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Yin F, Guo Z, Sun W, Hou C, Wang S, Ji F, Liu Y, Fu S, Liu C, Li R, Wang Y, Sun D. Comparing overall survival between pediatric and adult retinoblastoma with the construction of nomogram for adult retinoblastoma: A SEER population-based analysis. Asian J Surg 2024; 47:2178-2187. [PMID: 38395709 DOI: 10.1016/j.asjsur.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/19/2023] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Retinoblastoma (RB) is a rare primary malignant tumor primarily affecting children. Our study aims to compare the overall survival (OS) between pediatric and adult RB patients and establish a predictive model for adult RB patients' OS to assist clinical decision-making. METHODS This study retrospectively analyzed data from 1938 RB patients in the Surveillance, Epidemiology, and End Results (SEER) database, covering the period from 2000 to 2015. Propensity score matching (PSM) ensured balanced characteristics between pediatric and adult groups. A Cox proportional hazards regression model was used to assess prognostic factors, and selected variables were utilized to construct a predictive survival model. The Nomogram model's performance was evaluated through the C-index, time-dependent ROC curves, calibration curves, and decision curve analysis (DCA). RESULTS Following PSM, adult RB patients had lower OS compared to pediatric RB patients. Independent prognostic factors for adult RB OS included age, gender, disease stage, radiation therapy, income, and diagnosis confirmation. In the training cohort, the Nomogram achieved a C-index for OS of 0.686 and accurately predicted 2-year, 3-year, and 5-year OS with AUC values of 0.672, 0.680, and 0.660, respectively. The C-index, time-dependent ROC curves, calibration curves, and DCA in both training and validation cohorts confirmed the Nomogram's excellent performance. CONCLUSION In this study, adult RB patients have worse OS than pediatric RB patients. Consequently, we constructed a Nomogram to predict the risk for adult RB patients. The Nomogram demonstrated good accuracy and reliability, making it suitable for widespread application in clinical practice to assist healthcare professionals in assessing patients' prognoses.
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Affiliation(s)
- Fangxu Yin
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zheng Guo
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chong Hou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, China
| | - Song Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Fulong Ji
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yong Liu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Siqi Fu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunxiang Liu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Li
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuchao Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Daqing Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China.
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Abstract
Retinoblastoma is a rare malignant tumor of the retina usually seen in children before 5 years of age. The tumor is extremely rare in adults. We report here an unusual case of retinoblastoma in a 55-year-old adult female who presented to us with an orbital mass at a late stage of the disease. Detailed laboratory investigations and imaging studies could not make a precise diagnosis. The treating ophthalmologist suspected primary intraocular tumor, metastatic carcinoma, malignant melanoma, or lymphoma and referred the patient for fine needle aspiration cytology (FNAC). Cytopathological examination of Giemsa-stained FNAC smear was consistent with that of retinoblastoma and established the diagnosis.
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Affiliation(s)
- Vasudha Garg
- Department of Pathology, Dr B.S. Ambedkar Hospital, New Delhi, India
| | - Ashumi Gupta
- Department of Pathology, Dr B.S. Ambedkar Hospital, New Delhi, India
| | - Sonam K Pruthi
- Department of Pathology, Dr B.S. Ambedkar Hospital, New Delhi, India
| | - Pratima Khare
- Department of Pathology, Dr B.S. Ambedkar Hospital, New Delhi, India
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Abstract
Retinoblastoma (RB) is the most common primary malignant intraocular tumor of childhood presenting usually before 5 years of age. RB in adults older than 20 years is extremely rare. A literature search using PubMed/PubMed Central, Scopus, Google Scholar, EMBASE, and Cochrane databases revealed only 45 cases till date. Over the past decade, there has been a significant increase in the number of such reports, indicating heightened level of suspicion among ophthalmologists. Compared to its pediatric counterpart, adult onset RB poses unique challenges in diagnosis and treatment. This article summarizes available literature on adult onset RB and its clinical and pathologic profile, genetics, association with retinocytoma, diagnostics, treatment, and outcomes.
