1
|
Sherief ST, Mulatu DG, Wu F, O'Banion J, Dimaras H. Clinicopathological Presentation of Retinoblastoma in Ethiopia. Ocul Oncol Pathol 2022; 8:168-174. [PMID: 36938376 PMCID: PMC10015587 DOI: 10.1159/000525113] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 05/09/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction: The presenting symptoms of retinoblastoma in Ethiopia, as well as their relationship to the stage of the disease, are poorly understood, but they could be important as background knowledge for creating early detection initiatives. This study aimed to describe the clinical and histopathological characteristics of retinoblastoma among Ethiopian patients. Methods: A hospital-based cross-sectional analysis of all children with newly diagnosed retinoblastoma during the study period of May 2015 to December 2019, inclusive, who presented to a tertiary referral center during were included. Demographic, clinical, and histological characteristics were collected and descriptive statistics were done using SPSS Version 20.0 software. Results: A total of 217 patients (unilateral 84.3%, bilateral 15.7%) were studied. The median age at presentation was 29 months (34 months vs. 19.5 months in unilateral and bilateral cases, respectively, p < 0.001). Among all patients, 57.8% were male. Leukocoria was the most common presenting sign (37.3%) and followed by fungating mass (31.8%). Tumors were extraocular in 40.1% of cases. From the intraocular cases, 73.3% were advanced International Intraocular Retinoblastoma Classification Group D or E disease. Sixty-two (54.4%) of the eyes had high-risk pathological features. The median lag time was significantly shorter for intraocular versus extraocular cases (5 months vs. 12 months, respectively, p < 0.001). Conclusion: Our results show that the majority of Ethiopian children with retinoblastoma have delayed presentation and late stage at diagnosis. This suggests that national health promotion campaigns to increase public knowledge on the presenting signs of retinoblastoma may be critical to achieving early diagnosis. Furthermore, the development of standard management guidelines informed by this study will be helpful in managing the complex and advanced cases currently observed.
Collapse
Affiliation(s)
- Sadik Taju Sherief
- aDepartment of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia
- bDepartment of Ophthalmology, Menelik II Hospital, Addis Ababa, Ethiopia
| | | | - Fran Wu
- dDepartment of Ophthalmology, Emory University, Atlanta, Georgia, USA
| | | | - Helen Dimaras
- eDepartment of Ophthalmology and Vision Science, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Moeez Uddin M, Farooque U, Aziz MZ, Yasmin F, Qureshi F, Saeed Y, Asif S, Bollampally VC, Tauseef A. Different Types of Clinical Presentations and Stages of Retinoblastoma Among Children. Cureus 2020; 12:e10672. [PMID: 33133838 PMCID: PMC7592547 DOI: 10.7759/cureus.10672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Retinoblastoma (Rb) is the most common intraocular malignant tumor of childhood. The different modes of Rb presentation comprise proptosis, anterior chamber inflammatory signs, spontaneous hyphema, secondary glaucoma, and strabismus. The primary aim of this study was to investigate the different clinical presentations and stages of Rb that may help in early detection and timely diagnosis to prevent the advancement of the disease and increase rates of survival in children. Materials and methods This was a descriptive cross-sectional study conducted between December 2019 and May 2020 over a period of six months at a tertiary care hospital in Karachi, Pakistan. The sample size included 68 eyes of children with lesions of Rb at the time of presentation to the hospital. Brightness scans (B-scans), computed tomography (CT) scans, and magnetic resonance imaging (MRI) were performed. The International Intraocular Retinoblastoma Classification (IIRC) was used to stage each eye. In case of enucleation (if necessary) of the eye, the biopsy was performed to evaluate the histological features of cancer. All statistical analysis was performed using Statistical Package for Social Sciences version 17.0 (IBM Corp., Armonk, New York). Results The mean age of the children was 3.21 ± 1.75 years. Leukocoria was the most common clinical presentation observed in more than half (n = 35, 51.47%) of the sample population followed by proptosis reported in nearly two-fifths (n = 25, 36.76%), strabismus and phthisis bulbi observed in equal proportions (n = 3, 4.41%), and hypopyon documented in a minor proportion (n = 2, 2.94%) of patients. Regarding stages of the Rb disease, the most common stages were observed to be stage C and stage E. Conclusions This study concludes that the early detection of Rb is possible through a better understanding of presenting features of the disease. It can prevent the progression of the disease to the advanced stages and decrease morbidity and mortality. The early detection of Rb can be made possible through the examination of red reflex on the regular check-ups of children as leukocoria is the most common clinical presentation.
