What to expect from the neoplasm on the iris eye. Eye cancer: photo, first symptoms, treatment

20-09-2012, 05:26

Description

Screening

CLASSIFICATION

Tissue accessories allocate:

• moiogenic tumors (Leiomioma);
• epithelial (epithelioma):
• vascular (hemangioma);
• melanocytic tumors (neust, melanocytoma, iris-non-syndrome),

Leiomiomoma

It develops from the elements of pupil muscles, is characterized by extremely tornadow growth.

Clinical picture

The severity of clinical manifestations depends on the degree of tumor saturation by the pigment. In this regard, an unmanned and pigment leomyoma is distinguished.

Unmanned Leiomiomioma Presented with a yellowish-pink, translucent node of loose consistency, but with tight borders (Fig. 36-24).

A translucent increases are visible on the surface of the tumor, vascular loops are well visualized, which sometimes become a source of recurrent hyphem. It can be located on the pupil edge, in the zone of the Crane circle, and the root zone (region of ciliary crypt). The first symptoms most often have a hyphem or an increase in ophthalmotonus (with the growth of leomiomes in the zone of ciliary crypt).

Pigment Leiomiomomapainted in light brown or dark brown colors. According to the nature of growth, nodal, plane and mixed forms are distinguished. More often localized in the ciliary belt iris. The change in the shape of the pupil is characteristic: it is determined by the reveuming of a pigment cone, directed towards the location of the tumor (Fig. 36-25).

Pigment leiomioma on consistency is more dense, the surface is littering it. A secondary intraocular hypertension is accompanied by a tumor into the angle of the anterior chamber by more than 1/3 of its circle.

Signs of tumor progression:

DIAGNOSTICS

Leiomioma is diagnosed based on biomicroscopy data, gonoscopy and diaphanoscopy. Iridoangiography has characteristic features characteristic of Leiomioma - a drawing of the "green leaf".

Anamnesis

Complaints are usually absent.

Physical examination

Determination of central and peripheral vision, biomicroscopy, gonoscopy, diaphanoscopy, ophthalmoscopy, research of intraocular pressure.

Instrumental research

Informative echobiomicroscopy, iridoangiography.

Differential diagnosis

An unmanned leuomioma needs to be differentiated with a mesodermal iris dystrophy, chronic nonspecific granular, sarcoidosis, juvenile xantogrant, metastasis, abscess. Pigment Leioma should be differentiated from the progressive nevus, melanoma, pigment epithelium cysts, an encapsulated foreign body.

Treatment

Surgical (local tumor removal with a block of surrounding healthy fabrics).

Treats of treatment

Indications for hospitalization

For surgical treatment.

From 3-4 weeks to 2 months (depending on the volume of the operation).

Further maintenance

The dynamic observation of the ophthalmologist is shown.

FORECAST

For life, the forecast is favorable. The visual forecast depends on the initial sizes of the tumor.

Epithelioma

Epithelioma (adenoma pigment epithelium) is rare.

Clinical picture

The tumor is intense black, grows in the form of a separate node with raised edges, is localized mainly in the cylinder belt of iris. In the process of growth, the tumor shifts the quiver to the atrophic stroma of the iris and germinates it. On the edges of the tumor can be formed small pigment cysts. Tumor growth slow, after germination in rear Camera, the tumor comprises a lens, causing her clouds. Secondary glaucoma is the result of the tumor germination in the structure of the angle of the anterior chamber.

Diagnostics

Anamnesis

Anamnesis of the disease is usually long. The Dark Spot on Ruduzhka Patients notice accidentally.

Physical examination

Determination of central and peripheral vision, biomicroscopy, gonoscopy, diaphanoscopy, ophthalmoscopy. Investigation of intraocular pressure.

Differential diagnosis

It is necessary to carry out with a pigment leomyoma, melanoma, metastasis, non-neust, melanocytoma, pigment pile, foreign body.

TREATMENT

Surgical treatment (local removal of a tumor with a block of surrounding healthy fabrics) is shown.

Treats of treatment

Preservation of the eye as a functioning organ.

Indications for hospitalization

For surgical treatment.

Approximate disability

Further maintenance

Observation ophthalmologist.

FORECAST

For life, a good, the visual forecast depends on the initial sizes of the tumor.

Medulloepithelomoma

Developed from primitive germinal epithelium. Deterct in children at 6 months - 6 years.

Synonyms

Dikhal.

Clinical picture

On the surface of the iris, the tumor is represented by translucent grayish-white flakes, burned with interconnected, which creates conditions for the free movement of tumor cells on the anterior chamber. The obturation of the paths of outflow of intraocular fluid leads to the development of secondary glaucoma. The tumor can grow along the rear surface of the iris, mainly in its lower half, and go out into the front chamber through the pupil.

DIAGNOSTICS

The diagnosis is established on the basis of biomicroscopy data and gonoscopy. In particularly complex cases, a thin-game aspiration biopsy is shown.

Anamnesis

Non-informative.

Physical examination

It is necessary to determine central and peripheral vision, biomicroscopy, gonoscopy, diaphanoscopy, ophthalmoscopy. Investigation of intraocular pressure.

Differential diagnosis

It should be differentiated from the retinoblastoma, an unmanned melanoma, aseptic abscess, metastase.

TREATMENT

Surgical. Local tumor removal is fraught with a rapid appearance of relapse. More often, treatment is limited to enucleation, especially with an increase in intraocular pressure.

Treats of treatment

Removal of the tumor.

Indications for hospitalization

For surgical treatment.

Further maintenance

Observation ophthalmologist.

FORECAST

It is good for life, even if atypical cells and mitoses and mitoses are found in histopaparations.

Hemangioma

Congenital tumor. May manifest itself in the first years of the child's life and after the 2-3rd decades of life. Capillary, cavernous and racing hemangiomas may occur in the iris.

Clinical picture

Capillary hemangioma - Tumor of newborns or children of the first years of life. The iris is represented in the form of intertwined small vessels of dark color, growing into the iris tissue, occupying the area from one quadrant to half the surface of the iris. AT childhood Such hemangiomas can independently regress. When progressing the process, the development of secondary glaucoma is possible.

Cavernous hemangiomain the form of a node, it is more often in the pupil edge, has a brownish-yellow or red. Promination of the tumor may vary depending on the degree of filling its cavities with blood. Typical transient gifems.

Romacomous hemangioma In the iris, it is very rare in the form of sharply convicted vessels, located and the thickness of the iris and flowing into the angle of the anterior chamber. Secondary glaucoma develops early.

DIAGNOSTICS

The diagnosis is established according to biomicroscopy and gonoscopy.

Anamnesis

It indicates the appearance of a dark spot on the iris in childhood, there may be complaints of frequent gifems.

Physical examination

It is necessary to determine the central and peripheral vision, biomicroscopy, gonoscopy, ophthalmoscopy, tonometry.

Differential Digosis

Conducted with irresiscouched iris, melanoma, juvenile xantogrant, an unmanned leuomioma and a metastatic tumor.

TREATMENT

With cavernous hemangioma, laseroagulation is effective. Raperic hemangiomas are practically not amenable to treatment. When the secondary glaucoma appears, enucleation is shown.

Indications for hospitalization

For surgical treatment.

Approximate disability

Further maintenance

Observation ophthalmologist.

FORECAST

For life, a good, visual forecast is good at cavernous hemangiome. With capillary and racing hemangiomas, the forecast for vision is not defined.

Nevus

The color of the iris, the crypt drawing in each individual is genetically programmed, the character of its coloring in all is non-uniform: along the entire surface of the iris, sites of hymerapigmentation in the form of small specks (freckles) are located. True neutres are melanocytic tumors that detect both in children and in adults. Deterct usually by chance.

Clinical picture

Presented by the heinee of the height of the iris with even borders, the color varies from yellow to intensively brown. The surface of the tumor velvety, slightly rough, the picture of the iris over the tumor is smoothed, sometimes it protrudes over the surface of the iris (Fig. 36-27).

The size of the nevus varies from 2-3 mm to one quadrant of the surface of the iris. Stationary Netures For many years do not change their appearance. With the progression of the nevus, a change in its coloring (darkening or paging) appears, the size of the tumor increases, spraying the pigment appears around the nevus, the border becomes less than kidka, an extended vessels appear around the tumor in the iris.

DIAGNOSTICS

The diagnosis is established according to biomicroscopy and gonoscopy.

Synonyms

Large cellular neust.

Clinical picture

It is characterized by the appearance of a tumor intensively black painting, grows very slowly. Sometimes, for several months, it can suddenly increase as a result of spontaneously emerging necrosis with the discharge of pigment and the appearance of peripocal inflammation in the surrounding iris. During this period, it is possible to increase the ophthalmus with the enemy of the cornea.

DIAGNOSTICS

Helps in the diagnosis of biomicroscopy. In difficult cases, a thin-game aspiration biopsy can help.

Differential diagnosis

It is necessary to carry out melanoma, epithelium and pigment leuomioma.

TREATMENT

FORECAST

For life and view favorable.

Article from the book :.

Leiomioma is benignant neoplasm, developing from the myocytes of the iris. Immediately the iris is the front eye and has 3 layers:

• The border layer is represented by pigment cells; It is the number of pigment cells determines the color of the iris: the more they are more, the darker the rainbow shell.
• Stromal layer - vessels and nerve endings of iris are concentrated in it.
• Muscular layer in which muscles are located, expanding (dilatar) and narrowing (sphincter). On the back surface, this layer is coated with a layer of cells of the photosensitive shell of the eye.

Muscle reducing iris, i.e. Leiomiomes are rarely found. Their source can serve both muscle cells of dilator and muscle cells of the pupil sphincter. The tumor itself can develop in the form of a node or to be flat, and a mixed version is encountered. Leiomioma color can be diverse, from barely rose to dark brown. The tumor is growing very slowly, however can germinate in the eye fabric with outward. With a current of intraocular fluid or during the operating muscles, the cells of Leiomioma can spread inside eyeball: More often to the angle of the anterior chamber or on the surface of the iris.

Symptoms

Most often, the patient himself notices the first symptoms of Leiomioma in the form of a change in the color of the iris. However, as a rule, this does not occur immediately, but already with a significant size of the tumor. If a large number of vessels are located on the surface of the tumor, hemorrhages can occur in the front - the so-called. Sometimes such extensive hemorrhages may cause a decrease in visual acuity or an increase in intraocular pressure.

Tumor cells, spreading with current intraocular moisture, can overlap the paths of its outflow and cause the development of secondary. When the tumor achieved is a significant size, it begins to touch the C, provoking its clouding -. In severe cases, during the germination of the leomyomes of the fabrics of the eye, along with damage to the fabrics, its complete destruction is possible.

Diagnostics

To diagnose leuomioma, a detailed inspection under the microscope is needed, in addition, a transillyllifyment is performed, when the flow of light passes through the eyeball, and depending on the shade, which the tumor discardes its dimensions.