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Affiliation(s)
- Sabyasachi Sengupta
- Vitreoretina Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Puducherry, India
- Vitreoretina Services, Ojas Laser Eye Surgery Center, Mumbai, India
| | - Utsab Pan
- Vitreoretina Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Puducherry, India
| | - Vikas Khetan
- Vitreoretina Services, Shri Bhagwan Mahavir Vitreoretinal Service, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Retinoblastoma in the adolescent. Unusual clinical and histopathology findings. ACTA ACUST UNITED AC 2016; 91:145-8. [PMID: 26796428 DOI: 10.1016/j.oftal.2015.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/07/2015] [Indexed: 11/22/2022]
Abstract
CASE REPORT A 17-year- old male with 2years history of an intraocular mass and progressive visual loss of the left eye. Spontaneous sclera rupture occurred during enucleation. Microscopic evaluation with H-E, PAS and immunohistochemistry (NSE, GAFP, SYN, CD99) revealed a small blue round cell malignant neoplasm with extensive necrosis and apoptosis. The optic nerve, ciliary body, choroid, anterior chamber, and sclera were infiltrated. SYN was positive and CD99 was negative in neoplastic cells, consistent with a poorly differentiated retinoblastoma. DISCUSSION Retinoblastoma is the most frequent primary intraocular malignant tumour in childhood, but occasionally older patients can be affected. Immunohistochemistry is mandatory in poorly differentiated retinoblastomas.
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Raj A, Arya SK, Punia RS, Kohli P. Adult onset retinoblastoma: A diagnostic dilemma. Orbit 2015; 35:51-53. [PMID: 26709674 DOI: 10.3109/01676830.2015.1099697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/21/2015] [Indexed: 06/05/2023]
Abstract
Retinoblastoma is the most common intraocular tumor of childhood. About 95% of retinoblastoma cases are diagnosed before the age of 5 years. Not more than 30 cases of Adult-onset retinoblastoma have been reported in literature. A 32 year old male presented with a painful blind eye. There was sudden loss of vision accompanied by severe pain and redness in right eye about 1 year ago, for which some surgery was done with neither a gain in vision nor any relief from pain. Then he was put on maximum tolerable medical therapy, later cyclocryotherapy was done. Now he presented to us with complains of extreme pain and bleeding from right eye since 2 days. There is no history of any ocular trauma. Right eye had no perception of light & showed anterior staphyloma with perforation. Right eye evisceration was done & material sent for histopathological examination, which revealed an adult-onset retinoblastoma. CECT scan revealed thickening of optic nerve throughout its entire length with contrast enhancement. He was further taken up for enucleation of residual sclera with maximum optic nerve stump removal to reconfirm the diagnosis. Histopathological examination revealed tumor deposits present in orbital soft tissue, resection margins and optic nerve cut end.Retinoblastoma presenting in adult age creates a diagnostic dilemma because of its low frequency and atypical features. We want to highlight the importance of high clinical suspicion and imaging modalities before taking any patient for evisceration with unexplained vision loss. One should send the eviscerated material for histopathological examination.
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Affiliation(s)
- Amit Raj
- a Government Medical College and Hospital-Chandigarh, Ophthalmology , Chandigarh , India
| | - Sudesh Kumar Arya
- a Government Medical College and Hospital-Chandigarh, Ophthalmology , Chandigarh , India
| | - Rajpal Singh Punia
- b Government Medical College and Hospital-Chandigarh, Pathology , Chandigarh , India
| | - Piyush Kohli
- a Government Medical College and Hospital-Chandigarh, Ophthalmology , Chandigarh , India
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Affiliation(s)
| | | | | | - Fangtian Dong
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Yousef YA, Istetieh J, Nawaiseh I, Al-Hussaini M, Alrawashdeh K, Jaradat I, Sultan I, Mehyar M. Resistant retinoblastoma in a 23-year-old patient. Oman J Ophthalmol 2014; 7:138-40. [PMID: 25378879 PMCID: PMC4220401 DOI: 10.4103/0974-620x.142597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Retinoblastoma is a very rare disease in adults. We are reporting a rare case of resistant retinoblastoma in 23-year-old patient. A 23-year-old male patient presented with loss of vision in the right eye over one-month duration. Examination showed an epiretinal membrane in the right macula in addition to a white mass located inferiorly and associated with vitreous seeds. The diagnosis of retinoblastoma was established. In order to save the patient's life and to preserve the eye and vision, he was treated with chemotherapy, focal therapy, and radioactive Iodine125 plaque therapy. The tumor was resistant for treatment and recurred two years after plaque therapy, and enucleation showed well-differentiated retinoblastoma. Retinoblastoma may present in adults, and it was resistant to both chemotherapy and plaque radiation therapy in our case.
