONIATROGENIC INFECTION

SURGICAL : SURGICAL : CATARACTCATARACT CORNEAL GRAFTCORNEAL GRAFT PROSTHETIC LENSPROSTHETIC LENS

CONJUNCTIVITISCONJUNCTIVITIS

EXUDATE/DISCHARGE :EXUDATE/DISCHARGE :

- PURULENT - PURULENT CLOSE CLOSE

- FIBRINOUS- FIBRINOUS

- SEROUS- SEROUS

- HEMORRHAGIC- HEMORRHAGIC

CONJUNCTIVITISCONJUNCTIVITIS

TRACHOMATRACHOMA INF.CHRONIC (CLAMYDIA TRACHOMATIS)INF.CHRONIC (CLAMYDIA TRACHOMATIS) = SWIMMING POOL CONJUNCTIVITIS= SWIMMING POOL CONJUNCTIVITIS

OCULAR, GENITAL, SYST’MICOCULAR, GENITAL, SYST’MIC BLIND BLIND

CHILD CHILD REMISION (SP) REMISION (SP)

ADULT ADULT PROGRESSIVE PROGRESSIVE

BILATERAL, SUP > INF BILATERAL, SUP > INF

NEW BORN :NEW BORN : PURULENT CONJUNC. PURULENT CONJUNC. (BLENORRHOE)(BLENORRHOE)

ADULT :ADULT :• CHRONIC FOLLICLE CONJ. CHRONIC FOLLICLE CONJ. • LYMPHOCYTE (+)LYMPHOCYTE (+)• HYPERPLASIA HYPERPLASIA GERM. CENTRE NECROTIC GERM. CENTRE NECROTIC • TRACHOMATOUS PANNUSTRACHOMATOUS PANNUS

(EPIT – BOWMANN ZONE)(EPIT – BOWMANN ZONE)• FIBROSIS (CONJ. & EYELIDS) FIBROSIS (CONJ. & EYELIDS)

DISTORS EYELIDSDISTORS EYELIDS PATHOLOGY : PATHOLOGY :

• LOWER TARSAL CONJUNTIVALOWER TARSAL CONJUNTIVA• SCAR & NECROTIC (-)SCAR & NECROTIC (-)• KERATITIS (-)KERATITIS (-)

TRACHOMATRACHOMA(CHLAMYDIAL CONJUNCTIVITIS)(CHLAMYDIAL CONJUNCTIVITIS)

OPHTHALMIA NEONATORUMOPHTHALMIA NEONATORUM

ACUTE ACUTE SEVERE CONJUNCTIVITIS SEVERE CONJUNCTIVITIS COPIUS PURULENT DISCHARGECOPIUS PURULENT DISCHARGE GO GO GO-NEONATORUM GO-NEONATORUM ULC.CORNEA, PERFORATION ULC.CORNEA, PERFORATION

SCAR & PANOPH’ITIS SCAR & PANOPH’ITIS BLIND BLIND PREVENT PREVENT SILVER NITRAT (PNC) SILVER NITRAT (PNC)

OPTHALMIA NEONATORIUMOPTHALMIA NEONATORIUM

Microbial Agent : Neisseria gonorrhoeae Mode of Transmission: From mother to

newborn Classic Feature: purulent destructive

eye disease

DRY EYE SYNDROMEDRY EYE SYNDROME Common condition Common condition

Tear production << (ocular & systemic disease)Tear production << (ocular & systemic disease)

Older Older ♀♀ , menopause , menopause

Assc.: Assc.: “SJOGREN DISEASE”“SJOGREN DISEASE” (keratoconjunctivitis (keratoconjunctivitis sicca) sicca)

middle aged middle aged ♀♀ (atrophy of lacrimal glands) (atrophy of lacrimal glands)

Common causes :Common causes :• AgingAging• Dry environment or workplace (wind, air Dry environment or workplace (wind, air

conditioning) conditioning) • Sun exposure Sun exposure • Smoking / smoke exposure Smoking / smoke exposure • Cold / allergy medicines Cold / allergy medicines • Sjogren's syndrome Sjogren's syndrome includes dry eyes, mouth & mucus includes dry eyes, mouth & mucus

membranesmembranes often RA / other joint disorderoften RA / other joint disorder

The result of :The result of :• Sensitivity of the cornea Sensitivity of the cornea ↓↓• Evaporation of tears Evaporation of tears ↑↑• Disorder in the glands Disorder in the glands

PINGUECULAPINGUECULA

LUMP LUMP YELLOWISH YELLOWISH NASAL TO THE CORNEOSCLERALNASAL TO THE CORNEOSCLERAL SUN DAMAGED SUN DAMAGED INJURY INJURY DOES NOT GROW ONTO CORNEA DEPOSIT OF PROTEIN & FAT PARTICULARLY OLDER PEOPLE

PINGUECULAPINGUECULA

PTERYGIUM FOLD OF VASCULARIZED – RECURS AFTER EXISION FOLD OF VASCULARIZED – RECURS AFTER EXISION

(PINGUECULA)(PINGUECULA)

GROWS : TRIANGULAR SHAPE OVER THE CORNEA (THE TRANSPARENT PART OR FRONT WINDOW OF THE EYEBALL).