Many for more information The size of Leiomioma, about the degree of its introduction in the eye tissue gives an ultrasound examination. When identifying patients with leiomioma, they are necessarily inspected after 3-6-8 months, in order to eliminate the malignant nature of the tumor.

Treatment of leiomioma iris

Leiomioma treatment surgical. The operation is performed exclusively at large tumors, high risk of introduction in eye tissue or with existing germination. Volume surgical intervention Determined by the size of the tumor and the complications arisen.

If the surgical intervention is not shown, the patient is under the obligatory observation of the eyepiece or an ophthalmologist and is inspected 1 time per year.

3089 0

The tumors of the vascular shell constitute more than all intraocular neoplasms, are between the ages of 3 and 80.

About 23% of all tumors are localized in the iris and ciliary body, the rest is in the choroid.

The histogenesis is diverse, but the main part has neuroectodermal origin (pigment and unpaigla tumors), a smaller part relates to tumors of mesodermal origin (vascular neoplasms).

Up to 84% of the iris tumors belong to benign, most of them have a myogenic nature, which was proven in 1973. E.F. Lelkovoye. Several earlier Heals (1952) and Ashton (1963) showed a smaller frequency of miogenic tumors in the iris (2.3-14.5%). G.Ziangirova (1980) on a large material and during long-term observation of patients convincingly proved to the prevalence of MIOM (54%) among all iris tumors.

Confirmation of its data We found in our perennial observations over 476 patients with iris tumors and ciliary bodies, among which benign tumors amounted to 83.23%, and Miogenic among them are 62%. Malignant tumors are presented in the overwhelming majority melanoma and metastatic tumors.

Leiomiomoma

The tumor develops from the elements of the pupil muscles, is characterized by extremely slow growth, depending on the presence of pigment in the tumor, an unmanned and pigment leomyoma is distinguished.

This division is explained by a different clinical picture. The tumor is almost the same in almost the same man and women, mainly on the 3-4th decade of life. In recent years, the cases of detection by Leiomioma have 16-20 years old.

Clinic

Unmanned Leiomiomioma

It grows locally in the form of a yellowish-pink, translucent, prominent node. The tumor can be localized on the pupil edge, in the zone of steep is cracze, in the root zone (in the field of ciliary crypt). The borders of Leiomioma are quite clear, the consistency is loose, pupil (Fig. 6.1).

Fig. 6.1. Releasing leiomioma iris

On the surface of it is visible translucent increases, in the center of which are vascular loops. These newly formed vessels can be a source of recurring hemorrhages in the front chamber in the process of tumor growth.

With an unmanned leomyome in the zone of ciliary crypt, one of the first symptoms forcing the patient to consult a doctor is to increase intraocular pressure (ВГД) With all the signs typical for him. Often, so patients establish a diagnosis of one-sided primary glaucoma.

Pigment Leiomiomoma

It is painted from light brown to dark brown, it can be a nodal, flat or mixed growth form (Fig. 6.2).

Fig. 6.2. Leiomioma iris. a - the appearance of the pigment leomyoma; B - Gistopreparat

More often is localized in the ciliary belt of iris. Characterized by the change in the shape of the pupil, its elongation due to the withdrawal of the pigment border, directed towards the location of the tumor. The consistency of the pigment leuomioma is more dense, the surface is buggy, the newly formed vessels are not visible.

The germination of the tumor into the angle of the anterior chamber is more than 1/3 of the circumference, it leads to the emergence of secondary intraocular hypertension. Considering the extremely slow growth of Leiomioma, it is important to know signs of tumor progression.

These include:

1) the smoothing of the Relief of the iris around the tumor due to perifocal atrophy of its fabric;
2) the appearance of the spraying zone of the point pigment around the tumor and the formation of pigment paths to the side of the peripheral borders of the tumor;
3) change in the shape of the pupil with a violation of its reaction in this zone on light and maleria;
4) The appearance of a vascular whisk in the iris around the tumor.

Leiomiomes of iris, as a rule, in their growth are limited to the anterior chamber and in the rear chamber germinate extremely rarely. When the angle of the angle of the angle is distributed in the structure of the angle and the ciliary body, the yield of the tumor and to the rear chamber with the displacement and closet of the lens are observed.

Morfogenesis

For many years, the discussion on histogenesis Leiomiom continues in the literature. The judgments about the rarity of this tumor are expressed, a large frequency of melanoma in the iris is indicated. Meanwhile, G. Kaziacgirova in 1980 wrote that to understand morphological features Muscular tumors can only be compared with the morphogenesis of the iris: the pupil muscles of the iris are formed from the outer layer of the pigment epithelium of the iridocyllior incarnation.

In embryogenesis, the pupil sphincter cells produce melanin to myofibrils, in postnatal life, this ability disappears. The dilatar of the pupil retains its ability to synthesize melanin and in the postnatal period.

This can explain the absence of pigment in leuomiomas developing from the pupil sphincter and the presence of it in leuomiomas forming from the elements of the pile dilator. Histologically for leiomy is characterized by the presence of long, spind-like, well differentiated cells. The core of oval or rod shape, without inclusions and nucleists. Characteristic of the presence of myofibrils.

In the unmanned forms, thin-walled new-formated, telegangectatically extended vessels are visible. Neuroepithelial cells are found in pigment leiomiomas, they are the greater, the stronger the pigmentation is expressed. In the cytoplasm there are large consignrators of pigment granules.

Leiomioma is diagnosed based on biomicroscopy data and gonoscopy. The diaphanicopy of informative and at capeless forms, when against the background of the yellowish tumor node, a defect in the iris is clearly visible. Fluorescent angiography (Phage) He has characteristic features for leomyoma. Immunohistochemical studies are reliably documented by Leiomioma

Differential diagnosis

An unmanned leomyoma requires differentiation with a mesodermal iris dystrophy, chronic nonspecific granuloma, sarcondosis, juvenile xantogranhane, adenocarcinoma, metastasis, abscess. Pigment Leiomioma will be differentiated from the progressive nevus, melanoma, pigment sheet cysts, encapsulated foreign bodies.

Treatment

Given the possibility of progression of tumor growth with the development of secondary glaucoma, cataracts, leomiomes are subject to surgical treatment - local removal with the surrounding block of healthy tissues. When removing no more than 1/3 of the circumference of the iris, it can be restored by the overlap of microbes (Fig. 6.3).

Fig. 6.3. Leiomioma iris. a - the appearance of the eye before treatment; b - the same eye after removing a tumor with a single-stage iris plate

Many years of experience testifies to. That the restoration of the integrity of the iris, as a diaphragm, sharply reduces the degree and frequency of crustaceous astigmatism, reduces light aberrations (Fig. 6.4).

Fig. 6.4. Functional outcomes after local removal of iridocilk zone tumors

The forecast for life is favorable. The forecast for vision depends on the initial values \u200b\u200bof the tumor. The smaller the tumor, the more likely to the patient you can promise to preserve normal vision.

Epithelioma

Epithelioma, or adenoma pigment epithelium, is extremely rare. It is diagnosed equally often in men and women, usually on the 2-3rd decade of life, which can be explained by extremely slow tumor growth.

Clinic

The tumor is localized mainly in the ciliary belt of iris. Epithelioma, as a rule, has intensively dark, almost black color (Fig. 6.5. A, b).

Fig. 6.5. Epithelioma iris. A - the appearance of the tumor. B - the spread of the tumor into the structure of the eye. B - Gistopreparat

In the process of growth, the tumor shifts the quiver to the atrophic stroma of the iris and germinates it. As a rule, epithelium is represented by a single node with raised edges, sometimes the edges of the tumor gradually go into a healthy iris tissue, which makes it similar to melanoma.

At the edges of the tumor can be observed small pigment cysts. Epithelitoma is growing slowly, can germinate into the rear chamber, shifting and squeezing the lens, which leads to the formation of cataracts. Epithelioms often germinate in the structure of the angle of the anterior chamber, which is complicated by the secondary glaucoma.

Morfogenesis

Epithelioma develops from pigment epithelium cells and consists of mature single type of large polygonal cells with massive cytoplasm made by melanin granules and vacuoles. No cell mitoses are absent, but the tumor is characterized by invasive growth (Fig. 6.5, B).

The diagnosis of epitheliums is established on the basis of biomicroscopy data and gonoscopy. Fagi and radio phosphate test are not informative. The final diagnosis is confirmed in histological examination.

Differential diagnosis

It is necessary to carry out with a pigmented leomyoma, melanoma, metastasis, neust, melanocytoma, pigment cyan, foreign body, granuloma.

Treatment

Despite slow growth, iris epitheliums are subject to local removal. Taking into account the benign nature of the growth of local excision with the substitution of the defect of the tissue is possible when the tumor is spread and on the episkler.

The forecast for life is good. The tumor does not metastasizes. The preservation of vision depends on the size of the tumor and the available complications.

Medulloepitheloma (Dikhae)

The tumor in the iris is found in children aged 6 months of 6 years, refers to congenital neoplasms. In recent years, it is regarded as a malformation.

Clinic

On the surface of the iris, the tumor has a form of translucent white-gray flakes, loosely connected, which creates conditions for their movement along the anterior chamber. At the same time, the paths of chamber moisture outflows can be attracted or the area of \u200b\u200bthe pupil with the development of secondary glaucoma is closed.

A.Moonis and A.Gamer (1975) described the case of medullaepiethrum of iris in a 3-year-old child having a view of an isolated intense pigmented tumor with a buggy surface filling the lower half of the front chamber and soldered with rear epithelium cornea (SER). The tumor can grow along the rear surface of the iris, mainly in its lower half, and go out into the front chamber through the pupil.

Morfogenesis

Medulloepitheloma derivatives from a primitive embryonic epithelium.

The diagnosis is established on the basis of biomicroscopy. In particular difficulties possible thin game aspiration biopsy (Tiab).

Differential diagnosis should be carried out with a retinoblast, an unmanned melanoma, metastase, inflammatory granuloma, aseptic abscess of the anterior chamber.

Treatment

At the localized node, blockexcia is shown. Tumors occupying more than half of the surgeon of iris and extending to the ciliary body, retina, or leaving the fibrous capsule, can only be cured by enucleation.

The forecast for life is good even when atypical cells and mitoses and mitoses are found in histopaparations. The tumor does not metastasizes. The preservation of vision depends on the size of the tumor and involvement in the process of neighboring tissue structures.

Hemangioma

Gemangioma is a rare congenital tumor. Clinically manifests itself in both the first years of life and after the 2-3rd decades. Described hemangiomas of iris in patients on the 6-7th decade of life. In our 6 observations, Gemangioma found themselves after 20 years, more often in men.

There is reason to believe that the Oka is combined with a vascular systemic lesion of organs and tissues. Like I. vascular tumors Another localization, in the iris, there are capillary, cavernous and racing hemangiomas.

Clinic

The capillary hemangioma is a tumor of newborns or children of the first years of life. Presented in the form of intertwined vessels growing into the iris. The color of the tumor is reddish-shiny, occupies from one quadrant of iris to half the surface. Such hemangiomas can independently regress. In continuing growth, secondary glaucoma develops.