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Affiliation(s)
- Yacoub A Yousef
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Jihad Istetieh
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ibrahim Nawaiseh
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Imad Jaradat
- Department of Radiotherapy, King Hussein Cancer Center, Amman, Jordan
| | - Iyad Sultan
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Mustafa Mehyar
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
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Khetan V, Bindu A, Kamat P, Kumar SK. Failure of globe conservation in a case of adult onset retinoblastoma. Middle East Afr J Ophthalmol 2014; 21:358-60. [PMID: 25371646 PMCID: PMC4219232 DOI: 10.4103/0974-9233.142280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Adult onset retinoblastoma is a rare intraocular malignancy. The majority of the cases are treated with enucleation, due to late presentation and advanced-stage tumors. Here we report a case of a 30-year-old female who presented with an intraocular mass with exudative retinal detachment in her right eye. B-scan ultrasound and magnetic resonance imaging (MRI) confirmed the diagnosis of retinoblastoma. In an attempt to salvage the globe, she was treated with chemotherapy, which resulted in excellent regression of the tumor mass by the end of 8 months follow-up. The patient was followed-up regularly with focal treatment whenever necessary. Two years later, she developed a massive recurrence necessitating enucleation. Histopathologic examination revealed a moderately differentiated retinoblastoma with choroidal invasion. Attempt to salvage the globe in adult onset retinoblastoma with chemoreduction and focal therapy may be possible; however, regular long-term follow-up is necessary for recurrence which warrants timely intervention.
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Affiliation(s)
- Vikas Khetan
- Department of Ocular Oncology and Vitreoretina, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Appukuttan Bindu
- Department of Ocular Oncology and Vitreoretina, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pradnya Kamat
- Department of Ocular Oncology and Vitreoretina, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - S Krishna Kumar
- Department of Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Ramírez-Ortiz MA, Ponce-Castañeda MV, Cabrera-Muñoz ML, Medina-Sansón A, Liu X, Orjuela MA. Diagnostic delay and sociodemographic predictors of stage at diagnosis and mortality in unilateral and bilateral retinoblastoma. Cancer Epidemiol Biomarkers Prev 2014; 23:784-92. [PMID: 24521997 DOI: 10.1158/1055-9965.epi-13-1069] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND More invasive retinoblastoma, characterized by increased morbidity and mortality, with lower rates of eye salvage and higher rates of extraocular dissemination, seems more prevalent in resource-poor countries. The relationship of diagnostic delay (lag time) and sociodemographic factors on the extent of disease at diagnosis has not been examined separately for unilateral and bilateral retinoblastoma. METHODS At diagnosis, consenting parents of 179 Mexican children with retinoblastoma were interviewed about initial symptoms and household demographic characteristics. Clinical presentation was classified using St. Jude's, International Staging System (ISS), and International Intraocular Retinoblastoma Classification (IIRC) criteria. Lag time (delay between noting symptoms and diagnosis) and sociodemographic factors were examined as predictors for higher stage at diagnosis and overall survival (OS). RESULTS In bilateral disease, lag time predicts stage at diagnosis using St. Jude's, and ISS criteria (P < 0.005 in multivariate regression), and OS (P < 0.05, Cox hazards), but not extent of intraocular disease (by IIRC). In unilateral disease, lag time predicts neither extent of disease (using ISS, St Jude's, and IIRC), nor OS. Indicators of prenatal poverty, including lower maternal education and the presence of dirt flooring in the home, predict more advanced disease by IIRC for bilateral retinoblastoma, and for unilateral by ISS, and St Jude's (P < 0.001) as well as OS (P < 0.05). CONCLUSION These results suggest unilateral and bilateral retinoblastoma differs in factors governing progression and extraretinal extension, possibly reflecting underlying biologic heterogeneity. IMPACT This demonstrates differing effect of social factors on extent of intra- and extraocular disease depending on laterality with implications for screening strategies.