Collapse
Affiliation(s)
- Muhammad Moeez Uddin
- Ophthalmology, Prevention of Blindness Trust Charitable Eye Hospital, Karachi, PAK
| | - Umar Farooque
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Muhammad Zunair Aziz
- Ophthalmology, Prevention of Blindness Trust Charitable Eye Hospital, Karachi, PAK
| | - Farah Yasmin
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Faisal Qureshi
- Internal Medicine, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Yousaf Saeed
- Internal Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Saba Asif
- Medicine, University at Buffalo, Buffalo, USA.,Internal Medicine, Nishtar Medical University, Multan, PAK
| | | | | |
Collapse
|
3
|
Liu CC, Mohmood A, Hamzah N, Lau JH, Khaliddin N, Rahmat J. Intra-arterial chemotherapy for retinoblastoma: Our first three-and-a-half years' experience in Malaysia. PLoS One 2020; 15:e0232249. [PMID: 32357178 PMCID: PMC7194412 DOI: 10.1371/journal.pone.0232249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/10/2020] [Indexed: 12/04/2022] Open
Abstract
Aim To report our first three-and-a-half years’ experience with intra-arterial chemotherapy (IAC) in managing retinoblastoma (RB). Methods Single institution, retrospective, interventional case series of 14 retinoblastoma patients managed with IAC from December 2014 to June 2018. Demographics were described. Outcomes measures were tumor response, treatment complications and globe salvage. Results Subjects’ mean age at the first administration of IAC was 31.4 months. 57.1% of the eyes were Group D and E retinoblastoma, while 79% were bilateral disease. 93% of the eyes were as secondary treatment. Of 32 IAC cannulations performed, 23 (71.8%) were successful and received chemotherapy drug melphalan. Each eye received a mean of 1.8 (range 1–4) IAC injections. 53% of the eyes showed regression post treatment. After a mean follow up period of 19 months, globe salvage rate was 38%. Most of the adverse effects experienced were localized and transient. Conclusion IAC has provided an added recourse in the armamentarium of retinoblastoma treatment in our center. IAC treatment is a viable alternative in the treatment of retinoblastoma to salvage globe, for eyes that would conventionally require enucleation especially in bilateral disease.
Collapse
Affiliation(s)
- Chee Chung Liu
- University Malaya Eye Research Centre, University of Malaya, Kuala Lumpur, Malaysia
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- * E-mail: (CCL); (JR)
| | - Adzleen Mohmood
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- Department of Ophthalmology, University Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Norhafizah Hamzah
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Jia Him Lau
- Department of Radiology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Nurliza Khaliddin
- University Malaya Eye Research Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Jamalia Rahmat
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
- * E-mail: (CCL); (JR)
| |
Collapse
|
4
|
Clinicopathological Findings of Retinoblastoma: A 10-Year Experience from a Tertiary Hospital in Kampala, Uganda. J Ophthalmol 2019; 2019:5829284. [PMID: 31316824 PMCID: PMC6604297 DOI: 10.1155/2019/5829284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/28/2019] [Accepted: 05/21/2019] [Indexed: 12/19/2022] Open
Abstract
Background Retinoblastoma (RB) is one of the most common cancers occurring in young children in sub-Saharan Africa. The incidence rate reported in the literature is 9,000 new cases per year, which corresponds to 1 in 15,000 births. This study aimed at analyzing the clinicopathological findings in children with RB in Uganda. Purpose The purpose of this study was to describe and analyze the clinicopathological findings in the patients with RB. Design This was a cross-sectional analytical study involving 234 eyeball surgical specimens from 214 patients with RB diagnosed between January 2006 and December 2015. Results The mean age of the patients was 27.8 months (SD = 21.413, range: 1–132 months). More than half of the cases, 50.9%, presented with leucokoria. Invasion of choroid, sclera, anterior chamber, and optic nerve was found in 26.5% (n = 58), 51.2% (n = 88), 26.2% (n = 45), and 29.2% (n = 49), respectively. Twenty-six percent (n = 56) of the cases with intraocular tumour were at stage I and all patients with metastasis 4.7% (n = 11) had stage IV. The correlation between postlaminar optic nerve invasion and massive choroidal invasion was statistically significant (P = 0.002). Also, there was a statistical significance difference between metastasis and postlaminar invasion (P = 0.004). Conclusion The majority of children with RB in Uganda present clinically with leucokoria, and their parents or guardians seek medical intervention at a later stage. Moreover, there was a noticeably significant lag period for the patients to begin treatment after the diagnosis was done.