The cavernous hemangioma is located more often at the pupil edge, is represented by a brownish yellow or reddish node. Depending on the filling of the cavities of the tumor with blood, the industrialization changes it. Characterized transient gifems. In the hyphem, more than 1/2, the volume of the anterior chamber increases ing, the corneal swelling appears.

The raceous hemangioma in the iris occurs extremely rarely, manifests sharply convulsions, expanded, intertwining vessels, located in the thickness of the iris and leaving the angle of the front chamber. Early develops secondary intraocular hypertension.

Morfogenesis

Being a malformation, hemangioma histologically represented by newly formed thin-walled vessels located at different stages of development.

The diagnosis is established on the basis of biomicroscopy.

Differential diagnosis is carried out with iriscularization of iris, melanoma, juvenile xantogranhane, sarconondosis, an unmanned leomyoma and metastase.

Treatment

Local treatment is effective with a cavernous hemangiome in the form of a laser coagulation of the tumor. Capillary hemangiomas can spontaneously regress. Romacious hemangiomas are practically not subject to treatment.

The forecast for life is good. For view favorable with cavernous hemangioma. With capillary and racing hemangiomas, the forecast for vision is indefinite.

Nevus

The color of the iris, the crypt drawing in each person is genetically revogram. The character of her coloring is almost all of all uniform: on the surface of the iris, areas of hyperpigmentation in the form of small specks are scattered or, as they are called, "freckles".

True neutres refer to melanocytic tumors, which are found in both children and adults. Detected, as a rule, accidentally. When conversation with patients, it is possible to find out that the speech on the iris noticed in childhood, among those observed in our clinic 476 patients with the tumors of the iris and the ciliary bodies of the nevi were 2.5%.

Clinic

Nevi is represented by the heinee hyperpigmentation section, the color of which varies from yellow to intensively brown. The surface of the tumor velvety, slightly rough. Sometimes Nesus slightly protrudes over the surface of the iris. The borders are clear, the picture of the iris on the nevus surface is smoothed (Fig. 6.6).

Fig. 6.6. Nesus iris

In the central part, the tumor is more dense and the picture of the iris is missing. The sizes of the nevus range from 2-3 mm to large foci, which take up to one quadrant of iris. Stationary Netures with decades do not change their size, shape and coloring.

With the appearance of signs of progression, the tumor darkens, the size increases, there is a spraying of the previously observed pigment, the boundaries of education become less clear, the branch of the extended vessels around the tumor appears.

Morfogenesis

Netures of iris are the derivatives of a neural scallop, morphologically represented by the accumulation of mature melanocytes, spindle-shaped cells similar to Schwann elements, and large dense polygonal cells. In the cytoplasm of cells a lot of melanin granules. Tumor growth diffuse, but limited to surface layers of iris or outer layers of stroma.

The treatment of stationary nonsense is not required. When the nevus progression is shown, local excision is shown.

Forecast for life and vision is good.

Melanoma

Melanocytoma is a large-cellular (or magnetocellular) Necess in the iris occurred very rarely. It is characterized by intense black color. The tumor grows slowly, but for several months it can dramatically increase in size due to spontaneous necrosis with dissemination of pigment and perifocal inflamed in the surrounding tissues. Clinically, this is manifested by a sharp increase in intraocular pressure.

Histology

Nevi is represented by rounded, large, mature melanocytes.

Diagnosis

Bomicroscopy helps in diagnostics. In difficult cases, Tiab can be used.

Differential diagnosis is carried out with melanoma, epithelium and pigment leuomioma.

Treatment

In treatment, as a rule, patients do not need. Upon increasing WFA, local exciion of the tumor is possible.

Forecast for life and view favorable.

Iris Nestus-Syndrome

Kogan-rice syndrome - Iris-Nesus-syndrome - occurs a cup of women, is characterized by the appearance in the iris against the background of anomalous pigmentation (heterochromy) of multiple non-discontinuous nodules on the leg.

Typical is the development of peripheral front synechs, the growing of the endothelium of the cornea over the surface of the iris, the appearance of one-sided glaucoma with a decrease in vision. In contrast to the mesodermal iris dystrophy at iris-non-syndrome, there is no rarefaction of stroma. M.Khalil and M.Finlayson (1980) Morphologically, such a patient discovered an ectopic corneal endothelium covering the front surface of the iris.

The latter discovered the accumulation of melanophagic cells. According to T.makley (1988), the only method of treatment with iris-non-syndrome should be recognized as an anti-cloudsatous operation, which, unfortunately, leads to temporary success.

A.F.Borchina, V.Valsky, G.A.Gusev

Leiomioma iris is a benign neoplasm, developing from the myocytes of the iris. Directly rainbow shell is the front sector of the vascular shell of the eye and has 3 layers:

• The border layer is represented by pigment cells; It is the number of pigment cells determines the color of the iris: the more they are more, the darker the rainbow shell.
• Stromal layer - vessels and nerve endings of iris are concentrated in it.
• Muscular layer in which muscles are located, expanding (dilatar) and suspending (sphincter) pupil. On the back surface, this layer is coated with a layer of cells of the photosensitive shell of the eye.

Muscle reducing iris, i.e. Leiomiomes are rarely found. Their source can serve both muscle cells of dilator and muscle cells of the pupil sphincter. The tumor itself can develop in the form of a node or to be flat, and a mixed version is encountered. Leiomioma color can be diverse, from barely rose to dark brown. The tumor is growing very slowly, however can germinate in the eye fabric with outward. With a current of intraocular fluid or when the muscles of the iris, the cells of Leiomioma can spread inside the eyeball: more often in the angle of the front chamber or to the surface of the iris.

Symptoms

Most often, the patient himself notices the first symptoms of Leiomioma in the form of a change in the color of the iris. However, as a rule, this does not occur immediately, but already with a significant size of the tumor. If a large number of vessels are located on the surface of the tumor, hemorrhages can occur into the front chamber of the eye - the so-called gifems. Sometimes such extensive hemorrhages may cause a decrease in visual acuity or an increase in intraocular pressure.

Tumor cells, spreading with current intraocular moisture, can overlap the paths of its outflow and cause the development of secondary glaucoma. Upon reaching a tumor of considerable size, it begins to touch the lens tightly, provoking its turbidity - cataract. In severe cases, during the germination of the leomyomes of the fabrics of the eye, along with damage to the fabrics, its complete destruction is possible.

Diagnostics

To diagnose leuomioma, a detailed inspection under the microscope is needed, in addition, a transillyllifyment is performed, when the flow of light passes through the eyeball, and depending on the shade, which the tumor discardes its dimensions.

Much additional information on the size of Leiomioma, about the degree of its introduction in the eye tissue gives an ultrasound study. When identifying patients with leiomioma, they are necessarily inspected after 3-6-8 months, in order to eliminate the malignant nature of the tumor.

Treatment of leiomioma iris

Leiomioma treatment surgical. The operation is performed exclusively at large tumors, high risk of introduction in eye tissue or with existing germination. The volume of surgical intervention is determined by the size of the tumor and the complications arisen.

If the surgical intervention is not shown, the patient is under the obligatory observation of the eyepiece or an ophthalmologist and is inspected 1 time per year.

Moscow clinics

Below are the top 3 ophthalmological clinics of Moscow, where you can pass the leiomioma iris.

Moscow Eye Clinic

Clinic Dr. Shilova T.Yu.

MNTK named S.N. Fedorov

All Eye Clinic Moscow \u003e\u003e\u003e

We drink from the Bowl of Being with closed eyes, shaken ochicing edges with their own tears.

M. Yu. Lermontov

In the 60-70s of the XX century. In ophthalmology, an independent clinical direction was allocated - ophthalmomcology, which should solve the issues of diagnosis and treatment of organic tumors. Tumors of this localization are characterized by a large polymorphism, the originality of clinical and biological flow. Their diagnosis is difficult, the complex requires it tool methods Research owed ophthalmologists. Along with this, knowledge is needed to apply diagnostic measures used in general oncology. Significant difficulties occur in the treatment of eye tumors, its apparatus and orbit, since in small volumes of the eye and orbit, a large number of anatomical structures are concentrated in small volumes, which complicates the conduct of therapeutic measures with the preservation of visual functions.

The annual incidence of tumors of the vision organ of the patient is 100-120 per million people. The incidence of children reaches 10-12% of the indicators established for the adult population. Taking into account the localization, the tumors of the apparatus of the eye (eyelids, conjunctivation), intraocular (vascular shell and retina) and orbits are isolated. They differ in histogenesis, clinical flow, vocational and life

forecast. Among the primary tumors, the first place in the frequency occupy the tumors of the apparatus of the eye, the second - intraocular and third - orbit tumors.

20.1. Tumors of the Century

Benign tumorsmake up the main group of tumors of the eyelids. The source of their growth can be skin elements (papilloma, sedenive wart, follicular keratosis, keratoacanta, sedenie keratosis, skin horn, Bowen's epitheloma, pigment kservoch), hair follicles (Maller's epitheloma, tricoepitheloma). Less often occur tumors derived from other tissues.

Papilloma it usually occurs after 60 years, its favorite localization is the lower eyelid. Tumor grows slowly, for her characteristic

Fig. 20.1.Papilloma of the lower eyelid.

Fig. 20.2.Shenyl wart.

pauses of the sprouting of a spherical or cylindrical shape (Fig. 20.1). The color of papilloma is grayish yellow with a dirty rode due to horny plates covering the surface of the papillas. The tumor grows from skin elements, has a developed strom. Cell elements are well differentiated, the covering epithelium is thickened. Surgical treatment. Largeness is observed in 1% of cases.

Shenyl wark develops after 50 years. Localizes in the area of \u200b\u200bthe temple, eyelids, at the cereal edge or in the intermarpal space, more often of the lower eyelid. It has the form of a flat or slightly protruding education with clear and even boundaries (Fig. 20.2). Color gray, yellow or brown, dry and rough surface, horny plate discs. Height slow. In the treatment, there is effectively laser evaporation or cryodestruction. There are cases of misstitution, but without metastasis.

Shenyl keratosis appears after 60-65 years. It grows in areas that are subjected to insolation, especially often in the field of the skin of the eyelid, in the form of multiple flat sections of white color covered with scales. With a microscopic study, thinning or atrophy of the epidermis are detected. The most effective methods of

changing is cryodestruction and laser evaporation. In the absence of treatment, approximately 20% of cases occurs the misstatement.

Skin Rog it is a finger-shaped skin gross with elements of an enemy, the surface of it has a grayish-dirty shade. Diagnose from elderly. In the treatment, electrified laser cresisia is used.

Epithelioma Bowen. posted by flat, rounded shape stain dark red. The tumor thickness is insignificant, the edges are smooth, clear. It is covered with gentle scales, when removing which the waving surface is exposed. Infiltrative growth appears when switching to cancer. Effective treatment methods are cryodestruction, laser evaporation and short-flowing radiotherapy.