MAY GROW LARGE ENOUGH TO INTERFERE WITH VISION

COMMONLY : INNER CORNER OF THE EYE (APEX – PUPIL)

PTERYGIUM

CLOUDY CORNEA CLOUDY CORNEA CORNEA : TRANSPARENT CORNEA : TRANSPARENT

STRUCTURE STRUCTURE

LESS TRANSPARENT & LESS TRANSPARENT & CLOUDY :CLOUDY :• METABOLIC DISEASESMETABOLIC DISEASES• TRAUMATRAUMA• INFECTIOUS DISEASESINFECTIOUS DISEASES• NUTRITIONAL NUTRITIONAL

DEFICIENCIES &DEFICIENCIES &• ENVIRONMENTAL ENVIRONMENTAL

IT CAN LEAD TO VARIOUS IT CAN LEAD TO VARIOUS DEGREES OF VISION LOSS. DEGREES OF VISION LOSS.

CORNEACORNEA

HERPES SIMPLEXHERPES SIMPLEX ONCHOCERCIASISONCHOCERCIASIS ARCUS SENILISARCUS SENILIS BAND KERATOPATHYBAND KERATOPATHY CORNEAL DYSTROPHIESCORNEAL DYSTROPHIES

HERPES KERATITISHERPES KERATITIS

HYPEREMIAHYPEREMIA(TRAUMA)(TRAUMA)

EYE LENS ANATOMY EYE LENS ANATOMY

THE LENS OF THE EYE IS NORMALLY CLEAR.

LENSLENS

CATARACTCATARACT PRESBYOPIAPRESBYOPIA PHACO ANAPHYLACTIC PHACO ANAPHYLACTIC

ENDOPHTHALMITISENDOPHTHALMITIS

CATARACTCATARACT

THE LENS OF THE EYE IS NORMALLY CLEAR. IF THE LENS BECOMES CLOUDY OR IS OPACIFIED IT IS CALLED A CATARACT

NORMAL, NEAR & FARSIGHTEDNESS

UVEAUVEA

SYMPATHETIC OPHTHALMITISSYMPATHETIC OPHTHALMITIS SARCOIDOSISSARCOIDOSIS

RETINARETINA

HEMORRHAGEHEMORRHAGE OCCLUSIVE VASC.DISEASEOCCLUSIVE VASC.DISEASE

- CENTRAL R. ART.OCCLUSION- CENTRAL R. ART.OCCLUSION

- CENTRAL R. VEIN OCCLUSION- CENTRAL R. VEIN OCCLUSION HYPERTENSIVE RETINOPATHYHYPERTENSIVE RETINOPATHY DIABETIC RETINOPATHYDIABETIC RETINOPATHY RETINAL DETACHMENT RETINAL DETACHMENT

RETINARETINA

RETINITIS PIGMENTOSARETINITIS PIGMENTOSA MACULAR DEGENERATIONMACULAR DEGENERATION CHERRY-RED SPOT AT THE MACULACHERRY-RED SPOT AT THE MACULA ANGIOID STREAKSANGIOID STREAKS RETINOPATHY OF PREMATURITYRETINOPATHY OF PREMATURITY

OPTIC NERVEOPTIC NERVE

OPTIC NERVE HEAD EDEMAOPTIC NERVE HEAD EDEMA OPTIC ATROPHYOPTIC ATROPHY

EFFECTS OF INCREASE EFFECTS OF INCREASE INTRAOCULAR PRESSUREINTRAOCULAR PRESSURE

GLAUCOMAGLAUCOMA CORNEA/SCLERA CORNEA/SCLERA

BULGESBULGES OPTIC ATROPHYOPTIC ATROPHY

GLAUCOMA GLAUCOMA

Increased pressure Increased pressure causes compression of :causes compression of :

Retina and Retina and Optic nerve Optic nerve Nerve Nerve

damage. damage.