Collapse
|
5
|
Jin L, Zhang W, Pan H, Li T, Liu B, Zhao J, Wang B. Retrospective investigation of retinoblastoma in Chinese patients. Oncotarget 2017; 8:108492-108497. [PMID: 29312545 PMCID: PMC5752458 DOI: 10.18632/oncotarget.18174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/01/2017] [Indexed: 11/25/2022] Open
Abstract
This is a retrospective investigation of patients with Retinoblastoma (RB) conducted from 2013 to 2016 at the Quanzhou Maternal and Child Health Hospital (China). Demographic and clinical characteristics, treatment outcomes, and risk factors were studied. In total, 436 patients were included in the study. Most of the findings obtained in this study are consistent with other previous reports. The male: female ratio was 1.41:1, and the unilateral: bilateral ratio was 1.51:1. Leukocoria was the most common presenting sign (79.44%), followed by strabismus (12.38%). While, the overall rates of enucleation (15.82%) and mortality (0.92%) were markedly lower than in other reports of RB in Chinese, and most of the patients received conservative therapy. There were signficant differences (p < 0.001) in the age of at first sign and diagnosis, and treatment modalities between patients with bilateral and unilateral RB. The treatment modalities did not show a specific trend over the 3-year study period. Our results suggest that an incorrect initial diagnosis and long lag time may be risk factors for ineffective treatment and a poor prognosis in patients with RB. This was a comprehensive retrospective investigation in which the sample size exceeded most previous retrospective investigations of RB. Our study confirmed that early detection, accurate diagnosis, and active intervention are conducive to control of retention of patients’ vision. Fundus examinations, education regarding the early signs of RB, and optimization of the therapeutic strategy of RB may play important roles in ocular health.
Collapse
Affiliation(s)
- Liwen Jin
- Department of Ophthalmology, Maternal and Children's Hospital, Quanzhou, Fujian, China
| | - Wei Zhang
- Center for Genetics, National Research Institute for Family Planning, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Hong Pan
- Center for Genetics, National Research Institute for Family Planning, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Tengyan Li
- Center for Genetics, National Research Institute for Family Planning, Beijing, China
| | - Beihong Liu
- Center for Genetics, National Research Institute for Family Planning, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Junyang Zhao
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Binbin Wang
- Center for Genetics, National Research Institute for Family Planning, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| |
Collapse
|
6
|
Weaver MS, Heminger CL, Lam CG. Integrating stages of change models to cast new vision on interventions to improve global retinoblastoma and childhood cancer outcomes. BMC Public Health 2014; 14:944. [PMID: 25213666 PMCID: PMC4165911 DOI: 10.1186/1471-2458-14-944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 09/09/2014] [Indexed: 01/24/2023] Open
Abstract
Background Retinoblastoma, the most common intraocular tumor globally, represents a curable cancer when diagnosed early and treated promptly. Delay to diagnosis, lag time prior to treatment initiation, and abandonment of treatment including upfront treatment refusal, represent stark causes of high retinoblastoma mortality rates in low- and middle- income settings, particularly regions in Africa. While a health delivery-based approach has been a historic focus of retinoblastoma treatments globally and is essential to quality care, this is necessary but not adequate. Retinoblastoma is a compelling disease model to illustrate the potential insights afforded in theory-informed approaches to improve outcomes that integrate public health and oncology perspectives, prioritizing both health service delivery and social efficacy for cure. Discussion Given that barriers to appropriate and timely diagnosis and treatment represent main contributors to mortality in children with retinoblastoma in resource-limited settings such as certain areas in Africa, an important priority is to overcome barriers to cure that may be predominantly socially influenced, alongside health delivery-based improvements. While Stages of Change models have been effectively utilized in cancer screening programs within settings of economic and cultural barriers, this application of health behavior theory has been limited to cancer screening rather than a comprehensive framework for treatment completion. Using retinoblastoma as a case example, we propose applying stage-based intervention models in critical stages of care, such as the Precaution Adoption Process Model to decrease delay to diagnosis and a Transtheoretical Model to increase treatment completion rates in resource-limited settings. Summary Stage-based theories recognize that improved cure and survival outcomes will require supportive strategies to progress households, communities, and social and economic institutions from being unaware and unengaged to committed and sustained in their respective roles. Applying a stage-based model lens to programmatic interventions in resource-limited settings has potential for visible improvement in outcomes for children with retinoblastoma and other cancers.
Collapse
Affiliation(s)
- Meaghann S Weaver
- Department of Oncology, St, Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, Tennessee 38105, USA.
| | | | | |
Collapse
|