Mangaleshwari, M (2020) Histopathological Correlation with Outcome in Retinoblastoma. Masters thesis, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai.
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Abstract
INTRODUCTION: Retinoblastoma is an intraocular malignancy of childhood and found to be the most common tumor of this age, and its incidence ranges from 1 in 15,000 to 1 in 18,000 live births. The origin is thought to be either a precursor cone photoreceptor cell or may be a multipotent retinoblast. The first two years of birth is the most common period of presentation of retinoblastoma, but presentation in older age has also been noted. Retinoblastoma has not shown any gender difference, the probability is found to be equal on both sexes. Of the 100 cases 25 to 30 cases are showing bilateral presentation. The age of presentation depends on the laterality, bilateral cases presents ealier (around 12 months), compared to unilateral cases which is usually around 24 months, average age of presentation is about 18 months. Bilateral cases present at a younger age, while sporadic unilateral disease presents around 30 to 36 months of age .There are an estimated 5000 new cases worldwide annually, with India contributing to 1500–2000 cases. AIM OF THE STUDY: To study the Histopathological correlation with outcomes in patients with retinoblastoma in a tertiary care centre. Study Design: Prospective, Observational study based upon the histopathological high risk factors. MATERIALS AND METHODS: A prospective, observational study was carried out in patients with intraocular retinoblastoma who were identified at Aravind Eye Hospital, Madurai, India. Patients eligible for consideration were all cases of retinoblastoma who underwent primary or secondary enucleation between January 2018 and June 2019. All other cases who underwent enucleation elsewhere and on followup treatment at Aravind Eye Hospital, Madurai were excluded. Thae were staged according to the “Newly proposed classification for Intraocular Retinoblastom, and Group D and E was enucleated, after complete evaluation of ocular and systemic condition. The enucleated specimen was analysed for high risk histopathological character such as sclera, choroidal, optic nerve, resection margin and extra ocular invasion of tumor, and reviewed on regular basis. Most cases received 6 cycles of chemotherapy of triple drug regimen in One month interval (Vincristine, Etoposide, Carboplatin). Extented cycles of chemotherapy was given to patients with histopathological high risk factors. RESULTS: Our study included 50 eyes with retinoblastoma. We had 1 : 1 ratio distribution of retinoblastoma occurrence in male and female. The mean age at enucleation of retinoblastoma was 28.3 months .The minimum age of enucleation was 3 months and maximum age at enucleation 72 months. In our study the most common presentation was Leukocoria, followed by strabismus. The most common type of tumor growth was endophytic and the least common was diffuse infiltrative. Of the 50 eyes enucleated most tumors were differentiated tumors, optic nerve involvement was present in 36 eyes, resection margin was not free in 4 eyes and orbital extension in 3 patients. CONCLUSION: From our study we came to know that with the advancements in retinoblastoma, early diagnosis and treatment modalities had improved the prognosis of vision, globe and life salvage. It is important to create awareness in public and family members regarding the disease so that early presentation of the case to the treating center is possible. The prompt referral by the primary treating physician in case of suspicion is mandatory. Retinoblastoma requires a multimodal approach of treatment which invoves radiological imaging, pediatric evaluation, appropriate treatment by oncologist and ophthalmologist .Histopathological evaluation of all enucleated specimens are mandatory to determine the risk of metastasis and to schedule the adjuvant chemotherapy accordingly.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221713455 |
| Uncontrolled Keywords: | Retinoblastoma, histopathology , high risk factors ,optic nerve invasion, enucleation , chemotherapy. |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Feb 2021 16:08 |
| Last Modified: | 14 Feb 2021 16:08 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14206 |
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