Pigment Keroderma - Rarely observed disease with an autosomal-recessive type of inheritance. It manifests itself in small children (up to 2 years) in the form of increased sensitivity to ultraviolet radiation. In places exposed to even short-term insolation, the foci of erythema of the skin arise, subsequently replaced by the Pigmentation sites. The skin gradually becomes a dry, thinned, rough, in its atrophied areas, telegangectasy develops. After 20 years on the modified skin sections, multiple tumor foci appear along the edge of the century, more often than basal cell cancer. Treatment - eliminate ultraviolet irradiation.

Capillary hemangioma in 1/3 cases congenital, more often observed in girls. In the first 6 months of life, the tumor grows quickly, then the stabilization period occurs, and by 7 years most of the patients have complete regression of hemangioma. The tumor has the type of nodes of bright

red or bluish. It is often localized in the upper eyelid, it germinates it, which leads to the appearance of partial, and sometimes full ptosis. As a result of the closure of the eye cracking, ambulopia develops, and due to the pressure of the thickened century, corneal astigmatism arises. There is a tendency to spread the tumor outside the skin of the eyelids. Microscopically hemangioma is represented by capillary slots and trunks filled with blood. Treatment of flat surface capillary hemangioma is carried out using cryodestruction. In the node form, the immersion diathermocoagulation of a needle electrode is effective, with common forms use radiation therapy.

Nets - Pigment tumors - reveal in newborns with a frequency of 1 case for 40 children, in the second-third decades of life their amount increases sharply, and by 50 years significantly decreases. The source of nevus growth can be epidermal or dendritic melanocytes, non-agitous cells (non-agita), dermal or spindle-like melanocytes. The first two types of cells are located in the epidermis, and the latter in the subepithelial layer. The following types of nonsense are allocated.

Border(Yuncational) Necess is characteristic of childhood, is represented by a small flat dark spot, located primarily at the intermarpal edge of the century. Treatment is in full tumor electroxcision.

Juvenile(Roshetoecellular) Neva appears in children and young people in the form of a pinkish-orange well-graduated nodule, on the surface of which there is no hair cover. The tumor increases quite slowly. Surgical treatment.

Fig. 20.3.Giant Necess of the skin of the eyelid.

Giant(system melanocytic). As a rule, the tumor is intensively pigmented, can be located on symmetric sections of the age, as it develops as a result of migration of melanocytes at the stage of the embryonic age before their separation, captures the entire time of the century, spreading to intermarginal space, sometimes on the conjunctival of the eyelid. Neva borders uneven, coloring - light brown or intense black(Fig. 20.3). The tumor can have hair cover and papillary sprouts on the surface.Growth throughout the thicker leads to the appearance of PTOs. Pospill growths along the edge of the eyelid and improper growth of eyelashes cause tearing, stubborn conjunctivitis. Treatment is effective in phased laser evaporation, starting with infant age. The risk of illustrative at large nevists reaches 5%, the focuses of malignization are formed in deep layers of the dermis, and therefore its early diagnosis is almost impossible.

Neva Otaor Okulodermal melanomine, arises from dermal melanocytes. The tumor is congenital, almost always one-sided,

manifests itself with flat spots of reddish or purple color, usually located along the branches trigeny nerve. Necess OTA may be accompanied by melanosis conjunctivations, sclers and choroids. There are cases of mischief with the combination of a non-neuity of OTA with an intense melanomine.

Benign nevies can progress with different frequency and speed. In this regard, the selection is extremely important. signs of the progression of the nevus: the nature of the pigmentation changes, a delicate pigment is formed around the nevus, the nevus surface becomes uneven (papillomatous), stagnation vessels appear on the periphery of the nevus, its size increases.

Malignant tumorsthe age is presented mainly by the cancer of the skin and adenocarcinoma of the meibomic gland. In development, excessive ultraviolet irradiation play a role, especially in persons with sensitive skin, the presence of non-healing ulcer lesions or the effect of papillomatous human virus.

Basal cell cancer. The favorite tumor localization is the lower eyelid and the inner spike of the eyelids. Eliminate the nodal, corrosive and ulcerative and scleroderm-like forms of cancer. Clinical signs depend on the shape of the tumor. In the node form, the tumor boundary is quite clear (Fig. 20.4, a); It grows over the years, as the sizes increase in the center of the node, a crater-like bearent appears, sometimes covered with a dry or bleeding crust, after the removal of which the mockless painless surface is exposed; The edges of ulcers canal. With a corrosion-ulcer form, a small, almost imperceptible painless ulcer with raised edges appears at first. Gradually the area of \u200b\u200bulcers increases, it

Fig. 20.4.Basal cell cancer. a - upper eyelid (node \u200b\u200bform); B - Upper and lower eyelid (collapsed form).

it is covered with dry or blood crust, it is easy to bleed. After removing the crust, a rough defect is exposed, on the edges of which burglar growths are visible. The ulcer is more commonly localized near the marginal edge of the century, capturing all its thickness (Fig. 20.4, b). The scleroderm-like shape in the initial stage is represented by erythema with a mocking surface covered with yellowish flakes. In the process of tumor growth central part The wet surface is replaced by a sufficiently dense whisker scar, and the progressive edge applies to healthy fabrics.

Fig. 20.5.Scaly-cell cancer of the lower eyelid.

Scaly-cell cancer. In the initial stage, the tumor is represented by a lowered erythema of the skin, more often of the lower eyelid. Gradually, a seal with hyperkeratosis on the surface appears in the erythema zone. Perifocal dermatitis arises around the tumor, conjunctivitis develops (Fig. 20.5). The tumor grows for 1-2 years. Gradually, in the center of the node, a deepening with an ulcerated surface is formed, the area of \u200b\u200bwhich is gradually increasing. The edges of ulcers are dense, bug. When localizing the edge of the eyelid, the tumor quickly spreads to orbit.

The treatment of cancer is planned after obtaining the results of the histological research of the material obtained during the tumor biopsy. Surgical treatment is possible when the tumor diameter is not more than 10 mm. The use of microsurgical techniques, a laser or radiosurgical scalpel increases the effectiveness of treatment. Contact radiation therapy (brachytherapy) or cryodestruction can be performed. During localization

tumors near intermarginal space can be carried out only exterior irradiation or photodynamic therapy. In the case of germination of the tumor on the conjunctival or in orbit, the substitute for the latter extentation is shown. With timely treatment, 95% of patients live for more than 5 years.

Meibomic gland adenocarcinoma (iron cartilage gland). The tumor is located under the skin, as a rule, the upper eyelid in the form of a node with a yellowish tinge resembling a chalazion that recurns after removal or starts to grow aggressively after medical treatment and physiotherapy. After removal of the chalosion, histological examination of the capsule is performed.Adenocarcinoma may manifest itself with bluperoconjunctivitis and meibomitis, grows quickly, applies to cartilage, palpbral conjunctiva and its vaults, tear paths and nasal cavity. Given the aggressive nature of tumor growth, surgical treatment is not shown. With tumors of small sizes, limited to tissues of the eyelids, external irradiation can be used. In the event of a metastases in regional lymph nodes (near-dry, submandibular), their irradiation should be carried out. The presence of signs of the propagation of the tumor on the conjunctival and its vaults necessitates the extent of the orbit. The tumor is characterized by emergency malignancy. Within 2-10 years after radiation therapy or surgical treatment, 90% of patients occur. 50-67% of patients die from distant metastases for 5 years.

Melanoma developed from transformed intradermal melanocytes. Melanoma's risk factors: Netures, especially border, Melanose, individual increased sensitivity To intensive solar irradiation.

The clinical picture of the polysptomin. Melanoma can be represented by a flat focus of lesions with uneven and fuzzy edges of light brown, on the surface - nest more intense pigmentation. The nodal form of melanoma (more often is observed during localization on the skin of the eyelid) is characterized by a noticeable industrial over the surface of the skin, there is no skin pattern in this zone. The tumor increases rapidly, its surface is easily ulcerated, spontaneous bleeding are observed. Even with the easiest touch of the marlevary napkin or cotton swab to the surface of such a tumor, there remains a dark pigment (Fig. 20.6). Around the tumor leather is hyperemic as a result of the expansion of peripocal vessels, a veins of a sprayed pigment is visible. Melanoma early spreads to the mucous membrane, tear meat, conjunctiva and its vaults, in orbit fabrics. The tumor metasizes into regional lymph nodes, skin, liver and lungs.

Treatment should be planned only after a complete examination of the patient in order to identify metastases. With melanomas with a maximum diameter of less than 10 mm and the absence of metastases, it is possible to produce its surgical excision using a laser scalpel, a radioculpleel or electron-like with a mandatory tumor cryoction. Removing the focus of lesion through, retreat of at least 3 mm from visible (under the operating microscope) boundaries. Cryodestruction for melanomes is contraindicated.The nodal tumors with a diameter of more than 15 mm with a wedge of extended vessels are not subject to local excision, since metastases are already observed in this phase. Radiation therapy using a narrow medical proton beam is alternative

Fig. 20.6.Melanoma skin Nizhny

century.

circuit expendrates orbit. Regional lymph nodes should be exposed to irradiation.

The forecast for life is very heavy and depends on the depth of the proliferation of the tumor. Under the node form, the forecast is worse, because it is early arises invasion with tumor tissue cells vertically. The forecast deteriorates when the distribution of melanoma is spreading to the root edge of the century, intermarpal space and conjunctiva.

20.2. Tumors conjunctivations and cornea

The tumors of the conjunctivans and cornea are treated together, since the corneal epithelium is topographically continued by the epithelium of conjunctiva. The rich connective tissue basis of the conjunctiva predisposes to the occurrence wide spectrum tumors. In conjunctiva and the cornea, benign tumors (dermoids, dermolypes, pigment tumors) predominate, and at child age, they make up more than 99% of all tumors of this localization.

Benign tumors. Dermoid refers to malformations. This is the formation of whitish yellow

Fig. 20.7.Tumors conjunctiva and cornea.

a - Dermoid cornea; B - Dermolipoma conjunctiva and cornea.

colors, more often located near the outer or lower domain limb. With such localization, the tumor is early spreading to the cornea and can germinate to its deep layers. Advanced vessels are suitable for neoplasm. The surface of the dermoid on the cornea is smooth, shiny, white. In a microscopic examination, the elements of sweat glands, fat lobes, hair are found in education. Dermolipoma (Fig. 20.7) - Dermoid with a large content of adipose tissue, is often localized

in the field of consignments of conjunctiva. Surgical treatment.