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Affiliation(s)
- Marco A Ramírez-Ortiz
- Authors' Affiliations: Departments of Ophthalmology, Pathology, and Oncology of the Hospital Infantil de Mexico Federico Gomez; Hospital de Pediatria, Centro Medico Siglo XXI, Instituto Mexicano de Seguro Social, Mexico City, Mexico; Departments of Biostatistics and Environmental Health Sciences; and Pediatrics (Division of Oncology), Columbia University, New York, New York
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Zafar SN, Ahmad SQ, Zafar N. Retinoblastoma in an adult. BMC Res Notes 2013; 6:304. [PMID: 24059980 PMCID: PMC3734022 DOI: 10.1186/1756-0500-6-304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 07/30/2013] [Indexed: 11/13/2022] Open
Abstract
Background Retinoblastoma is the most common pediatric ocular tumour. It may rarely present in adults. The present case adds to the number of 26 cases already published in literature since 1919 till 2013. Our aim is to highlight the rare occurrence of retinoblastoma in adults along with its features which differentiate it from paediatric retinoblastoma. Case presentation We describe a case of adult onset retinoblastoma (group E, according to the international classification of retinoblastoma) occurring in a 25 year old male. He presented with decreasing visual acuity in the right eye of 4 months duration. He had neo-vascular glaucoma and pseudohypopyon. B scan ultrsonography of his right eye showed intraocular growth without any calcification. The CT scan of the orbits and brain showed intraocular growth in the right eye with no calcification. Enucleation of the right eye was carried out. Retinoblastoma was confirmed on histopathology of the enuleated globe. Conclusions The present case adds to the number of adult Rb patients reported in literature. Early detection to salvage the life can be made possible if the clinician keeps a high index of suspicion when observing retinal mass of adult onset. Proper counselling of the patient in order to seek his full involvement in management may help in improving the prognosis of the disease.
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Affiliation(s)
- Saemah Nuzhat Zafar
- Department of Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi 46000, Pakistan.
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Zhang Z, Shi JT, Wang NL, Ma JM. Retinoblastoma in a young adult mimicking Coats' disease. Int J Ophthalmol 2012; 5:625-9. [PMID: 23166876 DOI: 10.3980/j.issn.2222-3959.2012.05.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 10/09/2012] [Indexed: 01/12/2023] Open
Abstract
Retinoblastoma is the most common childhood primary intraocular malignancy, with the majority of cases being diagnosed before 5 years of age. Retinoblastoma in adults is extremely rare. Here, we report the case of a 20-year-old man who presented with a 3 year history of blurred vision in the right eye. Imaging did not reveal the typical presentation of retinoblastoma. After considering Coats' disease, a diagnosis of late-presenting retinoblastoma was made through cytological analysis. Diagnosis of retinoblastoma should be considered in the presence of uncertain mass lesions in the fundus of an adult.
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Affiliation(s)
- Zheng Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Vision Science Key Lab, Beijing 100730, China
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Abstract
Retinoblastoma is the commonest primary ocular malignancy of childhood. There are two forms - heritable and non heritable. Heritable retinoblastoma is a cancer susceptibility syndrome. Presentation is in the first few years of life, sometimes in the neonatal period. Early detection and prompt treatment can give cure rates up to 95% for intraocular tumours, but extraocular disease carries a very high mortality. The diagnosis is essentially clinical and biopsy is contraindicated due to the risk of extraocular spread. Treatment requires significant multidisciplinary input, with local ophthalmic treatment, systemic chemotherapy and external beam or plaque radiotherapy, or surgery to remove the affected eye. Screening of family members is essential for early detection. Lifelong surveillance of mutation carriers is needed due to the risk of second cancers. Newer treatment modalities including intra-arterial chemotherapy have been added to the therapeutic armamentarium in recent years.
