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67 Cards in this Set
- Front
- Back
Skin: SqCCa
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Invasion of epi BM by dysplastic Sq epi
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anaplasia
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severe atypia & abnormal polarity
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abnormal polarity
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loss of maturational order & normal layering of epi
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Epidermidalization
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keratinization & formation of skinlike feature by mucosal epi
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Skin: Carcinoma in situ
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Full thickness dysplasia
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Nucleoli atypia
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Individual cellular enlargement, pleomorphism, hyperchromasia, abnormal mitoses
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retinoblastoma: Histo:
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Flexner-Wintersteiner rosettes: cental clear lumen surrounded by parallel fibrils with a ring of nuclei
(also may see Homer Wright rosettes) |
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retinoblastoma: what indicates a Better prognosis:
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presence of gliosis, Histo=presence of fleurettes (clusters of nearly mature photoreceptor elements) (amt of differentiation not important!!!!)
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reese-Ellsworth
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predicts visual prognosis after tx for retinoblastoma (not life prognosis);
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retinoblastoma
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Chr 13 (“DOUBLE HIT GENE”) may present as *leukocoria*, uveitis, angle closure, orb cellulitis, strab, hyphema; 2/3=unilateral & 6% have fam hx; all familial, all bilateral & 15% sporadic unilateralcan pass down via AR (but acts as AD w/ 80% penetrance); hereditary form=increased incidence of secondary malignancies later in life (sarcomas); if 1 child has hereditary form, 40% of subsequent children (1/2 of 80%) & 40% risk to their own children;
Met w/u includes, bone scan, bone marrow aspirate, LP Increased incidence of coinciding primary pineal tumors |
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Leukemia: if infiltrates AC
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spontaneous hyphema & heterochromia;
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leukemia orbital infiltration
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edema, proptosis, ecchymosis
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leukemia cataract/glaucoma
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glaucoma secondary to hyphema, tumor cells clogging TM, papillary block w/synechiae
cataract secondary to inflammation or radiation |
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SqCCa of limbus
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gelatinous, leukoplakic or papilliform; Histo=epidermoid & spindle-shaped cells; Produce white keratin plaque; Tx=MMC, excision w/ local radiotherapy w/ plaque to scleral bed, excision w/ wide margins + Cryo; ***MOST common malignant epi tumor of the conj***
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Conjunctival intraepithelial neoplasia
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pre-invasive stage of SqCCa; NO invasion of BM; interpalpebral; leukoplakia & thickening of theepi w/ abnormal corkscrew BVs; Tx: excisional bx
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Benign reactive lymphoid hyperplasia
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prominent vascularity; heterogeneous cell population, numerous follicles
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Conjunctival lymphoma
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salmon colored lesion on bulbar conj; histo: monoclonal b-lymphocytes is associated w/ malignancy (no atypia in this malignancy); Tx=surgery, local chemo or radiation
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Lymphoma
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“leopard skin pattern”; >70y/o; vitritis (uni/bilateral)w/u: MRI, CT w/ contrast, LP? CNS lymphoma, PPV for cytology & staging; Tx=intrathecal MTX, IV cytotoxic agent, Whole brain & ocular XRT; poor prognosis (6mo following symptoms)
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Mucoepidermoid carcinoma
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aggressive form of SqCCa; suspect if recurrence; >60y/o & involves goblet cells (malignant mucus secreting); tends to invade globe
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Conjunctival papilloma
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DDx=seb K, actinic keratosis, verruca, SqCCa
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Conjunctival papilloma;
kids & young adults |
may be multiple in palpebral conj; viral; spontaneous resolution is common; histo=hyperkeratosis, parakeratosis, epidermidalization w/ lobular acanthotic epi over fibravascular core; HPV (also can cause SqCCa) pedunculated=HPV 6&8, sessile=HPV 16 & 18
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Conjunctival papilloma;
Adults |
single lesions, non-infectious, often at limbus; histo=atypical spindle cells w/ dark nuclei
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Conjunctival papilloma
Neoplastic |
older adults; unilateral; isolated; bulbar conj; will recur singley if not completely excised; fulminant conjunctivitis; rare spontaneous improvement
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Conjunctival papilloma
Viral |
kids/teens; occ bilateral; occ multiple; palpebral conj; incomplete excision=multiple recurrences; rarely assoc w/ conjunctivitis; may spontaneously resolve
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Basal Cell Ca