Papilloma. Tumor the first typeobserved in children; It is manifested by multiple nodules, often localized in the lower arch of conjunctiva. The nodules are translucent with a smooth surface consist of individuals permeated with their own vessels, which gives them a reddish-pink color. A soft consistency and a thin base in the form of a leg makes the nodules moving and easily-free: their surface is bleeding even with a slight touch with a glass stick. Elder patients have no oriental papilloma (second type),as a rule, it is localized near the limb in the form of single fixed formation of the grayish color. The surface of its rough, slices are poorly distinguishable. With such localization, papilloma applies to the cornea, where it has a type of translucent formation with a grayish tint. Papilloma of the first type of microscopically represented by non-illuminating papillary growths, in the center of which are the vascular loops. Such papillomas can spontaneously regress. Given the multipocheticity of the defeat, their surgical treatment is more often inefficient; Laser evaporation or applique of 0.04% mitomycin solution with the lesion area is shown. For energizing papilloma (second type), the papillary hyperplasia of the epithelium with severe phenomena of para- and hyperkeratosis is characterized. Such papilloma is subject to laserxcisia, as cases of its mischief are described. For full removal Tumors The forecast is good.

Epithelioma Bowen. it is a flat or slightly protruding conjunctivation surface plaque with clear borders of gray, with severe vascularization may have a reddish

tint. Bowen's epithelioma occurs in the epithelium, can penetrate into deep layers of conjunctiva, but the basal membrane always remains intact. By turning to the cornea, the tumor does not germinate the bowman membrane. Treatment Surgical or combined, including tumor treatment with a tumor 0.04% Mitomycin solution from 2-3 days before surgery, excision of the tumor and processing the operating room with a solution of mitomycin with an operating table and in the next 2 to 3 days. Effective short-circuit radiotherapy.

Vascular tumors conjunctivities are represented by capillary hemangioma and lymphangioma; Referent to the group GaMart are observed from birth or manifest themselves in the first months of life. Capillary hemangiomait is often localized in the inner corner of the eye slit, consists of sharply convoluted blue vessels of small caliber, which infiltrate the semi-short fold and the conjunctival of the eyeball. Navigating the vaults, the vessels can penetrate orbit. Spontaneous hemorrhages are possible. Treatment is a dosage submersible electrocoagulation. At an early stage, lasercoagulation is effective.

Lymphangomait occurs significantly less often by hemangiom, represented by extended thin-walked vascular channels of the wrong shape, the inner surface of which is lined with endothelium. These channels contain serous fluid with an admixture of red blood cells. The tumor is localized in the conjunctival of the eyeball or its vaults. The process involve a semi-lobby and tear meat. The tumor looks like a translucent yellowish thickening of the conjunctiva, consists of small lobes filled with transparent liquid, sometimes with an admixture of blood. On the surface of the lymphangioma are often visible

keea hemorrhage. In slices and between them there are vessels filled with blood. Tumor infiltrates soft orbit fabrics. Small, unpropered lymphangioma can be cured with C0 2 -Laser. With more common tumors, it is possible to recommend brachytherapy using a strontium applicator with the cutting of the cornea from the irradiation zone.

Nevus - Pigment tumor. On the clinical flow of nevuses are divided into stationary and progressive, Blue Nesus and primary acquired melanosis.

Stationary neust.The favorite localization is the eye conjunctivation of the eyeball in the field of the eye slit, never occurs in the mucous membrane of the eyelids. Neva coloring from light yellow or pink to light brown with a well-developed vascular network. Usually the tumor is located near the limb. Up to 1/3 stationary non-unprecedented nonsense. In a publ of the nevus color can change. The surface of the tumor is smooth or slightly rough due to the formation of small bright cysts in it, clear borders. When localizing in the conjunctival of the eyeball, the nevi is easily shifted over the scler, the Limb is immobile (Fig. 20.8). Semi-lord

Fig. 20.8.Nevi tear meat.

nesus is thickened, and in the field of the lacrimal meat, the tumor will break slightly. Borders are clear.

For progressive nevuscharacterized in size, color change. The nevus surface looks like a motley: along with unmanned or weakly pigmented areas, intensive pigmentation zones appear, the borders of the tumor becomes less clear due to the spraying of the pigment. The accumulation of pigment can be observed outside the visible borders of the tumor. Significantly expand their own tumors vessels, their number increases. Availability of triad signs - enhancing pigmentation, vascularization of the nevus and fuzziness of borders- Allows you to differentiate the true progression of the tumor from its increase due to the reactive hyperplasia of the epithelium. Restriction of the displaceability of the nevus in relation to the scler - the late symptom, indicating the development of melanoma.Treatment - the excision of the nevus - shown in the appearance of signs of its growth.

Blue (Cell) Neva- Congenital education, which occurs extremely rarely. It is considered as one of the symptoms of systemic lesion of the skin of the Okulodermal region. Flat formation, reaches large sizes, does not have a clear form, but its borders are well outlined. Blue Necess can be combined with melanosis. The treatment is not required, since the malignant variants of the blue nevus in the conjunctival is not described.

Primary acquired melanosis(PPM) conjunctiva, as a rule, one-sided. PPM foci flat, with sufficiently clear boundaries, have intense dark color. Reaching the limb zone, the tumor easily applies to the cornea. The treatment consists in wide laser -ugulation or tumor electroxcision with

Fig. 20.9.Melanoma conjunctiva and century on the background of the primary acquired melanosis conjunctiva.

a 0.04% appliqués of a 0.04% solution of Mitomycin C. With a slight distribution of PPM, quite good results gives cryodestruction. In cases of lesions of arches and barzal conjunctivations, brachytherapy is more effective. The prognosis is unfavorable, since in 2/3 cases, PPM is subjected to discharge (Fig. 20.9).

Malignant tumors. Cacheless Cancer Cancer it is rarely observed. The provoking factors include ultraviolet irradiation, a person's papillomatic virus and HIV infection. The tumor may have a form of a papillomatous white-pink node and even whiskers of pterigium in combination with inflammation elements. The boundaries of her fuzzy, on the surface in tumor papillars, chaotic gentle propelled vessels are clearly visible. The tumor is characterized by a sufficiently slow growth. The aggressiveness of it is due to invasion into the deepensing fabrics, the destruction of the cornea, sclera and germination of tumor masses in the cavity of the eye. The choice of treatment method is determined by localization and tumor sizes. With small tumors located on the limb and cornea, the pronounced effect gives instillation of the Mitomy

qina C according to a special scheme for 2 weeks. A combination of local excision tumor with cryodestruction is possible. When the localization of the tumor outside the limb and the cornea shows brachytherapy in combination with local laser -ugoagulation or electroxcision or wide excision with simultaneous cryoapplications on the wound surface.

Melanoma the conjunctivations develop from the primary acquired melanosis and pre-subsessing nonsense or is primary. The tumor can be pigmented or unmanned, the last long time flows asymptomatic; grows quickly in the form of a node or superficially; Sometimes multiple foci are formed, which can merge (Fig. 20.10). The surface of melanoma is smooth, brilliant. With a pigmented form on the border of the node, radially arranged pigment "tracks" or painting pigment are visible. A network of extended, stagnant-full-blood vessels is formed around the tumor. As the melanoma grows, its surface is ulcerated, the bleeding of the tumor appears. The occurrence of satellites as a result of the formation of eds and contact with the main tumor node is characteristic. The unmanned sections are especially dangerous, since because of the pink color, the doctor often does not notice them. Melanoma often sprouts in the cornea.

Treating tumor should be started as early as possible. With a localized melanoma, a combined organ-bearing treatment was shown, local excision and brachytherapy, local chemotherapy with Mitomycin C and Local Blockexcia (removal of a tumor with its healthy tissues). With a common tumor, as well as the melanoma of the tear butter and the semi-short folding effectively

Fig. 20.10.Melanoma conjunctiva.

lucky a narrow medical proton beam.

The forecast for the conjunctival melanoma is bad. When hematogenous metastasis, mortality reaches 22-30%. With adequate treatment, 5-year survival rate is 95%. The outcome of treatment largely depends on the localization and size of the tumor. With melanomes thick up to 1.5 mm, the forecast is better. If the tumor thickness reaches 2 mm and more, the risk of regional and distant metastases increases. The forecast is worsening in the case of the proliferation of the tumor on the tear meat, arches and palpbral conjunctiva. With epibulbar melanoma, especially localized in the field of limb, the forecast is more favorable.

20.3. Intraocular tumors

Among the neoplasms of the organ of vision, intraocular tumors in the frequency occupy the second place, most of them are malignant.

20.3.1. Tumors vascular eye sheath

The vascular shell tumors are more often represented by neuroectodermal genes, less commonly - mesodermal.

20.3.1.1. Tumors iris

Up to 84% of iris tumors belong to benign, more than half of them have a myogenic nature.

Benign tumors. Leiomiomoma it develops from the elements of the muscles of the iris, is characterized by extremely slow growth, it may be an unmanned and pigment.

Unmanned Leiomiomiomait grows locally in the form of a yellowish-pink translucent prominent node (Fig. 20.11, a). The tumor is localized along the edge of the pupil or, less often, in the root zone (in the field of ciliary crypt). The borders of the tumor clear, the consistency of loose, pupil. On the surface of it is visible translucent increases, in the center of which are vascular loops. Leiomioma, located at the edge of the pupil, leads to a twist of the pigment border and change its shape. When localizing the tumor in the zone of ciliary crypt, one of the first symptoms is an increase in intraocular pressure, so so patients often

put the diagnosis of one-sided primary glaucoma.

Pigment Leiomiomomait has a color from the light-brown light. The shape of the tumor can be nodal, plane or mixed (Fig. 20.11, b). It is more often localized in the ciliary belt of iris. Characteristically change in the shape of the pupil, its elongation due to the withdrawal of the pigment border, directed towards the tumor. The consistency of the pigment leuomioma is more dense than an unmanned, the surface is buggy, the newly formed vessels are not visible. The germination of the tumor into the angle of the anterior chamber is more than 1/3 of its circle leads to the development of secondary intraocular hypertension. Signs of the progression of the tumor is considered to be changes around the tumor: the smoothness of the Relief of the iris and the appearance of a pigment spraying zone, pigment tracks heading on the side of the tumor, the vascular whisk in the iris; Also the form of pupil is also changed. Passing in the structure of the angle of the anterior chamber and the ciliary body,

Fig. 20.11.Leiomioma iris. a - irrepressible; B - Pigment.

Fig. 20.12.Iridoagiogram. Leiomioma iris. Tumor vessels are clearly contrasted.

the tumor goes into the back chamber, causing shift and clouding. The diagnosis can be established on the basis of the results of biomicro-, gone, diaphanoscopy and iridoantagographics (Fig. 20.12). Surgical treatment: The tumor is removed along with the surrounding healthy tissues (blockexcia). The forecast for life is favorable, for view depends on the initial magnitude of the tumor: the smaller the tumor, the greater the likelihood of maintaining normal vision.

Nevus. Clinically Nesus has the form of a more intensively pigmented area of \u200b\u200bthe iris. Color varies from yellow to intense brown. The surface of the tumor velvety, uneven. Sometimes Nesus slightly protrudes over the surface of the iris. The boundaries are clear, the picture of the iris on the surface of the nevus is smoothed, in the central part, where the tumor is more dense, the drawing is absent. The sizes of the nevus oscillate from the pygmentation site of 2-3 mm to large foci, occupying one quadrant of the surface of the iris and more. When

gressing the tumor darkens and increases, there is a spray that did not observed the previously observed pigment and the vessel of extended vessels, the boundaries of education are becoming less clear.Stationary nevies should be under supervision. With the progression of the nevus, its excision is shown. Forecast for life and vision is good.