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Orellana ME, Brimo F, Auger M, Galic J, Deschenes J, Burnier MN. Cytopathological diagnosis of adult retinoblastoma in a vitrectomy specimen. Diagn Cytopathol 2010; 38:59-64. [PMID: 19582819 DOI: 10.1002/dc.21135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Retinoblastoma (RB) is extremely rare in adults. We describe a case of RB diagnosed by cytology in a vitrectomy specimen of a 23-year-old patient who presented with diminished visual acuity and retinal detachment in the absence of a clinically-visible mass. Cytological examination of the vitreous fluid showed clusters of loosely cohesive atypical cells with high nuclear to cytoplasmic ratio and "salt and pepper" chromatin pattern in a background of normal neuronal retinal cells. Nuclear molding was present as well as numerous apoptotic bodies. The cells were focally positive for epithelial markers and showed strong and diffuse positivity for neuroendocrine markers. Ki-67 stained 90% of the "atypical cells" nuclei, in contrast to nonneoplastic retinal neuronal cells, which were negative for the marker. A diagnosis of RB was rendered, and subsequently was confirmed in the enucleation specimen. The cytological differential diagnosis is discussed as well as the role that cytology and immunohistochemistry can play in differentiating neoplastic cells from normal retinal cellular elements in vitreous fluid specimens.
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Affiliation(s)
- Maria E Orellana
- Henry C. Witelson Pathology Laboratory, McGill University, Montreal, Canada.
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Chung EM, Specht CS, Schroeder JW. From the archives of the AFIP: Pediatric orbit tumors and tumorlike lesions: neuroepithelial lesions of the ocular globe and optic nerve. Radiographics 2007; 27:1159-86. [PMID: 17620473 DOI: 10.1148/rg.274075014] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tumors and tumorlike lesions of the globe and optic nerve in children represent a different histologic spectrum than in adults; the imaging appearances of these lesions reflect their pathologic features. Retinoblastoma is a tumor of infancy and the most common intraocular tumor in children. There are heritable and nonheritable forms. The most common clinical finding is leukocoria. The differential diagnoses of this sign include several nonneoplastic lesions: Persistent hyperplastic primary vitreous is a congenital persistence of an embryonic structure causing a retrolental mass. The primitive vasculature may produce a septum in the posterior chamber. Coats disease is a vascular malformation of the retina that produces a lipoproteinaceous subretinal exudate. The vascular malformation enhances with intravenous contrast material, and the fat-containing subretinal exudate does not. Larval endophthalmitis is a granulomatous reaction to the dead or dying larvae of Toxocara canis or T. cati. The most important feature that allows differentiation of retinoblastoma from these so-called pseudoretinoblastomas is the presence of calcification in the former. Medulloepithelioma has two histologic forms; the teratoid type may contain calcifications, but it usually arises anteriorly from the ciliary body rather than posteriorly from the retina. Optic nerve glioma is the most common tumor of the optic nerve in children and is frequently associated with neurofibromatosis type 1. These gliomas are usually pilocytic astrocytomas and cause fusiform enlargement of the nerve.
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Affiliation(s)
- Ellen M Chung
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Alaska and Fern streets NW, Washington, DC 20306-6000, USA.