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typically lower lid; nuclei @ periphery of tumor cell nests retain polarity w/ palisading; fibrosing=worst prognosis; causes morbidity & mortality via direct extension into skull/CNS
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SqCCa lid
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typically upper lid;
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SqCCa Cornea:
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limited by Bowmans
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Sebaceous Cell Ca
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older people; needs prompt resection; typically misdiagnosed as chalazia & drained frequently before sample sent to path; “skip” lesions—therefore, Moh’s is not good choice; need map biopsies w/ frozen sections to preserve fat for Oil red O stain; features: epithelial xanthomatization, intraepithelial tumor & inflammatory cells, multiple tumor nests; possible origins: zeiss, caruncle glands, meibomian glands (NOT Moll)
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Pilomatrixoma
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“calcifying epithelioma of Malherbe”--benign; more common in kids; assoc w/ myotonic dystrophy
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Syringoma
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tumor derived from sweat gland; associated with Down syndrome, Marfan syndrome, and Ehlers-Danlos syndrome
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Kaposi’s sarcoma
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malignant counterpart in abnormal immune system (AIDS) of pyogenic granuloma; w/ normal immune system, affects lower extremities of older men; Tx=radiation
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Multiple discrete eyelid nodules DDx=
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JXG, Hand-Schuller Christian disease, lipoid proteinosis, syringoma
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Pyogenic granuloma
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small caliber vascular channels in a collagenase stroma
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Epithelial inclusion cysts
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lined nonkeratinizing stratified Sq Epi
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PAM
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unilateral; middle aged white people; multiple, superficial flat patches; 20-30% result in melanoma; if nodular, BX
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Racial / ocular melanosis
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perilimbal dusting; no malignant potential
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Ocular
(“blue nevus”) |
more common in whites; deep & flat; present @ birth
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Cellular blue nevus
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blue nevus as above w/ many dendritic nevus cells
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Oculo-cutaneous (“nevus of Ota”)
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more common in blacks/Asians but only malignant potential in whites; diffuse cong deep dermal nevus in periocular skin
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Junctional nevus
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nests of nevi cells in basal epi layer
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Spindle cell nevus
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compound nevus of childhood w/ bizarre cellular components but no malignant potential
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Melanocytoma
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elevated, deeply pigmented lesion near ON
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Keratoacanthoma
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form of pseudoepitheliomatous hyperplasia; rapidly growing (1-2 Mo) circular lesion w/ central ulceration filled w/ keratin, may have lash loss & appear malignant; left untreated, may resolve spontaneously; excisional bx is recommended to r/o malignancy; bx=inflammatory tissue (pseudoepitheliomatous hyperplasia), acantosis, hyperkerasosis, dyskeratosis
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Hyperostosis / osteoblastic
(increase in bone) DDx: |
prostate mets, sphenoid meningeoma, fibrous dysplasia (typically younger pts)
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Lacrimal sac tumors
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most primary malignant tumors are of the papillary carcinomas (SqCCa, Transitional cell, mixed cell); palpable subQ mass above medial canthal tendon Tx=local excision; good prognosis; next most common=lymphomas; Tx=radiation & systemic w/u
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lacrimal gland tumor: Pleomorphic adenoma (benign mixed cell neoplasm):
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most common lacrimal tumor; epithelial; typically painless, but may occasionally have bony erosion & expansion; >9 Mo duration of lacrimal enlargement ; spindle cells w/ ductal epi & mixed stromal pattern; pseudoencapsulated; Tx=excisional bx to confirm dx
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lacrimal gland tumor: Primary lymphoma
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epithelial; “molding/putty” to globe; acute or chronic; B & T cells w/ predominance of B cells
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lacrimal gland tumor: Adenoid cystic carcinoma
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most common malignant lacrimal tumor; epithelial; painful w/ bony destruction & rapid progression; histo=swiss cheese pattern; often w/ perineural invasion; TX=exenteration; +/-chemo & radiation
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lacrimal gland tumor: Malignant Pleomorphic adenoma
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lymphoproliferative; painful w/ bony destruction; ductal epi in tubular formation w/ malignant degeneration
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Lymphoplasmacytoid proliferation w/ Dutcher bodies DDx:
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Waldenstrom macroglobulinemia or systemic lymphoma w/ immunoglobulins