Malignant tumors. Melanoma. According to the nature of the growth of melanoma, there are nodal, diffuses (it is extremely rare) and mixed. The nodular melanoma has the appearance of a delimited node that is prompted into the front chamber. The tumor surface is uneven, the depth of the front chamber is uneven. The color of melanoma varies from a light tree of dark. Right in the stroma iris, the tumor can imitate the cyst. When contacting melanoma with rear epithelium, the cornea arises its local turbidity. A prolonged dilator of the iris, the tumor leads to a change in the shape of the pupil: its edge on the side of the tumor is compact, does not react to mydriatics. The tumor can fill the rear chamber, causing the compression of the lens, its turbidity and deployment of the stop. On the surface of the iris, complexes of tumor cells are scattered, it acquires a variety (Fig. 20.13). Due to persp

Fig. 20.13.Melanoma iris (iridocilization).

tannium tumor into the angle of the anterior chamber is disturbed by the outflow of intraocular fluid, a persistent, non-drugic therapy develops intraocular hypertension.

The diagnosis is established on the basis of the results of biomicro-, gone, diaphanoscopy and fluorescent iridoantagography. Surgical treatment. Localized melanoma iris, which occupies no more than 1/3 of its circle, is subject to local removal. It is possible to carry out local photodynamic therapy. With a larger focus of the defeat, it is necessary to recommend an enucleation of the eyeball. The forecast for life is usually favorable with the prevalence of the reluctoral type of tumor. Metastasation is observed in 5-15% of cases and mainly at large tumors. Forecast for view after the fulfillment of organ-powered operations is usually favorable.

20.3.1.2. Tumor ciliary body

Benign tumorsit is rarely observed, represented by adenoma, epithelium, medullo-absorment.

Malignant tumorsthere are more often found.

Melanoma carnish body. According to the morphological characteristics, this tumor is no different from melanoma choroids and iris, but there is a predominance of its epithelioid and mixed forms. Through a wide pupil is clearly visible a clearly eliminated node of the rounded shape, more often a dark color. For a long period of time, the disease proceeds asymptomatic. When the tumor is germinated, the form of the pupil changes into the dilator. Pupil does not respond to light. An impracticable melanoma has a pinkish shade, its own vessels are well visualized.

In the sector where the tumor is localized, congestive, convoluted episcileral vessels. In the later stages, secondary glaucoma develops. The tumor can germinate, forming under the conjunctiva node, more often dark.

Bomicroscopy, microcycloskopia, help in the diagnosis of melanoma wide pupil, gone and diaphanoscopy. In the treatment of localized melanomes, the ciliary body can be limited to its removal (partial lamellated scleroulectoectomy). Perhaps radiation treatment. With large tumors (occupying more than 1/3 of the circle of the ciliary body), only enucleation of the eyeball is shown. The germination of the tumor of the gloral capsule with the formation of concubitative nodes determines the need for an enucleation with the instrumentally proven absence of regional or hematogenous metastases. The forecast depends on the cell composition and sizes of the tumor.

20.3.1.3. Tumors Horioidemi

Benign tumors rarely occur, represented by hemangioma, osteooma and fibrous histiocyte.

Hemangioma - Rare congenital tumor, belongs to Gamartoms. It is randomly detected either when violating visual functions. Reducing vision is one of the early symptoms of growing hemangioma in adults, in childhood, the squint is appointments. In the hemangioma chorioide, it almost always has the appearance of an isolated node with sufficiently clear boundaries, a rounded or oval shape, the maximum tumor diameter is 3-15 mm. Promination of the tumor varies from 1 to 6 mm. Typically, the color of the tumor pale gray or yellowish-pink may be intense

sure red. Secondary retinal detachment, its folding is observed with almost all patients, with large tumors it becomes bubble.

The diagnosis of cavernous hemangioma is difficult. The discrepancy between clinical data and the results of histological studies are noted in 18.5% of cases. In recent years, the diagnosis has become more reliable due to the use of fluorescent angiography. Treatment for a long time was considered unpromising. Currently use laser -ugulation or brachytherapy (contact irradiation with radioactive ophthalmapplists). The forecast for life is favorable.

Pignet tumors. Nevus- The most commonly occurring benign intraocular tumor. At the eye day, they have a form of flat or slightly prominent foci (up to 1 mm height) of light gray or gray-green color with cervical, but clear boundaries, the diameter of them ranges from 1 to 6 mm (Fig. 20.14). Eurent neules have an oval or rounded shape, their borders are more even, but less clear due to the lack of pigment.

Patients with stationary nevys are not required treatment, but they need a dispensary observation, since in the process of the tumor's life can grow, turning into the stage of the progressive nevus and even the initial melanoma. Progressive nevuses, taking into account the potential to be reborn and the transition to melanoma is treated.Most effective method The destruction of the progressive nevus is a laseroagulation.

Melanoma- Large-cellular nonsense with a benign flow, usually localized on the disk of the optic nerve, but can be located in other departments

Fig. 20.14.Nesus chorioide.

suddy shell. The tumor is asymptomatic, and in 90% of patients it is revealed by chance. With large melanocytes, small impairment of violations and an increase in the blind spots may be occurred. The color of the tumor in most patients is intense-black, on the surface there may be bright hotels - druses of a glassy plate (Fig. 20.15). Treatment

Fig. 20.15.The melanocytoma of choroids, localizing in the peripapillary region and spreading to the disk of the optic nerve.

Fig. 20.16.Melanoma Horoids.

a - Eye bottom; B - Macrobreparation eyes with melanoma choroid.

not required, but patients must be under the systematic observation of an ophthalmologist.

Malignant tumorspresented mainly melanomas.Raverocellular melanoma metastasizes in almost 15% of cases. The frequency of metastasis of epithelioid melanoma reaches 46.7%. Thus, cellular

Fig. 20.17.An unmanned melanoma node of choroids with hemorrhages on the surface of the tumor.

the characteristic of an involuntary melanoma is one of the defining factors of the forecast for life. More than half of melanoma is localized by the equator. The tumor, as a rule, grows in the form of a solitarian node (Fig. 20.16). Typically, patients are presented with complaints of impairment, photo and morphopia.

In the initial stage, the tumor is represented by a small hearth brown or dark gray. As the tumor increases, it can become more intense (sometimes even dark brown) or remains yellowish-pink, unmanned (Fig. 20.17). The increase in the thickness of melanoma causes dystrophic changes In the membrane of Bruch and pigment epithelium of the retina, as a result of which the intake of the glassy plate is disturbed and the tumor germinates under the retina - the so-called mushroom form of melanoma with a wide base is formed (Fig. 20.18).

It is extremely difficult to recognize melanoma choroids with opaque environments. In such cases, the diagnosis is helped by additional

Fig. 20.18.Ultrasonic scanogram eye. The shadow of the forming mushroom melanoma of choroids and the secondary retinal detachment are visible.

research methods ( ultrasonic scanning, cT scan). Before addressing the question of the nature of the treatment of the oncologist must be a thorough examination of the patient in order to exclude metastases. It should be remembered that during the initial handling of the metastase ophthalmologist is found in 2-6.5% of patients with large tumors and in 0.8% with small melanomes.

For more than 400 years, the only treatment of melanoma choroid was an enucleation of the eyeball. Since the 70s of the 20th century, organ-bearing treatment methods, the purpose of which is to preserve the eye and visual functions, has begun to use the purpose of which is the preservation of the tumor. Such methods include laser buds, hyperthermia,

cryodestruction, radiation therapy (brachytherapy and tumor irradiation with a narrow medical proton beam). Naturally, organ-bearing treatment is shown only with small tumors.

Melanoma metastasizes the hematogenic path, most often in the liver (up to 85%), the second place in the frequency of metastasis occurs

lungs. The use of chemo and immunotherapy in metastases of inhaul melanoma is still limited due to the absence positive effect. The forecast for view after brachitherapy is determined by the size and localization of the tumor. Vision succeeds in the localization of the tumor outside the macular zone. Eye as a cosmetic authority remains 80% of patients. After treatment, patients should be under observation almost until the end of life. After radiation therapy and local tumor removal, the doctor should examine patients every 3 months in the first 2 years, then 2 times a year during the 3rd and 4th year, then 1 time per year.

20.3.1.4. Network tumors

The retinal tumors make up 1/3 of all intraocular neoplasms. Benign tumors(Hemangioma, astrocytic Gamartom) are extremely rare. The main group is represented by the only malignant tumorretina in children - retinoblast.

The predisposition to the occurrence of the retinoblastoma is currently associated with the presence of germinal mutation in one of the hen alleles RB1,which is inherited by autosomal dominant type.

Tumor develops in children early age (up to 1 year). In 2/3 patients with the hereditary form of the retinoblastoma, it turns out to be bilateral. In addition, with family forms of retinoblastoma gene RB1damaged in all somatic cells, therefore such patients are highly risk of other localization tumors. The detection of the retinoblastoma in the child under the age of 10 months indicates its congenital character, the tumor after 30 months can be considered

to give as sporadic. The sporadic form is about 60% of all the retinoblast, always one-sided.

The retinoblastoma is developing in any department of an optically active part of the retina, at the beginning of its growth looks like a disruption of the definition of reflex on the eye day. A grayish, turbid flat focus appears later with fuzzy contours. In the future, the clinical picture varies depending on the peculiarities of the retinoblast growth. Endophytic, exofic and mixed tumor growth.

Endophyato growingthe retinoblastoma occurs in the inner layers of the retina and is characterized by growth in the vitreous body. The surface of the tumor is buggy. The thickness of the node gradually increases, the color is preserved by whiteish yellow, the retinal vessels and the eigen breeding vessels are not visible (Fig. 20.19). In the vitreous body over the tumor, conglomerates of tumor cells appear in the form of stearin drops, stearine tracks. Fast tumor growth accompanied by a violation in it exchange processes, leads to the appearance of necrosis areas with cotton decay, subsequently ordinary

Fig. 20.19.Retinoblastoma (endophyte

naya form).

with the formation of calcifications. When the tumor is localized in the pre-consisual zone of its cell, settled in the rear and front chambers of the eye, create a picture of the pseudogopopion, the color of which is, in contrast to the color of the true hypocoon, whitish-gray. By increasing in size, the tumor fills the entire cavity, resulting in an intraocular pressure. In early age children develops a buffathalm, there is a thinning of the sclerichimbal zone, which facilitates the spread of the tumor outside the eye. Under germination, the sclera's tumor behind the equator occurs a cellulite pattern.

