Clinical and histopathological correlation: A study on 334 eyes with retinoblastoma from Vietnam
Abstract
Purpose: To elucidate the clinical features which predict high-risk histopathological factors for subsequent metastatic disease as well as to report the incidence of these high-risk histopathological factors in a cohort of Asian patients with retinoblastoma.
Design: A retrospective and non-randomized sequential cases series.
Methods: A retrospective study was done on 334 eyes with retinoblastoma at Vietnam National Institute of Ophthalmology during a 10 year period (January 2004 – December 2013). All pathology specimens and medical records were reviewed and assessed for invasion and clinical signs.
Results: Among 334 eyes, 225 (67.4%) had high-risk retinoblastoma and 109 (22.6%) had non-high-risk features on histopathology. The high-risk histopathological features included anterior chamber seeding (48.2%), iris infiltration (14.7%), ciliary body involvement (14.1%), massive choroidal invasion (29.9 %), post-laminar optic nerve invasion (21.2%), invasion of optic nerve transection (9.6 %), combined choroidal and optic nerve invasion (9.6 %), scleral invasion (3.3%), and extra-scleral infiltration (11.4%). The significant clinical features in high-risk group versus non-high-risk group included hyphema (19.6% vs 3.7%, p < 0.001), pseudohypopyon (19.1% vs 6.4%, p = 0.001), iris neovascularization (25.3% vs 5.5%, p < 0.001), vitreous seeding (72.4% vs 37.6%, p < 0.001), staphyloma (24% vs 4.6%, p < 0.001) and scleritis (20% vs 3.7%, p < 0.001).
Conclusions: Clinical signs including hyphema, pseudohypopyon, iris neovascularization, vitreous seeding, staphyloma, and scleritis were significantly associated with high-risk features on histopathology. Globe preserving methods should be used with caution in patients with these signs.
References
2. MacCarthy A, Birch J, Draper G, et al. Retinoblastoma: treatment and survival in Great Britain 1963 to 2002. Br J Ophthalmol 2009;93(1):38-39.
3. Bowman R, Mafwiri M, Luthert P, Luande J, Wood M. Outcome of retinoblastoma in east Africa. Pediatr Blood Cancer 2008;50(1):160-162.
4. Kaliki S, Shields CL, Rojanaporn D, et al. High-risk retinoblastoma based on international classification of retinoblastoma: analysis of 519 enucleated eyes. Ophthalmology 2013;120(5):997-1003.
5. Kashyap S, Sethi S, Meel R, et al. A histopathologic analysis of eyes primarily enucleated for advanced intraocular retinoblastoma from a developing country. Arch Pathol Lab Med 2012;136(2):190.
6. Sastre X, Chantada GL, Doz F, et al. Proceedings of the consensus meetings from the International Retinoblastoma Staging Working Group on the pathology guidelines for the examination of enucleated eyes and evaluation of prognostic risk factors in retinoblastoma. Arch Pathol Lab Med 2009;133(8):1199.
7. Grossniklaus HE, Kivëla T, Harbour JW, Finger PT. Protocol for the examination of specimens from patients with retinoblastoma. Based on AJCC/UICC TNM. 7th ed. Northfield, IL: College of American Pathologists 2013.
8. Nabie R, Taheri N, Fard AM, Fouladi RF. Characteristics and clinical presentations of pediatric retinoblastoma in North-western Iran. Int J Ophthalmol 2012;5(4):510.
9. Kazadi Lukusa A, Aloni MN, Kadima-Tshimanga B, et al. Retinoblastoma in the democratic republic of congo: 20-year review from a tertiary hospital in kinshasa. J Cancer epidemiol 2012.
10. Meel R, Radhakrishnan V, Bakhshi S. Current therapy and recent advances in the management of retinoblastoma. Indian J Med Paed Oncol 2012;33(2):80.
11. da Rocha-Bastos R, Araújo J, Silva R, et al. retinoblastoma: experience of a referral center in the north region of Portugal. Clin Ophthalmol (Auckland, NZ) 2014;8:993.
12. Honavar SG, Singh AD, Shields CL, et al. Postenucleation adjuvant therapy in high-risk retinoblastoma. Arch Ophthalmol 2002;120(7):923-931.
13. Kaliki S, Shields CL, Shah SU, Eagle RC, Shields JA, Leahey A. Postenucleation adjuvant chemotherapy with vincristine, etoposide, and carboplatin for the treatment of high-risk retinoblastoma. Arch Ophthalmol 2011;129(11):1422-1427.
14. Kaliki S, Srinivasan V, Gupta A, Mishra DK, Naik MN. Clinical Features Predictive of High-Risk Retinoblastoma in 403 Asian Indian Patients: A Case-Control Study. Ophthalmology 2015;122(6):1165-1172.
15. Kashyap S, Meel R, Pushker N, et al. Clinical predictors of high risk histopathology in retinoblastoma. Pediatr Blood Cancer 2012;58(3):356-361.
16. Yousef YA, Hajja Y, Nawaiseh I, et al. A Histopathologic Analysis of 50 Eyes Primarily Enucleated for Retinoblastoma in a Tertiary Cancer Center in Jordan/Ürdün’de Üçüncü Basamak Kanser Merkezinde Retinoblastoma Nedeniyle Primer Enükleasyon Uygulanan 50 Gözün Histopatolojik İncelemesi. Turk J Pathol 2014;30(3):171-177.
17. Eagle Jr RC. High-risk features and tumor differentiation in retinoblastoma: a retrospective histopathologic study. Arch Pathol Lab Med 2009;133(8):1203.
18. Shields CL, Shields JA, Baez K, Cater JR, de Potter P. Optic nerve invasion of retinoblastoma. Metastatic potential and clinical risk factors. Cancer 1994;73(3):692-698.
19. Shields CL, Shields JA, Baez KA, Cater J, De Potter PV. Choroidal invasion of retinoblastoma: metastatic potential and clinical risk factors. Br J Ophthalmol 1993;77(9):544-548.
20. Shields CL, Shields JA. Basic understanding of current classification and management of retinoblastoma. Curr Opin Ophthalmol 2006;17(3):228-234.
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