Association of retinoblastoma with clinical and histopathological risk factors

Asad Aslam Khan, Mulazim Hussain Bukhari, Riffat Mehboob

Department of Ophthalmology, Mayo Hospital, King Edward Medical University, Lahore, Pakistan.

DOI: 10.4236/ns.2013.54056                

Abstract

A study was conducted to see the association of retinoblastoma with age, bilaterism, Tumor size, site, grades, involvement of anterior chamber, iris, ciliary body, choroid, sclera and optic nerve, and extraocular extension. This was a retrospective descriptive analytical study. The records of the Institute of Ophthalmology, King Edward Medical University/Mayo hospital, Lahore: Pakistan January 2006-Dec 2011 was analyzed. Five years biopsies (June 2006 to June 2012) of the retinoblastoma, from the Pathology department, was retrieved to see optic nerve involvement in all the retrieved specimens. The mean age was 3.54 ± 1.686 years. There were 15 cases of bilateral retinoblastoma and 37 cases with unilateral neoplasms. The age range of bilateral tumors was 2 - 6 years while the range in unilateral tumor was 1 - 10 years male to female ratio was 1:1.5. Among 52 cases, 37 (71.2%) patients were unilateral retinoblastoma and 15 (28.28%) patients were with bilateral disease. On radiological examination of patients suffering from retinoblastoma by B-Scan (Ultrasound), there were 33 (63.5%) cases with exophytic presentation while 18 (34.6%) cases showed endophytic morphology. On clinical examinations, 28 patients presented with proptosis of (it was the most common presenting sign in our patients, accounting for about 53.8% of cases), 20 cases presented with leucocoria eye with strabismus. 29/52 patients showed involvement with optic nerve, 17 were from 1 - 3 years age and 12 were from 4 - 6 years. Statistically there was no difference in the involvement of optic nerve, disc involvement and extra ocular extension with the age of patients (p = 0.217). There was also no statistical difference seen in age and gender for but a strong association was seen with patient’s presentation, symptoms and size of the tumors and anterior chamber, iris, ciliary body, choroid, sclera and optic nerve, and extra ocular extension. We concluded that a positive association was seen with tumor size and tumor extension (optic nerve, and extraocular extension). No Association was seen with age, gender and laterality of the tumors.

