EYE TUMORS

Eyelid Tumors

There are several different types of eyelid tumors. Nevus and papilloma are the most common. Malignant eyelid tumors include basal cell carcinoma, sebaceous carcinoma, squamous cell carcinoma, and melanoma.

Nevus
Benign pigmented or nonpigmented lesion on the eyelid or eyelid margin with rare tendency for malignant transformation.

Papilloma
Benign, slowly evolving tumor of the eyelid mostly found in the elderly.

Chalazion

Benign, inflammatory tumor of the sebaceous gland.

Basal Cell Carcinoma
Malignant tumor arising from the epidermis that can appear as a nodular, nodulo-ulcerative, or sclerosing lesion.  Complete resection is important.

Sebaceous Carcinoma
Malignant tumor arising from the sebaceous glands that can invade the surface of the eye and grow into the orbit.  This tumor tends to arise in elderly women most often and has a greasy yellow color and loss of eyelashes.  Complete resection is important. 

Squamous Cell Carcinoma
Malignant tumor of the epidermis in patients with heavy sun exposure.  This can be treated surgically or with topical creams.

Conjunctiva Tumors

 

Pingueculum
Benign degenerative tissue on the eye in the sun exposed regions that can look like an ocular surface tumor.

Pterygium
Benign tumor on the eye in which the conjunctival tissue overgrows onto the cornea.  This can simulated squamous cell carcinoma.

Cyst
Benign fluid-filled lesion.

Nevus
Benign pigmented or nonpigmented mass on the eye surface.  This is the most common tumor of the conjunctiva.  Detection occurs in children and young adults.

Primary acquired melanosis
Prelmalignant pigmented condition causing brown discoloration of the ocular surface.  This condition carries relatively high rate for transformation into melanoma.

Melanoma
Malignant tumor of the conjunctiva that arises from long-standing nevus, primary acquired melanosis, or de novo.  Early, complete resection is important.

Squamous Cell Carcinoma
Malignant tumor appearing as a foamy, yellow-white vascular mass on the ocular surface.  Treatment can be surgical or with eyedrops.

Lymphoma
Malignant tumor that can occur with systemic lymphoma.  Tends to hide in the upper or lower quadrants deep behind the eyelids.

INTRAOCULAR TUMORS

Iris

 

Cyst
Benign condition that can occur in the iris stroma (front of iris) or iris pigment epithelium (back of iris).  Some can be observed while others need surgical treatment.
Nevus
Benign tumor appearing as a brown or yellows spot on the iris stroma.

Melanoma
Malignant tumor often detected when small size so prognosis is usually favorable. 

Choroid


 


Nevus 
Benign tumor that classically remains stable.  Can lead to reduced visual acuity.  Can transform into melanoma. 

Melanoma 
Malignant tumor with relatively high risk for metastasis.  Classified into small, medium, or large sizes.  Often treated with radiation or eye removal.



Hemangioma 
Benign tumor that can leak and result in poor vision.

Metastasis 
Malignant tumor that spread to the inner eye from remote site such as cancer of the breast or lung. 

Lymphoma 
Malignant tumor often associated with similar tumor in the abdomen.
Pseudomelanoma 
Conditions that simulate malignant melanoma.

Nevus 
Benign tumor.

Peripheral exudative hemorrhagic chorioretinopathy
Hemorrhagic retinal disease of the elderly.

Retina

Retinoblastoma

  • Clinical features- Most common presentation is with leukocoria (white pupil) or strabismus (crossed eye). The tumor appears as a yellow-white mass in the retina of small  , medium, or large size. Often there is a large retinal detachment. 
  • Genetic testing – Performed on all children to investigate chromosome 13.
  • Treatment
    • Intravenous chemotherapy (chemoreduction) 
    • Subtenon’s chemotherapy
    • Intra-arterial chemotherapy (IAC)
    • Intravitreal chemotherapy (melphalan)
    • Plaque radiotherapy
    • Cryotherapy/Thermotherapy
    • Enucleation

‚Äč

                  Leukocoria (white pupil)
 
Small Tumor                             Large Tumor
Before IAC Treatment           After IAC Treatment

                
                  Large Retinal Detachment

Astrocytic hamartoma
Benign retinal tumor, sometimes found with Tuberous Sclerosis Complex.

Coats disease
Benign vascular abnormality where the retinal vessels leak yellow exudation and fluid. 

Familial exudative vitreoretinopathy
Benign vascular condition with leakage and possible hereditary trait.

Vasoproliferative tumor
Benign vascular tumor with leakage.

Hemangioblastoma
Benign vascular tumor with leakage, and often associated with von Hippel Lindau disease.

Lymphoma
Malignant tumor of the retina and vitreous that can be associated with brain lymphoma.

 

Retinal pigment epithelium (RPE)

Combined hamartoma
Congenital benign tumor that often leads to poor vision.

Congenital hypertrophy of the RPE
Benign flat tumor often confused with nevus or melanoma.  

Adenoma/Adenocarcinoma
Rare tumor that is nodular, pigmented and slowly grows over many years.

Sclera

Sclerochoroidal calcification 
Benign chronic calcification of the eye wall.
Solitary idiopathic choroiditis 
Benign inflammatory focus of the eye wall.

ORBIT TUMORS

Inflammatory

Pseudotumor (idiopathic orbital inflammation) 
Rapid onset inflammation and pain in the tissues around the eye.  Responds to oral prednisone.

Vascular

Capillary hemangioma 
Benign red skin tumor that has onset after birth and grows until about 6 months of age then undergoes slow spontaneous involution.
Lymphangioma 
Benign, often ill-defined, tumor of the lymphatics.

Cavernous hemangioma 
Benign tumor with large cavernous spaces filled with blood. 

Lymphoid

Benign reactive lymphoid hyperplasia 
Benign tumor comprised of lymphocytes. Can achieve a large size before discovery.

Lymphoma
Mucosa associated lymphoid tissue (MALT) – Malignant low-grade tumor that can be associated with lymphoma in the abdomen.  Can respond to surgical removal or systemic medications.

Metastasis
Malignant tumors that spread to the orbit through the blood stream from remote sites like cancer of the breast, lung, or prostate.

Lacrimal Gland

Pseudotumor 
Inflammation of the lacrimal gland.
Lymphoma 
Malignant tumor with lymphocytes.
Pleomorphic adenoma 
Benign tumor that arises from the lacrimal gland structures and remains localized to the orbit.
Adenoid cystic carcinoma 
Malignant tumor arising from the lacrimal gland with propensity to grow into surrounding tissue and spread to other organs.

PATHOLOGY

Retinoblastoma
Globe filled with retinoblastoma appearing as a white mass. 

Melanoma 
Globe filled with pigmented (brown) or nonpigmented (yellow) mass.  

 

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