Exofite growingthe retinoblastoma occurs in the outer layers of the retina and applies to the retina, which leads to its massive detachment, the dome of which is visible for a transparent lens. At ophthalmoscopy, the tumor detects in the form of one or more delimited nodes with a smooth surface. Draining extended and convinced retinal vessels are suitable for tumors. On the surface of the tumor are visible tender convolutions, chaotic neoporated vessels.

For retinoblastoma, multifocal growth is characteristic. Tumor nodes are localized at different sections of the eye dna, they have a rounded or oval shape, the thickness of them is different. Sometimes hemorrhages on the surface of the tumor merge and completely overlap the tumor. In such cases, with the peripheral location of the retinoblastoma, the first symptom may be "spontaneously" the hemophthalm arising.

Mixedretinoblastoma is characterized by a combination of ophthalmic symptoms peculiar to the two forms described. Well known signs of retinoblastoma - "Glow" of pupil and squint, heterochromia or rubles

iris, microphalm, buffals, gifema, hemophthalm - should be regarded as indirect, which may be observed with other diseases. Retinoblastoma can flow without indirect signs and is discovered, as a rule, with preventive inspections.

Retinoblastoma in older children is characterized by a decrease in visual acuity. In the clinical picture, signs of sluggish uveitis prevail, the secondary sick glaucoma, retinal detachment, rarely develops retinal angiomatosis. The occurrence of the retinoblastoma at this age when the probability of its development is small, complicates the diagnosis.

Trilateralthe retinoblast is regarded as a bilateral tumor, combined with an ectopic (but not metastatic!) Inrastranial tumor. The third tumor is usually localized in the area sishkovoid glandBut may occupy the median brain structures. Clinically tumor manifests 2-3 years after the detection of bilateral retinoblastoma.

Retinocytomaregarding as a rare variant of retinoblastoma with a more benign flow due to incomplete mutation of the Retinoblast gene. The predinocytime prognosis is more favorable due to the presence of clear signs of differentiation in the form of the formation of true sockets and the inclination to spontaneous regression.

For the diagnosis of retinoblastoma use ophthalmoscopy, which should be carried out at maximize pupil expansion,and in young children - during medication sleep. When viewed an eye-catching bottom on extreme peripherals, it is necessary to apply sclerokompression, which makes it possible to more detail these hard to access the sections for visual control. Ophthalmo-

fIU follows all meridians(!). In difficulties, with the pre-equipment of the tumor or the presence of the pseudogipopion, a thin-game aspiration biopsy is shown. Ultrasonic scanning allows you to determine the dimensions of the retinoblastoma, confirm or eliminate the presence of calcifications.

The treatment of the retinoblastoma is integrated, aimed at preserving the life of a sick child and his eyes, always individual, it is planned depending on the stage of the process, the overall condition of the child, the risk of the occurrence of second malignant tumors and the ultimate requirement of parents to preserve vision. With small tumors, the use of local destruction methods allows to preserve the eye, and in combination with polyhemotherapy - to achieve 5-year survival rate of almost 90%. For large tumors, polychimotherapy in combination with enucleation of the eye provides a 4-year survival rate of more than 90%. The retinoblastoma is disseminated along the optic nerve along the inter-bore space, the hematogenic path is propagated into the bone, the brain, lymphogenic pathway - into regional lymph nodes.

In order to identify early recurrences of the tumor after enucleation of the eyeball or the occurrence of a tumor in a double eye, a test inspection of a child is obligatory. With a monolateral retinoblast, it should be carried out every 3 months for 2 years, with bilateral - for 3 years. In children over 12 months after the end of treatment, 1 time per year it is advisable to carry out computer tomography of the head, which will control the condition of the soft tissues of orbits and eliminate the metastasis of the tumor in the brain. Healing children must be under dispensary observation for life.

20.3.1.5. Elets tumors

In the orphanage, almost all tumors observed in humans are developing.

Benign tumors.For

benign orbit tumors are characterized by a common clinical picture: edema, stationary exophthalm, the difficulty of reposition and restrictions of eye mobility, changes on the eye day, reducing vision, pain in the affected orbit and the corresponding half of the head. A small tumor located at the vertex of the orbit, for a long time can proceed asymptomatic.

Vascular tumors most often presented cavernous hemangioma.The tumor is detected at the age of 12-65, women are 2.5 times more often; It has a well-pronounced pseudocapsula. Microscopically, the cavernous hemangioma consists of large extended vascular channels lined with compressed endothelial cells, there is no direct transition of the tumor vessels in the vessels of surrounding orbital tissues. Clinically, the tumor is characterized by slowly increasing stationary exophthalm (Fig. 20.20, a). The close arrangement of it at the sclera leads to the formation of the vitreous plate (membrane of the Bruha) and dry dystrophic devices in the paramaacular region (Fig. 20.20, b). The reposition of the eye, despite the sufficient elasticity of hemangioma, as a rule, difficult. The deeper localization of the cavernous hemangioma (the top of the orbit) may be accompanied by pain in the affected orbit and the corresponding half of the head. Usually, with such localization, the picture of the congestion of the optic nerve or its primary atrophy occurs early. The diagnosis is clarified using computed tomography, when

Fig. 20.20.Cavernous hemangioma right orbit.

a - the eye slit is expanded, exophthalm with a slight displacement of the eyeball; B - Eye bottom: Broch membrane folding (symptom of the "cross-alling retinal").

the second is detected with a cellular rounded shadow with even contours, delivered from the capsule surrounding tissues. The intensity of the teeth of the tumor increases in the case of its contrast. With ultrasound scanning, a tumor shadow is found limited to a capsule. Surgical treatment. Taking into account the capabilities that have appeared with a clear tumor topometry using computed tomography and the use of microsurgical equipment should be recommended to perform the operation immediately after the diagnosis is established. There is no reason to wait for the progression of clinical

symptoms, since their appearance can lead to irrelevant loss of visual functions.

Tumors of the optic nerve presented with meningoma and glioma.

Meningomadeveloped from arachnoid pile, located between solid and bypass shells. The diameter of the optic nerve, affected by the tumor, increases 4-6 times and can reach 50 mm (Fig. 20.21). Meningioma is able to germinate the shell of the optic nerve and spread to soft orbit fabrics. As a rule, the tumor is one-sided, characterized by an exophthalm with an early decline in vision. During germination of orbit tissues, restriction of eye movements occurs. At the eye day - a sharply pronounced congestion disk of the optic nerve, less often - his atrophy. The appearance of a significantly expanded vein of the shiny color on a stagnant disk testifies to the spread of the tumor directly to the rear pole of the eye.

The diagnosis of meningioma is difficult, as even on computer tomograms, especially in the initial stage of the disease, the optic nerve is not always so increased to assume its tumor defeat. Treatment - operation or radiation therapy. Forecast for vision is unfavorable. With the growth of tumors along the stem of the optic nerve there is a threat to the spread of it into the cavity of the skull and the damage of the chiasma. The forecast for life is favorable at the location of the tumor within the cavity of the orbit.

Gliomaconsists of three types of cells: astrocytes, oligodendrocytes and macroglia. It is characterized by extremely slow, but steadily progressive decrease in visual acuity. In children under 5 years old, the first sign, which is paid by parents, - squint, is possible Nistagm. Exophthalm

Fig. 20.21.Computer tomogram eye. Meningioma optic nerve. A shadow of an uneven thickened optic nerve is visible, the tumor does not go beyond the limits of the orbit.

a chionary, painless, appears later and very slowly increasing. It can be axial or shifted with eccentric tumor growth. The reposition of the eye is always difficult. At the eye day, the stagnant disc or atrophy of the optic nerve is equally revealed. The intracranial propagation is accompanied by a violation of the functions of the hypothalamus, the fifth grazing gland, an increase in intracranial pressure.

The diagnosis of glioma is determined based on the results of computed tomography, with which it is possible not only to visualize an increased visual nerve in orbit, but also judge the propagation of the tumor along the channel of the optic nerve into the skull cavity (Fig. 20.22). Ultrasonic scanning is not informative enough, as it represents the image of only the proximal and medium third-party spawning nerve. Taking into account the extremely slow tumor growth, treatment is strictly individually. When preserving the view and the possibility of observing the patient alternative to the long-term

Fig. 20.22.Computer tomogram eye. Glioma optic nerve. In the lumen of the orbit, the shadow of the spine-like thickened optic nerve is projected, the visor's nerve canal is free from the tumor.

there may be radiation therapy, after which there is a stabilization of tumor growth, or even an improvement in vision. Surgical treatment is shown in the damage to the tumor only orbital segment of the optic nerve. If the tumor germinates to a gloomy ring, which is clearly visible on computer tomograms, the affected visual nerve is to be removed with the eye. In the case of tumor propagation in the channel of the optic nerve or the cavity of the skull, the question of the possibility of execution operational intervention Solves neurosurgeon. The forecast for vision is always bad, and it depends on the spread of the tumor to the skull's cavity. In engaging in the tumor process, the mortality rate reaches 20-55%.

Nevnoma(Synonyms: Lemma, Swannoma, Neurolamma). In orbit, the source of this tumor is in most cases the ciliary nerves, appropriate or dischard, it can also be formed from the Lemmocytes of the sympathy

ticker nerves, innervating vessels of the meningeal shell of optic nerve and retinal artery. One of the first signs of the tumor can be localized pain in the affected orbit, the abnormal edema of the age (more often than the top), partial ptosis, diplopia. In 25% of patients, primarily attracts attention to exophthalm, axial or displacement. The tumor is more often located under the upper orbital wall in the outer surgical space. The zone of sebum anesthesia suggests the "interest" of a blank or outbound nerve. In 1/4 patients there are anesthesia of the cornea. A large tumor limits the movement of the eye towards its localization. On the eye dna - swelling of the optic nerve. With ultrasound scanning, it is possible to visualize the shadow of the tumor, drawn by the capsule. On a computer tomogram is visible not only the shadow of the tumor, but also its relationship with the visual nerve. The final diagnosis is set after histological research. Treatment only surgical. Not fully removed tumor prone to recurrence. The forecast for sight and life is favorable.

Congenital neoplasms.The neoplasms of this group include dermoid and epidermoid (choleateatom) cysts. The growth is accelerated by the transferred injury, the cases of misstitution are described.

Dermoid cyst it grows extremely slow, but in the pubertal period and during pregnancy there are cases of its rapid increase. The cyst develops from the wandering epithelial cells concentrating near the bone seams, is located under the periosteum. The epithelium of the inner wall of the cyst secretes the mucous membrane

my admixture of cholesterol crystals, which gives it a yellowish tint. In the cyst can be short hair. Favorite localization - area of \u200b\u200bbone seams. Complaints of patients, as a rule, are reduced to the emergence of painless edema of the upper eyelid, respectively, the location of the cyst. The skin of the century in this zone is slightly stretched, but its painting is not changed, the elastic, painless, still education is palpable.

Extremely rarely dermoid cyst is localized deep in orbit. This is the so-called kotomkovoid dermoid cyst orbits.