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de Jong PTVM, Mooy CM, Stoter G, Eijkenboom WMH, Luyten GPM. Late-Onset Retinoblastoma in a Well-Functioning Fellow Eye. Ophthalmology 2006; 113:1040-4. [PMID: 16631255 DOI: 10.1016/j.ophtha.2006.02.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Revised: 02/21/2006] [Accepted: 02/21/2006] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe the documented growth, clinical course, and histopathology of retinoblastomas in an untreated and otherwise normal right eye of a 27-year-old white male with a g.153211T>A (p.Tyr606X) mutation in the retinoblastoma 1 gene, whose left eye was enucleated at age 2 years for 2 retinoblastomas. DESIGN AND PARTICIPANTS Retrospective interventional case report. INTERVENTIONS Over the years, the right eye was irradiated twice and underwent trans-pars plana vitrectomy, transscleral cryocoagulation, argon laser photocoagulation of tumors and their feeder vessels, extracapsular cataract extraction with posterior chamber lens implantation, and neodymium:yttrium-aluminum-garnet laser treatment of after-cataract in the form of Elschnig's pearls. Finally, the patient received combination chemotherapy with etoposide, methotrexate, actinomycin D, cisplatin, and vincristine. RESULTS The eye finally had to be removed 12 years later due to tumor recurrences and seeding, pseudohypopyon, and elevated intraocular pressure. Histopathology showed microcellular retinoblastoma cells in the anterior chamber angle and trabecular meshwork without subconjunctival extension and in the nasal ciliary body, pars plana, internal limiting membrane, and optic nerve head anterior to the cribriform plate. The patient is without local or systemic recurrences at age 50, 11 years after the last eye was enucleated. CONCLUSIONS This report shows that retinoblastoma patients may have tumor growth in their fellow eye 25 years after the first eye and also that Elschnig's after-cataract pearls still can arise after irradiation of a lens with 45 Gy.
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Affiliation(s)
- Paulus T V M de Jong
- Netherlands Institute for Neurosciences, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
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Abstract
PURPOSE To assess red reflex testing of the pharmacologically dilated pupil in screening for retinoblastoma. PATIENTS AND METHODS Children with a family history of retinoblastoma or a history of treated retinoblastoma who were admitted to our institution for examination using anesthesia during a 3-month period underwent red reflex testing of the pharmacologically dilated pupil in a masked fashion. Red reflexes were classified as normal (unremarkable), abnormal (in brightness or color), or absent (no reflex, black pupil). The results of the screenings were later compared with actual retinal findings. RESULTS Red reflex testing of the dilated pupil failed to identify all 13 eyes that harbored retinoblastoma lesions (all 13 were classified as normal). The 3 eyes that were identified as having abnormal red reflexes had neither disease nor significant refractive error. CONCLUSION Red reflex testing of the dilated pupil is a poor screening technique for retinoblastoma.
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Affiliation(s)
- Arif O Khan
- King Khaled Eye Specialist Hospital, Riyadh, SaudiArabia
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Odashiro AN, Pereira PR, de Souza Filho JP, Cruess SR, Burnier MN. Retinoblastoma in an adult: case report and literature review. Can J Ophthalmol 2005; 40:188-91. [PMID: 16049534 DOI: 10.1016/s0008-4182(05)80032-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Moll AC, Imhof SM, Meeteren AY, Boers M. At what age could screening for familial retinoblastoma be stopped? A register based study 1945-98. Br J Ophthalmol 2000; 84:1170-2. [PMID: 11004105 PMCID: PMC1723250 DOI: 10.1136/bjo.84.10.1170] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To evaluate until what age children in families with retinoblastoma should be screened. METHODS A register based cohort (n= 685) study of Dutch retinoblastoma patients (1945-1998). The records of all familial hereditary retinoblastoma patients from 1945 were reviewed and the age at diagnosis and either they were screened from birth determined. RESULTS 75 patients had the familial hereditary form of retinoblastoma. The mean age at diagnosis in patients with fundus screening (n=50) from birth on was 4.9 months (median 1.9 months; range 1 day to 48 months). Thus, 4 years was the latest onset of familial retinoblastoma properly evaluated from birth. This mean age was significantly different (p<0.0001) from the mean age at diagnosis in patients without fundus screening (n=25) from birth (mean 17.2 months; median 10.0 months; range 1.5-63.0 months). CONCLUSIONS Ophthalmological screening of children and sibs at risk for familial hereditary retinoblastoma is recommended until the age of 4 years in order to detect retinoblastoma as early as possible.
