Year : 1975 | Volume
: 23 | Issue : 3 | Page : 20--22
Clinico-pathological observations on retinoblastoma
Arvind Kumar Sinha
Patna Medical College Hospital, Patna-4, India
Arvind Kumar Sinha
Department of Ophthalmology, Patna Medical College Hospital, Patna-4
|How to cite this article:|
Sinha AK. Clinico-pathological observations on retinoblastoma.Indian J Ophthalmol 1975;23:20-22
|How to cite this URL:|
Sinha AK. Clinico-pathological observations on retinoblastoma. Indian J Ophthalmol [serial online] 1975 [cited 2020 Apr 10 ];23:20-22
Available from: http://www.ijo.in/text.asp?1975/23/3/20/31314
Retinoblastoma is a congenital malignant tumour of the eyeball occuring primarily in infancy and childhood. It formed 31.25% of all the observed malignant growths of eye and its adnexa. This paper presents a detailed observations on clinical and pathological aspects of twenty cases of this growth.
Out of the twenty cases, enucleation was done in eleven and in two others partial exenteration of the affected eyeball was performed. A detailed histopathological examination was done in each case. In the rest of the seven cases a clinical study could only be made because of refusal for removal of the eyeball.
(A) Incidence-The incidence of retinoblastoma works out to a very low figure of 0.06% (all eye cases taken together) in Patna Medical College Hospital.
(B) Age and sex distribution-The most susceptible age group in which the tumor was noted, was 3 to 5 years (55%), the average age incidence being 3 years 8 months, 60% of the cases were seen in males.
(C) Eye involved-Both eyes were affected with equal frequency. Bilateral involvement was found in 20% cases.
(D) Heredity-Cases observed in the present study were sporadic in nature and had no hereditary history.
(E) Clinical findings-It would appear from the [Table 1] that majority of cases were seen in fairly advanced stage of the growth. 40% cases came with proptosis without preauricular lymph-adenopathy whereas 35% cases were seen with yellowish pupillary reflex and raised intraocular tension. These two groups constituted majority of the cases.
(F) Microscopic findings-The enucleated eye balls were observed with regard to the site of origin of the growth, its type and extent.
The common findings were as follows: The tumours were yellowish or yellowish white in appearance, with scattered areas of haemorrhages, necrosis and calcifications. In two, the tumour was found to be breaking through the cornea and bulging outside the eye and it was therefore, difficult to identify lens, cornea and other structures of the eye. Majority of the cases (92.3%) showed the origin of the tumour in the posterior half of the retina. Only in one case (7.6%) the growth was seen to be arising from the anterior half of the retina, in front of the equator. Endophytic type of growth (92.3%) was more common than exophytic type (7.6%)
(G) Microscopic findings-The tumour was characterized by small round cells. The nuclei were dark and hyperchromatic with indistinct cytoplasmic outline. Mitotic figures were seen. The cell had a characteristic arrangement. They formed either true rosettes (38.4% cases) or pseudo-rosettes (46.1 % cases) and in a few (15.3%) no specific cellular arrangements could be seen.
In true rosettes, the tumour cells were columnar in shape with fibrillary processes arranged around small empty spaces [Figure 1].
Pseudo-rosettes were formed by cells arranged around blood capillaries [Figure 2]. Large areas of necrosis, haemorrhage and calcifications were also seen. Optic nerve infiltration was recorded in 61.5% cases.
Inside the eyeball, choroid was found infiltrated with malignant cells in 53.8%, ciliary body in 38.4% and iris showed invasion in 23.0% cases. Corneal infiltration though less common, was recorded in 15.3% cases and sclera was found invaded in 23.0% cases. It was further observed that these infiltrations in choroid, ciliary body, iris, cornea and sclera were not independent foci but were in combination with each other.
The clinical signs suggesting the possibility of retmoblastoma are yellow reflex from behind the pupil, strabismus, dilated pupil, pseudohypopyon and phthisical eyes where the cause is unknown. Retinoblastoma arises from the nuclear layers of the retina. Like many other cancers in the human body, retinoblastoma has a multicentric origin and the rate of growth of this tumour is variable.
One of the characteristic histological feature in many cases of retinoblastoma is the formation of rosettes. The presence of rosettes indicates that the tumour is well differentiated and has in general a better prognosis. The prognosis was however always poor because of the patients coming for attention in an advanced stage of the disease. Tsukahara  found no statistically significant difference in the mortality rate of patients with tumours that were well-differentiated.
The tumour predilection for invading the optic nerve is of great clinical significance, because in a large number of cases, the death is due to direct extension of tumour to the brain by way of optic nerve. It is important to exercise carefully the optic nerve to be certain that the tumour has been removed completely.
In the histological material studied, calcification was observed and found scattered within the tumour area. Calcium is an inhibitor of the tumour growth. Reese , has suggested that in cases of spontaneous regression calcium concentration has been sufficient to prevent growth.
The paper presents clinico-pathological observations on twenty cases of retinoblastoma in Indian children. Sex and religion had no role to play in its aetiology. Bilaterality was observed in 20% cases. No hereditary or family history could be obtained in any case. Yellowish pupillary reflex was the commonest symptom for seeking medical advice. The origin of retinoblastoma was more commonly seen from the posterior half of the retina behind the equator. Glioma endophytum (92.3%) was commoner than Glioma exophytum (7.6%). Characteristic cellular arrangements in the form of rosettes (38.4%) and pseudo-rosettes (46.1%) were seen. In a few (15.3%)however, no specific celluar arrangements could be observed. Optic nerve infiltration was recorded in 61.5% cases.
|1||Mcgavic, J.S., 1959, Pediet. Clin. North America, 6, 359-367.|
|2||Reese, A.B., 1949, Arch. Ophthal. 42, 119-122.|
|3||Reese, A.B., 1963, Tumours of eye, 2nd Bdn, Paul B. Hoeber Inc, New York.|
|4||Tsukahara, L, 1960, Arch. Ophthal. 63 1005-1008.|