Treatment surgical: showing substitute orbitotomy. Forecast for life and view favorable. Recurious should be expected in pronounced changes in the subordinate bones or the appearance of postoperative fistula. Recurrent dermoid cysts can be ill countered.

Choleateatom or an epidermoid cyst, develops in the fourth decade of life. Etiology and pathogenesis are unclear. For cholesteatoms, the local arrangement of bone tissue, which becomes soft; The areas of osteolysis increase. As a result of the detachment of the periosteum to the necrotic masses, the volume of the orbit decreases. Gradually develops painless exophthalm. The reposition is difficult. There are no changes in the eye day, the functions of extracular muscles are preserved in full. The diagnosis is set based on radiography results and computed tomography. Treatment only surgical. The forecast for life and vision is usually favorable, however, cases of illustrative of cysts are described.

Pleomorphic adenoma (mixed tumor) - a benign version of the primary tumor of tears

iron gland. The tumor consists of two tissue components: epithelial and mesenchymal. The epithelial component forms plots of mucus and chondrop-like structures. Stromrom (mesenchymal component) is heterogeneous within one node: sometimes it is loose, there are connective tissues in some sites, sites of hyalinosis are noted. The tumor develops slowly. Patients appeal to the doctor in 2-32 years from the date of appearance clinical symptoms. One of the first is painless, unreactive edema of the age. Gradually, the eyeball shifts down the book and Knutrice. Exophthalm occurs much later and very slowly increases. During this period, a fixed formation is already possible to palpate, located under the top-load or upper edge of the orbits. The surface of the tumor is smooth, with palpation it is painless, dense. The reposition is difficult.

When radiography, an increase in the orbit cavity is detected due to thinning and offset, and the duck of its wall in the field of a lacrimal fox. Ultrasonic scanning allows you to determine the shadow of a dense tumor, surrounded by a capsule, and the deformation of the eye. In computed tomography, the tumor is visualized more clearly, you can trace the intake of the capsule, the prevalence of the tumor in the orbit, the state of its adjacent bone walls. Treatment only surgical. The forecast for life and vision in most cases is favorable, but the patient should be prevented about the possibility of recurrence, which may arise after 3-4 years. The danger of malignant rebirth of the pleomorphic adenoma increases as the remission period increases.

Malignant tumorsorbits, like benign, poly-

the morphs of histogenesis, the degree of their malignancy is variable. More often meet sarcoma and cancer. General clinical symptoms of malignant orbit tumors - early diplopia and century edema, originally transient, appearing in the mornings, and then passing to stationary. For these tumors, the permanent pain syndrome is characterized, the Exophthalm occurs early and increases rather quickly (within a few weeks or months). Due to the compression of the vascular bundle of the growing tumor, the deformation of the eye and the large exophthalma is disturbed by the protective function of the eyelids: these patients are rapidly growing dystrophic changes in the cornea, ending with its complete melting.

Cancer in orbit in the overwhelming majority of cases, it develops in a lacrimal gland, it is less commonly represented by heterotopic cancer or embryonic infantile carcinoma.

Cancer glanddiffers in significant cellular variability, grows quickly. The history of the disease usually does not exceed 2 years, most often patients note the accelerated increase of all symptoms within a few (up to 6) months. Often the first symptoms of developing cancer are pain, discomfort, tear, uneven omission of the upper eyelid. It develops to exophthalm with the displacement of the eyeball of the Book and Knutrice. As a result of mechanical deformation of the eye, astigmatism develops the tumor. The palpable tumor is littering, almost does not shift towards the subjectable tissues. The movement of the eye towards the location of the tumor is limited, the reposition is sharply difficult.

The diagnosis is established only after histological examination. Presumable diagnosis

it can be installed on the basis of the analysis of clinical symptoms and instrumental results. With radiography, against the background of the orbit in size, the areas of bone degradation are detected. Computer tomography allows you to determine the length of the teased of the tumor, the distribution to the adjacent extracular muscles and the uneven contours of the bone wall of the orbit or its complete destruction, and the ultrasonic study is only the presence of a tumor shade and its density. The radiocyntigram of the orbit during adenocarcinoma is characterized by an increase in the asymmetry coefficient characteristic of malignant tumors. Informative remote thermography, especially with sugar load. Preoperative fine game aspiration biopsy helps to clarify the diagnosis.

Treatment of tear cancer is a complex task. Along with a radical point of view, the supporters of which require mandatory extents of the orbit, there is an opinion on the possibility of conducting organ-bearing treatment, combining the excision of the tumor with a block of adjacent healthy tissues and postoperative outer irradiation of the orbit. The choice of this or that method of treatment depends on the size of the tumor and its prevalence. In disruption of bone objects of orbit, surgical treatment, including extentation, contraindicated. The forecast for life and vision is bad, since the tumor is not only prone to recurrence with germination into the cavity of the skull, but also to metastasis in the lungs, spine or regional lymph nodes. The timing of metastases varies from 1-2 to 20 years.

Primary cancer orbitit is rare. The tumor grows slowly, without capsule. When localizing

holi B. front Department Orbits The first symptom is the displacement of the eye to the side, the opposite localization of the tumor, its mobility is sharply limited, slowly increasing the exophthalm, which never reaches large degrees, but the reposition of the eye is impossible. There is a stagnation in episcrue veins, an ophthalmotonus increases. The eye, as it were, a tumor in orbit, the bone edges are "smoothed" by the surrounding tumor and become inaccessible to palpation. Summary functions are preserved over a long period of time, despite the secondary intraocular hypertension.

When the tumor localization, the vertices of the orbit, pain with irradiation in the corresponding half of the head occur. As the tumor grows, complete ophthalmoplegia arises. The primary atrophy of the optic nerve disk with a rapid decline in visual functions is characteristic. Exophthalm notice late, usually it does not reach high degrees.

Features clinical picture And the results of ultrasound scanning allow you to determine the infiltrative distribution of the pathological process, without discovering its nature. Computer tomography demonstrates a dense infiltratively growing tumor, its relationship with surrounding soft and bone structures orbits. The results of radionuclide scintigraphy and thermography indicate the malignant nature of the tumor growth. A thin-game aspiration biopsy with cytological studies of the material obtained is possible when the tumor is localized in the forefront of the orbit. In the case of its layout at the top of the orbit, the implementation of aspiration is associated with the danger of damage to the eye.

Surgical treatment (indinctional extentation of the orbit) is shown in the front localization of the process. Treatment of more deeply located tumors is difficult, as they early germinate in the skull cavity. Radiation therapy is ineffective, since the primary heterotopic cancer is refractive to irradiation. Forecast bad.

Sarcoma - The most common cause of primary malignant growth in orbit.

Rabdomiosarcoma- Extremely aggressive orbit tumor, is the most common cause of malignant growth in orbit in children.

The favorite localization of the tumor is the Upper-ended quadrant of the orbit, so the muscle is involved in the process, raising upper eyelid, and upper straight muscle. Ptosis, restriction of eye movements, shifting his book and Knutrice's book - these are the first signs that pay attention to both the patients themselves and the surrounding faces. In children, Exophthalm or eye displacement during the localization of the tumor in the front department of the orbit develops for several weeks (Fig. 20.23, a). In adults, the tumor grows slower, for several months. The rapid increase in Exophthalma is accompanied by the appearance of stagnant changes in episcoleral veins, the eye slot is not fully closed, infiltrates on the cornea and its ulceration are noted. On the eye day - a stagnant disk of the optic nerve. The tumor quickly destroys the adjacent thin bone wall, grows into the nasal cavity, causing nasal bleeding. Ultrasound scanning, computed tomography, thermography and a thin-game aspiration biopsy - this is the optimal diagnostic complex of instrumental methods

Fig. 20.23.Rabdomiosarcoma right orbit.

a - non-inflammatory edema, Exophthalm with a displacement of the eyeball of the Book and Knutrice; B - Computer tomogram: The shadow of a tumor with fuzzy and uneven boundaries in the area of \u200b\u200bthe outermost muscle.

dov research during a rhabomiosarcoma (Fig. 20.23, b). Combined treatment. The treatment protocol provides for the preliminary carrying out of polychimotherapy for 2 weeks, after which the outer irradiation of the orbit is carried out. After a combined treatment for more than 3 years, 70% of patients live.

Malignant lymphoma currently consider as a neoplasm of the immune system. The process involves predominantly lymphoid elements of T- and B-cell affiliation, as well as elements of zero populations. During morphological examination in orbit more often diagnosed

Fig. 20.24.Malignant lymphoma right orbit.

a - Ptosis of the upper eyelid, the eye slit is narrowed, exophthalm with displacement; B - Eye bottom: Stagnation of an optic nerve; B is a computer tomogram of the eye: the shadow of the tumor fills almost the entire cavity of the orbit.

the in-cell lymphoma is low-quality, which contains quite mature tumor and plasma cells. As a rule, one orbit is affected. The sudden appearance of painless exophthalma and swelling of periorubital tissues are characteristic. Exophthalm can be combined with ptosis (Fig. 20.24, a). The process is locally steadily progressive, red chemosis develops, the reposition of the eye becomes impossible, changes in the eye day, more often the congestion disk of the optic nerve (Fig. 20.24, b). Sharply decreases eyesight. During this period, pain in the affected orbit may appear.

The diagnosis of malignant lymphoma orbit is difficult. From the instrumental research methods, more informative ultrasound scanning, computed tomography (Fig. 20.24, c) and a thin-game aspiration biopsy with cytological research. It is necessary to examine the hematologist to eliminate systemic lesion. Outdoor irradiation of the orbit is a practically non-alternative highly efficient treatment method. Polykhimotherapy is connected to the systemic lesion. The effect of treatment is manifested in the regression of the symptoms of the pathological process in orbit and restore the lost vision. The prognosis for primary malignant lymphoma for life and view is favorable (83% of patients are experiencing a 5-year period). The forecast for life is sharply deteriorated in disseminated forms, but they are rare.

Questions for self-control

1. Name the signs of the progressive nevus of the eyelid.

2. Transfer clinical signs of basal-cell skin cancer.

4. Note the signs of the melanoma of the skin of the eyelids. In the basis of which symptoms can be distinguished from the nevus? Is there a surgical treatment with the skin melanoma?

5. Transfer the signs of the progressive nevus conjunctiva.

6. Name signs of the progressive growth of the leomioma iris.

7. Transfer the signs that allow differentiation of non-Neva and Pigment Leiomyoma.

8. What causes the occurrence of cataracts in the melanoma of the iridociliary region and the ciliary body?

9. Name signs of the progression of chorioide nevus. What is the doctor's tactics in this case?

10. Transfer sources of melanoma choroids.

11. Why develop visual disorders at melanoma choroids?

12. Is Enuccorating in all cases of melanoma choroids?

13. How are the causes of family retinoblastoma?

14. Why can you explain the high risk of developing second malignant tumors in patients with a retinoblast?

15. Is it possible to appear indirect signs with the initial retinoblastoma?

16.Inucleation of the eye is the only method of treatment of retinoblastoma?