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dutcher bodies
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(intranuclear PAS + inclusions of immunoglobulins)
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Orbital lymphangioma
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kids; appears as bluish lesion; acute proptosis if crying, after URI, or hemorrhages (often after trauma)(endothelial lined thin wall interstitial capillary channels that are easily brokenecchymosis); MRI=layered hemorrhage in ocular & cystic mass “chocolate cysts” behind the eye; benign; observe for growth/compression then debulk/CT guided drainage & ?IV steroids if needed; typically starts superonasal
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Rhabdomyosarcoma
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most common primary malignancy in kids; rapid evolution of unilateral proptosis& reddish discoloration of eyelids mimicking orbital cellulitis; biopsy, radiation, chemo; DDx: myocele, mucopyocele, encephalocele, neurofiboroma
embryonal=most common alveolar=worst prognosis differentieated=least common; best prognosis |
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Neuroblastoma
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most common metastatic tumor in kids (1/3 present as mets); abrupt eccymotic proptosis that may be bilateral (50%); in kids, mets to orbit (rapid proptosis, spontaneous ecchymosis, cellulitis like); in adults, mets to uveal tract from adrenal, mediastinum, neck; 20% have orbital involvement; mean age of presentation=2 y/o; poor prognosis if <1 y/o or bone mets; spontaneous regression rarely seen
metastatic==associated w/ opsoclonus (dancing eyes) |
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Neuroblastoma histo
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Histo: Mets: sheets of round cells w/ scant cytoplasm; copious mitotic figures, areas of tumor necrosis, bony invasion
Primary tumor: Homer Wright rosettes: ring of nuclei w/ no central lumen surrounded by haphazardly arranged cell processes (see pic). **pseudorosettes (which have a BV in the center) |
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Capillary hemangioma
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high flow; spontaneous resolution; 70% resolve by age 7; most common benign tumor in kids (mostly girls); blanch with pressure; may also occur in adults; slow growth w/ progressive proptosis; Tx=corticosteroids or interferon; complications: Kassabach-Merritt syndrome= thrombocytopenia due to platelet sequestration;
--in retina: 20% risk for cerebellar hemangioblastomas pathology: appears same as port wine stain |
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Cavernous hemangioma
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low flow (phlebolith common)—does not cause proptosis with valsalva; slow growing lesions; does not acutely leak/bleed but in retinal cavernous hemangioma, VH is most common complication (most likely due to traction); most common, well=circumscribed orbital lesion in adults; increases in pregnancy; assoc findings=retinal striae, hyperopia, ON compression, increased IOP, strab
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Orbital varix
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irregular mass w/ phlebolith potential; increases w/ valsalva; Tx=conservative
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Enophthalmos malignant differential
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DDx=breast, GI, lung, prostate
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Meningiomas histo
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psammoma bodies
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Schwannomas
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(“neurilemmoma”) Present in 1% of NF pts; usually benign; perineural spread + compression=pain;
Antoni A: regularly arranged eosinophilic spindles w/ palisading nuclei Antoni B: haphazardly arranged stellate cells in myxomatous matrix Path=Schwann cells; true capsule present; S-100 +staining |
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Neurofibroma
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Lesion of upper lid=strong correlation to congenital glaucoma
Plexiform=most specific for neurofibromatosis Grows independent of peripheral nerves=painless; generally osteolytic Path=axons + perineural cells + Schwann cells; S-100 + staining; no capsule |
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Optic nerve glioma
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present w/ visual loss, strab, ptoptosis, hypothalamic abnormalities; 90% by age 20 (typically 2-6y/o); 15-60% have NF1; in adult, malignant gliomasurvival is 6-12 months; CT= “kinking” + fusiform enlargement of nerve; cannot remove w/out removing optic nerve as tumor is not encapsulated & involves nerve
if involves chiasm or hypothalamus—may appear as spasmus nutans |
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Optic nerve meningioma
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occur primary in women; NF increases risk, but still only a few pts w/ tumor have NF; CT w/ contrast=”tram-track”, may show calcification (“psammoma bodies”); tumor=benign prolif of whorls of meningotheial cellsdamage via compression
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Disc collaterals
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(optociliary shunt vessels): DDx=CRVO, spheneoid wing meningioma, long standing POAG, optic gliomas, chronic papilledema, ON meningioma
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Suprasellar craniopharyngiomas
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remnants of Rathke’s pouch; near pituitary & chiasmgrowth & pituitary like compression on nerves; often calcified;
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Parinaud’s dorsal midbrain syndrome
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(ex. Pinealoma) skew deviation, lid retraction (Collier’s sign), papillary light-near dissociation, contraction-retraction nystagmus, upgaze paralysis
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