Glaucoma can cause :Glaucoma can cause :• Partial vision loss, Partial vision loss, • Blindness as a possible Blindness as a possible

eventual outcome. eventual outcome.

GLAUCOMA IS A CONDITION OF INCREASED FLUID GLAUCOMA IS A CONDITION OF INCREASED FLUID PRESSURE INSIDE THE EYE.PRESSURE INSIDE THE EYE.

GLAUCOMAGLAUCOMA

CONGENITAL GLAUCOMACONGENITAL GLAUCOMA INFANTILE GLAUCOMA, INFANTILE GLAUCOMA,

BUPHTHALMOSBUPHTHALMOS PRIMARY OPEN-ANGLE GLAUCOMAPRIMARY OPEN-ANGLE GLAUCOMA PRIMARY CLOSED-ANGLE GLAUCOMAPRIMARY CLOSED-ANGLE GLAUCOMA SECONDARY GLAUCOMASECONDARY GLAUCOMA LOW-TENSION GLAUCOMALOW-TENSION GLAUCOMA

GLAUCOMAGLAUCOMA

NEOPLASMANEOPLASMA

XANTHELASMAXANTHELASMA NEUROFIBROMANEUROFIBROMA PAPILLOMAPAPILLOMA LIPOMALIPOMA HEMANGIOMAHEMANGIOMA LIMPHANGIOMALIMPHANGIOMA NEVUSNEVUS

BENIGNBENIGN MALIGNANTMALIGNANT

BOWEN DISEASEBOWEN DISEASE SQ.CELL.CASQ.CELL.CA BASAL CELL CABASAL CELL CA MALIG. MELANOMAMALIG. MELANOMA AD. CARCINOMAAD. CARCINOMA SARCOMASARCOMA LYMPHOMALYMPHOMA

XANTHELASMAXANTHELASMA

HYPERCHOLESTEROLEMIA HYPERCHOLESTEROLEMIA DM DM REPRODUCTION WOMANREPRODUCTION WOMAN LOC : LOC : CANTUS INTERNAL CANTUS INTERNAL PAL PAL

PEBRAE XANTHELASMAPEBRAE XANTHELASMA FOAMY CELLS FOAMY CELLS MICRO INTRA CYTOMICRO INTRA CYTO

PLASMA VACUOLE.PLASMA VACUOLE.

NEUROFIBROMANEUROFIBROMA

SINGLE OR MULTIPLE SINGLE OR MULTIPLE NEUROFIBRONEUROFIBRO

MATOSIS (VON RECKING HAUSEN.D)MATOSIS (VON RECKING HAUSEN.D) LOC. LOC. PALPEBRAEPALPEBRAE OTHER SITE (+)OTHER SITE (+)

PAPILLOMAPAPILLOMA STOLK (+) STOLK (+) SQ.EPITH.CELL SQ.EPITH.CELL PROLIFERATION PROLIFERATION

LYMPHANGIOMALYMPHANGIOMA

LESS COMMONLESS COMMON LYMPH VESSELLYMPH VESSEL PROLIFERATION PROLIFERATION LUMPLUMP

NEVUSNEVUS

EPITHELIAL CELLSEPITHELIAL CELLS NEVI CELLSNEVI CELLS TYPETYPE : - INTRA DERMAL: - INTRA DERMAL

- JUNCTIONAL- JUNCTIONAL

- COMPOUND- COMPOUND

BOWEN DIASEASEBOWEN DIASEASE

INTRA EPITHELIAL NEOPLASMINTRA EPITHELIAL NEOPLASM CA INSITUCA INSITU ATIPICAL CELLSATIPICAL CELLS PLEOMORFISMPLEOMORFISM UNCOMMONUNCOMMON

SQUAMOUS CELL CASQUAMOUS CELL CA

EPITHELIAL CELLSEPITHELIAL CELLS FORM : - NON KERATINIZINGFORM : - NON KERATINIZING

- KERATINIZING- KERATINIZING PLEOMORFISM CELLSPLEOMORFISM CELLS HYPERCHROMATIC NUCLEUSHYPERCHROMATIC NUCLEUS KERATIN (+/-) KERATIN (+/-)

BASAL CELL CABASAL CELL CA

BASAL CELLSBASAL CELLS MONOTONMONOTON NUCLEUS NUCLEUS BASOPHYLIC BASOPHYLIC STRANDSTRAND PALISADE (+)PALISADE (+)

