BAGIAN PATOLOGI ANATOMIBAGIAN PATOLOGI ANATOMIFAKULTAS KEDOKTERANFAKULTAS KEDOKTERAN

USU USU –– MEDANMEDAN

20072007

NORMAL ANATOMYNORMAL ANATOMY

PalpebraePalpebraeConjunctivaConjunctivaCorneaCorneaLensLensUvea tractUvea tractRetinaRetinaRetinaRetinaVitreous humorVitreous humorNerveNerveGlandGlandMuscleMuscleBlood vesselsBlood vessels

NORMAL ANATOMYNORMAL ANATOMY

A A -- Vitreous humorVitreous humor

B B -- LensLens

C C -- CorneaCornea

D D -- PupilPupilD 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 :�� 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 •• 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 MUCINOUSMINOR MUCINOUS

DISORDER OF EYEDISORDER OF EYE

�� MICRO ORGANISMS *MICRO ORGANISMS *

�� ANTIGEN *ANTIGEN *

�� TOXIC CHEMICAL *TOXIC CHEMICAL *

SOLAR RADIATION *SOLAR RADIATION *�� SOLAR RADIATION *SOLAR RADIATION *

�� SYSTEMIC DISEASE *SYSTEMIC DISEASE *

* * �� BLINDNESSBLINDNESS

CONGENITAL ANOMALICONGENITAL ANOMALI

�� RARELY : RARELY :

-- ANOPTHTHALMOSANOPTHTHALMOS

-- EYE’S (EYE’S (--))

-- MICROPHTHALMOSMICROPHTHALMOS-- MICROPHTHALMOSMICROPHTHALMOS

-- MEDIAN EYEMEDIAN EYE

-- HYPOPLASIA EYE’SHYPOPLASIA EYE’S

-- COLOBOMACOLOBOMA

-- CONGENITAL CATARACTSCONGENITAL CATARACTS

-- COLOR BLINDCOLOR 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) •• Down syndromeDown syndrome (trisomy 21) (trisomy 21) •• PierrePierre--Robin syndrome Robin syndrome •• Familial congenital cataracts Familial congenital cataracts •• HallermanHallerman--Streiff syndrome Streiff syndrome •• Lowe syndrome Lowe syndrome •• Trisomy 13Trisomy 13•• Conradi syndrome Conradi syndrome •• Ectodermal dysplasiaEctodermal dysplasia syndrome syndrome •• MarinescoMarinesco--Sjogren syndrome Sjogren syndrome

CONGENITAL CATARACTS CONGENITAL CATARACTS

PIGMENTATIONPIGMENTATION

EXOGENEXOGEN ENDOGENENDOGEN

MELANINMELANINIRONIRON

ALBUMIN ALBUMIN �� MELANOSISMELANOSIS

MELANINMELANIN

HEMOSIDERINE HEMOSIDERINE

I.O.HI.O.H

IRONIRONCOPPER COPPER SILVERSILVER

PIGMENTATIONPIGMENTATION

�� KAYSER KAYSER -- FLEISCHER RINGFLEISCHER RING��WILSON’S DISEASE (HEPATOLENTIWILSON’S DISEASE (HEPATOLENTI

CULAR DEGENERATION)CULAR DEGENERATION)

DEPIGMENTATIONDEPIGMENTATION

VITILIGOVITILIGO

PHYSICAL & CHEMICAL INJURIESPHYSICAL & CHEMICAL INJURIES

�� TRAUMA :TRAUMA : ECCHYMOSISECCHYMOSIS

�� SUP.FICIAL :SUP.FICIAL :

•• CONTACT LENSCONTACT LENS•• 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 ECCRINE SWEAT GLANDSGLANDS

MOLUSCUM CONTANGIOSUMMOLUSCUM CONTANGIOSUM

�� VIRAL INFECT VIRAL INFECT �� WART LIKEWART LIKE

�� CENTRAL UMBILICAL CENTRAL UMBILICAL �� KERATINKERATIN

CYSTIC LESSIONCYSTIC LESSIONCYSTIC 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 �� 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 ��GRANULATIONGRANULATIONGRANULATIONGRANULATION

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�� 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 DISEASETHYROID 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 )( + 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�� THRACHOMATHRACHOMA