Keywords

Retinoblastoma; Optic Nerve; Optic Disc; Extra Ocular Extension

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Yun, J., Li, Y., Xu, C.T. and Pan, B.R. (2011) Epidemi ology and Rb1 gene of retinoblastoma. International Jour nal of Ophthalmology, 4, 103-109.
[2]	Knudson Jr., A.G. (1971) Mutation and cancer: Statistical study of retinoblastoma. Proceedings of the National Aca demy of Sciences of the United States of America, 68, 820-823. doi:10.1073/pnas.68.4.820
[3]	Broaddus, E., Topham, A. and Singh, A.D. (2009) In cidence of retinoblastoma in the USA: 1975-2004. British Journal of Ophthalmology, 93, 21-23. doi:10.1136/bjo.2008.138750
[4]	Benedict, W.L. (1929) Homologous retinoblastoma in identical twins. Transactions of the American Ophthal mological Society, 27, 173-176.
[5]	Canty, C.A. (2009) Retinoblastoma: An overview for advanced practice nurses. Journal of the American Aca demy of Nurse Practitioners, 21, 149-155. doi:10.1111/j.1745-7599.2008.00378.x
[6]	Dimaras, H., Dimba, E.A. and Gallie, B.L. (2010) Chal lenging the global retinoblastoma survival disparity through a collaborative research effort. British Journal of Oph thalmology, 94, 1415-1416. doi:10.1136/bjo.2009.174136
[7]	Lohmann, D. (2010) Retinoblastoma. Advances in Ex perimental Medicine and Biology, 685, 220-227. doi:10.1007/978-1-4419-6448-9_21
[8]	Du, W. and Pogoriler, J. (2006) Retinoblastoma family genes. Oncogene, 25, 5190-5200. doi:10.1038/sj.onc.1209651
[9]	Harbour, W. (2001) Retinoblastoma: Pathogenesis and diagnosis. In: Char, D.H., Ed., Tumours of the Eye and Ocular Adenexa, American Cancer Society, Atlas of Cli nical Oncology, BC Decker Inc., Hamilton, 253.
[10]	Muhammad, M.H. (1987) A statistical analysis of 581 primary orbital tumours in Pakistan. Pakistan Journal of Ophthalmology, 3, 111-114.
[11]	Nabie, R., Taheri, N., Fard, A.M. and Fouladi, R.F. (2012) Characteristics and clinical presentations of pediatric re tinoblastoma in North-Western Iran. International Jour nal of Ophthalmology, 5, 510-512.
[12]	Lohmann, D.R., Brandt, B., Hopping, W., Passarge, E. and Horsthemke, B. (1996) The spectrum of RB1 germ line mutations in hereditary retinoblastoma. American Journal of Human Genetics, 58, 940-949.
[13]	Arif, M. and Islam, Z. (2010) Retinoblastoma: Poste nucleation orbital recurrence. Canadian Journal of Oph thalmology, 45, 606-609. doi:10.3129/i10-059
[14]	Bhurgri, Y., Bhurgri, H., Usman, A., Faridi, N., Malik, J., et al. (2003) Epidemiology of ocular malignancies in Ka rachi. Asian Pacific Journal of Cancer Prevention, 4, 352-357.
[15]	Saiju, R., Thakur, J., Karmacharya, P.C. and Shah, D.N. (2006) Retinoblastoma in Nepal: A clinical profile of 30 cases. Nepal Medical College Journal, 8, 171-175.
[16]	Zhao, J., Li, S., Shi, J. and Wang, N. (2011) Clinical presentation and group classification of newly diagnosed intraocular retinoblastoma in China. British Journal of Ophthalmology, 95, 1372-1375. doi:10.1136/bjo.2010.191130
[17]	Balasubramanya, R., Pushker, N., Bajaj, M.S., Ghose, S., Kashyap, S., et al. (2004) Atypical presentations of retin oblastoma. Journal of Pediatric Ophthalmology and Stra bismus, 41, 18-24.
[18]	Kashyap, S., Meel, R., Pushker, N., Sen, S., Bakhshi, S., et al. (2012) Clinical predictors of high risk histopa thology in retinoblastoma. Pediatric Blood & Cancer, 58, 356-361. doi:10.1002/pbc.23239
[19]	Gunalp, I., Gunduz, K. and Arslan, Y. (1996) Retin oblastoma in Turkey—Treatment and prognosis. Japan ese Journal of Ophthalmology, 40, 95-102.
[20]	Abdu, L. and Malami, S. (2011) Clinicopathological pattern and management of retinoblastoma in Kano, Ni geria. Annals of African Medicine, 10, 214-219. doi:10.4103/1596-3519.84705
[21]	Shah, P.K., Kalpana, N., Narendran, V. and Ramakrishnan, M. (2011) Severe aseptic orbital cellulitis with subtenon carboplatin for intraocular retinoblastoma. Indian Journal of Ophthalmology, 59, 49-51. doi:10.4103/0301-4738.73714
[22]	Eagle Jr., R.C. (2009) High-risk features and tumor dif ferentiation in retinoblastoma: A retrospective histopa thologic study. Archives of Pathology & Laboratory Me dicine, 133, 1203-1209.
[23]	Shields, C.L., Shields, J.A., Baez, K.A., Cater, J. and De Potter, P.V. (1993) Choroidal invasion of retinoblastoma: Metastatic potential and clinical risk factors. British Jour nal of Ophthalmology, 77, 544-548. doi:10.1136/bjo.77.9.544
[24]	Essuman, V., Ntim-Amponsah, C.T., Akafo, S., Renner, L. and Edusei, L. (2010) Presentation of retinoblastoma at a paediatric eye clinic in ghana. Ghana Medical Journal, 44, 10-15.
[25]	Chawla, B., Sharma, S., Sen, S., Azad, R., Bajaj, M.S., et al. (2012) Correlation between clinical features, magnetic resonance imaging, and histopathologic findings in retin oblastoma: A prospective study. Ophthalmology, 119, 850 856. doi:10.1016/j.ophtha.2011.09.037
[26]	Mukhopadhyay, S., Ghosh, S., Chattopadhyay, D. and Dutta, S.K. (2006) An observational study on retinob lastoma cases attending a medical college in Calcutta. Journal of the Indian Medical Association, 104, 67-70.
[27]	Shields, C.L., Shields, J.A., Baez, K., Cater, J.R. and De Potter, P. (1994) Optic nerve invasion of retinoblastoma. Metastatic potential and clinical risk factors. Cancer, 73, 692-698. doi:10.1002/1097-0142(19940201)73:3<692::AID-CNCR2820730331>3.0.CO;2-8
[28]	Yang, I.H., Kuo, H.K., Chen, Y.J., Lee, J.J. and Lin, S.A. (2008) Review of 20 years’ clinical experience with re tinoblastomas in southern Taiwan. Chang Gung Medical Journal, 31, 484-491.
[29]	Yu, C.L., Tucker, M.A., Abramson, D.H., Furukawa, K., Seddon, J.M., et al. (2009) Cause-specific mortality in long-term survivors of retinoblastoma. Journal of the Na tional Cancer Institute, 101, 581-591. doi:10.1093/jnci/djp046