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Affiliation(s)
- A C Moll
- Department of Ophthalmology, Vrije Universiteit, Amsterdam, Netherlands.
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Biswas J, Mani B, Shanmugam MP, Patwardhan D, Kumar KS, Badrinath SS. Retinoblastoma in adults. Report of three cases and review of the literature. Surv Ophthalmol 2000; 44:409-14. [PMID: 10734240 DOI: 10.1016/s0039-6257(99)00132-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Retinoblastoma usually presents in children younger than 5 years. To our knowledge, 20 cases of retinoblastoma in adults (older than 20 years) have been reported in the literature. Of 173 patients with histopathologically proven retinoblastoma seen in our institute, three were adults. All the patients had endophytic tumors with vitreous seeds. Ultrasonography did not reveal calcification in two cases. Immunohistochemistry with neuron-specific enolase was used to confirm the diagnosis in two cases. All three patients ultimately required enucleation. None of the patients had been referred with a diagnosis of retinoblastoma. The diagnosis of retinoblastoma should be considered in cases of whitish mass lesion in the fundus of an adult.
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Affiliation(s)
- J Biswas
- Medical Research Foundation, Chennai, India.
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Park JJ, Gole GA, Finnigan S, Vandeleur K. Late presentation of a unilateral sporadic retinoblastoma in a 16-year-old girl. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1999; 27:365-8. [PMID: 10571403 DOI: 10.1046/j.1440-1606.1999.00217.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Retinoblastoma is the commonest intraocular tumour of childhood with the majority of cases being diagnosed before 5 years of age. Late presentation of retinoblastoma is rare. CASE HISTORY A healthy 16-year-old Caucasian girl presented with a 1-day history of blurred vision in the left eye. Examination revealed an inferonasal mass in the left retina with an overlying haemorrhage and vitreous seeding. Imaging studies revealed a 5-mm densely calcified opacity. Other investigations, including cerebral spinal fluid examination, bone marrow aspirate trephine, toxocara serology and serum protein studies, were normal. After considering the differential diagnoses such as toxocariasis and Coat's disease, a diagnosis of late-presenting retinoblastoma was made. The patient subsequently underwent enucleation with a primary orbital implant. The diagnosis was confirmed histopathologically. CONCLUSION Late presentation of retinoblastoma is uncommon but can be a cause of acute visual impairment in the non-paediatric age group. Retinoblastoma should be considered in the differential diagnosis of a fundal mass in any age group.
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Affiliation(s)
- J J Park
- Department of Ophthalmology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Decaussin M, Boran MD, Salle M, Grange JD, Patricot LM, Thivolet-Bejui F. Cytological aspiration of intraocular retinoblastoma in an 11-year-old boy. Diagn Cytopathol 1998; 19:190-3. [PMID: 9740993 DOI: 10.1002/(sici)1097-0339(199809)19:3<190::aid-dc7>3.0.co;2-h] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Only a few cases of retinoblastomas in older children have been reported and the clinical diagnosis may be difficult. In case, fine-needle aspiration from an atypical retinal mass of an 11-yr-old boy was performed. The vitreous fluid was stained with Diff-Quik for an immediate cytological examination and the diagnosis of retinoblastoma was suggested. The rest of the specimen was separated into two parts. One was stained with May-Grünwald-Giemsa and the other was centrifuged, embedded in paraffin, and finally stained with hematoxylin-eosin-safran. The undifferentiated blue cells were associated with abundant necrotic debris and portions of capillaries with perivascular tumor cells around. The cytoplasm of the tumor cells was strongly stained with neuron-specific enolase antibody. The diagnosis of retinoblastoma was confirmed. The specimen of enucleation confirmed the diagnosis. In conclusion, cytological aspiration can categorically diagnose suspected intraocular tumors of older children in whom clinical and noninvasive investigations have failed to establish the diagnosis.
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Affiliation(s)
- M Decaussin
- Department of Pathology, Hôpital de la Croix Rousse, Lyon, France
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