�� CHLAMYDIAL INFECTIONCHLAMYDIAL INFECTION

�� OPHTHALMIA NEONATORUMOPHTHALMIA NEONATORUM

�� DRYDRY--EYE SYNDROMEEYE SYNDROME

�� PINGUECULA & PTERYGIUMPINGUECULA & PTERYGIUM

HYPEREMIA HYPEREMIA -- CONJUCTIVACONJUCTIVA

�� DILATASI BLOOD VESELDILATASI BLOOD VESEL

�� CONJUNCTIVITISCONJUNCTIVITIS

�� CORNEA DISEASECORNEA DISEASE

IRIDOCYCLITISIRIDOCYCLITIS�� IRIDOCYCLITISIRIDOCYCLITIS

�� CORNEA DEFECTCORNEA DEFECT

�� GLAUCOMAGLAUCOMA

�� IRITISIRITIS

HEMORRHAGE CONJUNCTIVAHEMORRHAGE CONJUNCTIVA

�� TRAUMATRAUMA

�� ANOXIAANOXIA

SEVERE COUCHING SEVERE COUCHING SPONTANEUSSPONTANEUS�� SEVERE COUCHING SEVERE COUCHING �� SPONTANEUSSPONTANEUS

SUBCONJUNCTIVAL HEMORRHAGE SUBCONJUNCTIVAL HEMORRHAGE

�� Causes :Causes :

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

press press ↑)↑)

•• Streneuous Exercising Streneuous Exercising •• 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

�� MICROMICRO--ORG ORG �� CONJUNCTIVITISCONJUNCTIVITIS

�� KERATITISKERATITIS

�� CORNEAL ULCERCORNEAL ULCER

HEMATOGEN HEMATOGEN �� HEMATOGEN HEMATOGEN

�� IATROGENIC INFECTIONIATROGENIC INFECTION

�� SURGICAL : SURGICAL :

�� CATARACTCATARACT

�� CORNEAL GRAFTCORNEAL GRAFT

�� PROSTHETIC LENSPROSTHETIC LENS

CONJUNCTIVITISCONJUNCTIVITIS

�� EXUDATE/DISCHARGE :EXUDATE/DISCHARGE :

-- PURULENT PURULENT �� CLOSECLOSE

-- FIBRINOUSFIBRINOUS-- FIBRINOUSFIBRINOUS

-- SEROUSSEROUS

-- HEMORRHAGICHEMORRHAGIC

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 �� BLIND BLIND

�� CHILD CHILD �� REMISION (SP) REMISION (SP)

�� ADULT ADULT �� PROGRESSIVEPROGRESSIVE

�� 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 (EPIT –– BOWMANN ZONE)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 CONJUNCTIVITISSEVERE CONJUNCTIVITIS

�� COPIUS PURULENT DISCHARGECOPIUS PURULENT DISCHARGE

�� GO GO �� GOGO--NEONATORUMNEONATORUM

ULC.CORNEA, PERFORATION ULC.CORNEA, PERFORATION �� 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 membranesmembranesmembranesmembranes�� 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 �� YELLOWISHYELLOWISH

�� NASAL TO THE CORNEOSCLERALNASAL TO THE CORNEOSCLERAL

SUN DAMAGED SUN DAMAGED �� INJURYINJURY�� SUN DAMAGED SUN DAMAGED �� INJURYINJURY

� DOES NOT GROW ONTO CORNEA

� DEPOSIT OF PROTEIN & FAT

� PARTICULARLY OLDER PEOPLE

PINGUECULAPINGUECULA

PTERYGIUM

�� FOLD OF VASCULARIZED FOLD OF VASCULARIZED –– RECURS AFTER EXISION 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•• TRAUMATRAUMA•• INFECTIOUS DISEASESINFECTIOUS DISEASES•• NUTRITIONAL NUTRITIONAL

DEFICIENCIES &DEFICIENCIES &•• ENVIRONMENTAL ENVIRONMENTAL

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

CORNEACORNEA

�� HERPES SIMPLEXHERPES SIMPLEX

�� ONCHOCERCIASISONCHOCERCIASIS

�� ARCUS SENILISARCUS SENILIS

BAND KERATOPATHYBAND KERATOPATHY�� 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 ENDOPHTHALMITISENDOPHTHALMITISENDOPHTHALMITISENDOPHTHALMITIS

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.OCCLUSIONCENTRAL R. ART.OCCLUSION

-- CENTRAL R. VEIN OCCLUSIONCENTRAL R. VEIN OCCLUSION-- CENTRAL R. VEIN OCCLUSIONCENTRAL R. VEIN OCCLUSION

�� HYPERTENSIVE RETINOPATHYHYPERTENSIVE RETINOPATHY

�� DIABETIC RETINOPATHYDIABETIC RETINOPATHY

�� RETINAL DETACHMENT RETINAL DETACHMENT

RETINARETINA

�� RETINITIS PIGMENTOSARETINITIS PIGMENTOSA

�� MACULAR DEGENERATIONMACULAR DEGENERATION

�� CHERRYCHERRY--RED SPOT AT THE MACULARED SPOT AT THE MACULA

ANGIOID STREAKSANGIOID STREAKS�� 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 BULGESBULGESBULGESBULGES

�� OPTIC ATROPHYOPTIC ATROPHY

GLAUCOMA GLAUCOMA

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

�� Retina and Retina and

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

�� Retina and Retina and

�� Optic nerve Optic nerve �� NNerve erve 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.