MALIGNANT MELANOMAMALIGNANT MELANOMA

UVEAL MELANOMAUVEAL MELANOMA MELANOCYTE OR NEVI CELLSMELANOCYTE OR NEVI CELLS CHOROID (COMMON SITE)CHOROID (COMMON SITE) TYPE : MELANOCYTE/AMELANOCYTETYPE : MELANOCYTE/AMELANOCYTE MACRMACR : - CIRCUMSCRIBED: - CIRCUMSCRIBED

- INV.BRUCH’S MEMBRANE- INV.BRUCH’S MEMBRANE MICRMICR: - SPINDLE CELLS : - SPINDLE CELLS

- POLYGONAL CELLS- POLYGONAL CELLS

- EPITHELOID CELLS- EPITHELOID CELLS

ADENO CARCINOMAADENO CARCINOMA

GLAND PATERNGLAND PATERN UNCOMMONUNCOMMON DIFFERENTIATED :DIFFERENTIATED :

- WELL- WELL

- MODERATE- MODERATE

- POORLY- POORLY

SARCOMASARCOMA

CONNECTIVE TISSUECONNECTIVE TISSUE RHABDO/LEIOMYO SARHABDO/LEIOMYO SA FIBRO SAFIBRO SA LIPO SALIPO SA

LYMPHOMALYMPHOMA

LYMPHOID TISSUELYMPHOID TISSUE ROUND CELLSROUND CELLS MONOTONEMONOTONE TYPETYPE : - IMMATURE CELLS: - IMMATURE CELLS

- MATURE CELLS - MATURE CELLS

RETINOBLASTOMARETINOBLASTOMA

IMMATURE CELLSIMMATURE CELLS CHILD ( >> )CHILD ( >> ) FIRST 2 YRS OF LIFE FIRST 2 YRS OF LIFE BIRTH ( +/- )BIRTH ( +/- )

RETINOBLASTOMARETINOBLASTOMA

PATHPATH : - INTERNAL : - INTERNAL VITR.BODY VITR.BODY - EXTERNAL- EXTERNAL

CREAM COLOREDCREAM COLORED CALCIFIED CALCIFIED YELLOW YELLOW MICRMICR : - SMALL CELLS: - SMALL CELLS

- ROUND CELLS- ROUND CELLS - ROSET (+)- ROSET (+) - NECROSIS- NECROSIS - HEMORRHAGIC - HEMORRHAGIC

RETINOBLASTOMARETINOBLASTOMA

EARLY DIAG EARLY DIAG OPERATIVE OPERATIVE SURVIVAL ( 90 % )SURVIVAL ( 90 % ) UNTREATED UNTREATED FATAL FATAL INCIDENT 1/20000 (BIRTH)INCIDENT 1/20000 (BIRTH) FAMILIAL ( 5 – 10 % )FAMILIAL ( 5 – 10 % ) CHROMOSOME 13 (-) CHROMOSOME 13 (-) Q 14 BAND Q 14 BAND

RETINOBLASTOMARETINOBLASTOMA

CLINICCLINIC : : WHITE PUPILS ( LEUCORIA)WHITE PUPILS ( LEUCORIA) POOR VISIONPOOR VISION HYPEMIAHYPEMIA STARBISMUSSTARBISMUS REDRED PAINFUL EYEPAINFUL EYE

INTRAOCULAR PHOTOGRAPH OF AN INTRAOCULAR PHOTOGRAPH OF AN ISOLATED ISOLATED

"ENDOPHYTIC" RETINOBLASTOMA"ENDOPHYTIC" RETINOBLASTOMA

GLIOMA NERVE OPTICUSGLIOMA NERVE OPTICUS

UNCOMMONUNCOMMON CHILD AND ADULTCHILD AND ADULT NEUROFIBROMATOSIS NEUROFIBROMATOSIS GLIOMA GLIOMA VISION VISION << (PROGRESIVA) << (PROGRESIVA) PROPTOSISPROPTOSIS PAPIL EDEMA PAPIL EDEMA MICRMICR : - ASTROSITOMA LIKE CELLS: - ASTROSITOMA LIKE CELLS

- WELL DIFFERENTIATED- WELL DIFFERENTIATED SURGICAL AND RADIOTH/ SURGICAL AND RADIOTH/ OK OK 5 YSR 5 YSR 90 % 90 %

METASTATIC NEOPLASMMETASTATIC NEOPLASM

MORE COMMON X PRIMERMORE COMMON X PRIMER PRIMER LESSION :PRIMER LESSION :

- LEUKEMIA- LEUKEMIA

- BREAST CA- BREAST CA

- LUNG CA- LUNG CA DIAG : DIAG : AFTER DEATH AFTER DEATH