Ophthalmic pathology and ocular tumor questions for residents
Ophthalmic pathology links what you see at the slit lamp to what the pathologist sees under the microscope. BCSC Section 4, Ophthalmic Pathology and Intraocular Tumors, covers specimen handling, stains and basic tissue reactions, the pathology of each ocular structure from eyelid and conjunctiva to retina and orbit, and the diagnosis and management of intraocular tumors such as uveal melanoma, retinoblastoma, lymphoma and metastases.
Board questions lean heavily on pattern recognition. Expect to identify a lesion from a described or pictured histologic section, match a corneal stromal dystrophy to its stain, recognize the rosettes of retinoblastoma, or distinguish a choroidal nevus from a small melanoma on clinical features. Tumor questions also test genetics, prognostic markers, systemic associations and the major treatment trials.
Use practice questions to train clinical and histologic recognition together, reading each explanation for why the correct answer fits and why every distractor does not. Group your review by tissue and tumor type, and use weak-topic drills to return to the categories you consistently miss, such as intraocular lymphoma or eyelid malignancies.
Free pathology & tumors practice questions
Pathology & tumors questions are in the OphthoMentor app: create a free account to practise them with explanations, flowcharts and spaced-repetition review.
High-yield pathology & tumors topics for boards
- Granulomatous patterns: zonal (phacoantigenic), diffuse (sympathetic ophthalmia), discrete (sarcoidosis)
- Sympathetic ophthalmia: Dalen-Fuchs nodules with choriocapillaris sparing
- Corneal stromal dystrophy stains: granular trichrome, lattice Congo red, macular alcian blue
- Retinal ischemia histology: inner retinal atrophy after central retinal artery occlusion
- Uveal melanoma histology: spindle versus epithelioid cells and prognosis
- Uveal melanoma prognostics: monosomy 3, BAP1 loss, gene expression profiling
- COMS: similar survival with brachytherapy or enucleation for medium melanoma
- Choroidal nevus versus melanoma: thickness, subretinal fluid, orange pigment
- Retinoblastoma genetics: RB1 at 13q14, germline versus somatic, two-hit hypothesis
- Retinoblastoma histology: Flexner-Wintersteiner and Homer Wright rosettes, fleurettes, calcification
- Retinoblastoma high-risk features: postlaminar optic nerve and massive choroidal invasion
- Germline retinoblastoma: pineoblastoma (trilateral disease) and second cancers such as osteosarcoma
- Choroidal metastasis: most common adult intraocular malignancy; breast and lung primaries
- Vitreoretinal lymphoma: masquerade syndrome, diffuse large B-cell type, raised IL-10:IL-6 ratio
- Choroidal hemangioma: circumscribed isolated versus diffuse with Sturge-Weber syndrome
- Sebaceous carcinoma: chalazion masquerade, pagetoid spread, oil red O staining
- Conjunctival tumors: ocular surface squamous neoplasia, primary acquired melanosis with atypia
- Orbital tumors: cavernous venous malformation in adults, rhabdomyosarcoma in children
- Specimen handling: formalin fixation, fresh tissue for lymphoma flow cytometry
How pathology & tumors is examined
On the OKAP and ABO written examination, BCSC Section 4 content can appear as histopathology images or descriptions paired with a clinical scenario, alongside questions on tumor genetics, prognostic factors and trial evidence. Retinoblastoma and uveal melanoma recur because they combine all of these elements.
FRCOphth Part 1 includes pathology among its basic sciences, while tumor diagnosis and management are assessed in the clinical Part 2 examinations. EBOD questions tend to emphasize recognition and management of ocular tumors and masquerade syndromes within a clinical context.
In orals, tumors are frequent discussion cases: examiners may present a fundus photograph or ultrasound and ask for a differential diagnosis, the investigations needed and the principles of treatment and systemic surveillance.