GLAUCOMAGLAUCOMA

�� CONGENITAL GLAUCOMACONGENITAL GLAUCOMA

�� INFANTILE GLAUCOMA, INFANTILE GLAUCOMA, BUPHTHALMOSBUPHTHALMOS

PRIMARY OPENPRIMARY OPEN--ANGLE GLAUCOMAANGLE GLAUCOMA�� PRIMARY OPENPRIMARY OPEN--ANGLE GLAUCOMAANGLE GLAUCOMA

�� PRIMARY CLOSEDPRIMARY CLOSED--ANGLE GLAUCOMAANGLE GLAUCOMA

�� SECONDARY GLAUCOMASECONDARY GLAUCOMA

�� LOWLOW--TENSION GLAUCOMATENSION GLAUCOMA

GLAUCOMAGLAUCOMA

NEOPLASMANEOPLASMA

�� XANTHELASMAXANTHELASMA

�� NEUROFIBROMANEUROFIBROMA

BENIGNBENIGN MALIGNANTMALIGNANT

�� BOWEN DISEASEBOWEN DISEASE

�� SQ.CELL.CASQ.CELL.CA�� NEUROFIBROMANEUROFIBROMA

�� PAPILLOMAPAPILLOMA

�� LIPOMALIPOMA

�� HEMANGIOMAHEMANGIOMA

�� LIMPHANGIOMALIMPHANGIOMA

�� NEVUSNEVUS

�� SQ.CELL.CASQ.CELL.CA

�� BASAL CELL CABASAL CELL CA

�� MALIG. MELANOMAMALIG. MELANOMA

�� AD. CARCINOMAAD. CARCINOMA

�� SARCOMASARCOMA

�� LYMPHOMALYMPHOMA

XANTHELASMAXANTHELASMA

�� HYPERCHOLESTEROLEMIA HYPERCHOLESTEROLEMIA �� DMDM

�� REPRODUCTION WOMANREPRODUCTION WOMAN

�� LOC : LOC : �� CANTUS INTERNAL CANTUS INTERNAL �� PALPAL

PEBRAE XANTHELASMAPEBRAE XANTHELASMAPEBRAE 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 MATOSIS (VON RECKING HAUSEN.D)HAUSEN.D)HAUSEN.D)HAUSEN.D)

�� LOC. LOC. ��PALPEBRAEPALPEBRAE

�� OTHER SITE (+)OTHER SITE (+)

PAPILLOMAPAPILLOMA

�� STOLK (+) STOLK (+)

�� SQ.EPITH.CELL SQ.EPITH.CELL �� PROLIFERATIONPROLIFERATION

LYMPHANGIOMALYMPHANGIOMA

�� LESS COMMONLESS COMMON

�� LYMPH VESSELLYMPH VESSEL

�� PROLIFERATION PROLIFERATION �� PROLIFERATION PROLIFERATION

�� LUMPLUMP

NEVUSNEVUS

�� EPITHELIAL CELLSEPITHELIAL CELLS

�� NEVI CELLSNEVI CELLS

�� TYPETYPE : : -- INTRA DERMALINTRA DERMAL

-- JUNCTIONALJUNCTIONAL-- JUNCTIONALJUNCTIONAL

-- COMPOUNDCOMPOUND

BOWEN DIASEASEBOWEN DIASEASE

�� INTRA EPITHELIAL NEOPLASMINTRA EPITHELIAL NEOPLASM

�� CA INSITUCA INSITU

�� ATIPICAL CELLSATIPICAL CELLS

PLEOMORFISMPLEOMORFISM�� PLEOMORFISMPLEOMORFISM

�� UNCOMMONUNCOMMON

SQUAMOUS CELL CASQUAMOUS CELL CA

�� EPITHELIAL CELLSEPITHELIAL CELLS

�� FORM : FORM : -- NON KERATINIZINGNON KERATINIZING

-- KERATINIZINGKERATINIZING

PLEOMORFISM CELLSPLEOMORFISM CELLS�� PLEOMORFISM CELLSPLEOMORFISM CELLS

�� HYPERCHROMATIC NUCLEUSHYPERCHROMATIC NUCLEUS

�� KERATIN (+/KERATIN (+/--) )

BASAL CELL CABASAL CELL CA

�� BASAL CELLSBASAL CELLS

�� MONOTONMONOTON

�� NUCLEUS NUCLEUS �� BASOPHYLICBASOPHYLIC

STRANDSTRAND�� 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�� TYPE : MELANOCYTE/AMELANOCYTETYPE : MELANOCYTE/AMELANOCYTE

�� MACRMACR : : -- CIRCUMSCRIBEDCIRCUMSCRIBED

-- INV.BRUCH’S MEMBRANEINV.BRUCH’S MEMBRANE

�� MICRMICR : : -- SPINDLE CELLS SPINDLE CELLS

-- POLYGONAL CELLSPOLYGONAL CELLS

-- EPITHELOID CELLSEPITHELOID CELLS

ADENO CARCINOMAADENO CARCINOMA

�� GLAND PATERNGLAND PATERN

�� UNCOMMONUNCOMMON

�� DIFFERENTIATED :DIFFERENTIATED :

-- WELLWELL-- WELLWELL

-- MODERATEMODERATE

-- POORLYPOORLY

SARCOMASARCOMA

�� CONNECTIVE TISSUECONNECTIVE TISSUE

�� RHABDO/LEIOMYO SARHABDO/LEIOMYO SA

�� FIBRO SAFIBRO SA

LIPO SALIPO SA�� LIPO SALIPO SA

LYMPHOMALYMPHOMA

�� LYMPHOID TISSUELYMPHOID TISSUE

�� ROUND CELLSROUND CELLS

�� MONOTONEMONOTONE

TYPETYPE : : -- IMMATURE CELLSIMMATURE CELLS�� TYPETYPE : : -- IMMATURE CELLSIMMATURE CELLS

-- MATURE CELLS MATURE CELLS

RETINOBLASTOMARETINOBLASTOMA

�� IMMATURE CELLSIMMATURE CELLS

�� CHILD ( >> )CHILD ( >> )

�� FIRST 2 YRS OF LIFE FIRST 2 YRS OF LIFE

BIRTH ( +/BIRTH ( +/-- ))�� BIRTH ( +/BIRTH ( +/-- ))

RETINOBLASTOMARETINOBLASTOMA

�� PATHPATH : : -- INTERNAL INTERNAL �� VITR.BODYVITR.BODY

-- EXTERNALEXTERNAL

�� CREAM COLOREDCREAM COLORED

�� CALCIFIED CALCIFIED �� YELLOWYELLOWCALCIFIED CALCIFIED �� YELLOWYELLOW

�� MICRMICR : : -- SMALL CELLSSMALL CELLS

-- ROUND CELLSROUND CELLS

-- ROSET (+)ROSET (+)

-- NECROSISNECROSIS

-- HEMORRHAGIC HEMORRHAGIC

RETINOBLASTOMARETINOBLASTOMA

�� EARLY DIAG EARLY DIAG �� OPERATIVEOPERATIVE

�� SURVIVAL ( 90 % )SURVIVAL ( 90 % )

�� UNTREATED UNTREATED �� FATALFATAL

INCIDENT 1/20000 (BIRTH)INCIDENT 1/20000 (BIRTH)�� INCIDENT 1/20000 (BIRTH)INCIDENT 1/20000 (BIRTH)

�� FAMILIAL ( 5 FAMILIAL ( 5 –– 10 % )10 % )

�� CHROMOSOME 13 (CHROMOSOME 13 (--) ) �� Q 14 BANDQ 14 BAND

RETINOBLASTOMARETINOBLASTOMA

�� CLINICCLINIC: :

�� WHITE PUPILS ( LEUCORIA)WHITE PUPILS ( LEUCORIA)

�� POOR VISIONPOOR VISION

HYPEMIAHYPEMIA�� 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 �� GLIOMAGLIOMA

�� VISION VISION �� << (PROGRESIVA)<< (PROGRESIVA)

PROPTOSISPROPTOSIS�� PROPTOSISPROPTOSIS

�� PAPIL EDEMA PAPIL EDEMA

�� MICRMICR : : -- ASTROSITOMA LIKE CELLSASTROSITOMA LIKE CELLS

-- WELL DIFFERENTIATEDWELL DIFFERENTIATED

�� SURGICAL AND RADIOTH/ SURGICAL AND RADIOTH/ �� OKOK

�� 5 YSR 5 YSR �� 90 % 90 %

METASTATIC NEOPLASMMETASTATIC NEOPLASM

�� MORE COMMON X PRIMERMORE COMMON X PRIMER

�� PRIMER LESSION :PRIMER LESSION :

-- LEUKEMIALEUKEMIA

-- BREAST CABREAST CA-- BREAST CABREAST CA

-- LUNG CALUNG CA

�� DIAG : DIAG : �� AFTER DEATHAFTER DEATH