A. Intraocular calcification.
B. CT scan is more sensitive for detection of extraocular extension.
C. Hetrogenous mass.
D. Necrotic components with increased vascularization.
Ans:B. CT scan is more sensitive for detection of extraocular extension
The child shown in the picture above is suffering from Retinoblastoma.
- It is a cancer that rapidly develops from the immature cells of a retina.
- It is the most common malignant cancer of the eye in children, and it is almost exclusively found in young children.
- Almost half of children with retinoblastoma have a hereditary genetic defect associated with retinoblastoma.
- In other cases, it is caused by a congenital mutation in the chromosome 13 gene, 13q14.
- Abnormal appearance of the retina as viewed through the pupil(leukocoria, also known as amaurotic cat’s eye reflex).
- Deterioration of vision, a red and irritated eye with glaucoma, squint.
- Clinical patterns of retinoblastoma growth.
- Endophytic tumor,Exophytic tumor or Diffuse infiltrating growth
- Retinoblastoma can demonstrate local spread along the optic nerve directly into the orbit. It can also metastasize hematogenously to bone, liver, brain and other organs.
- Red Reflex:Whitening of red reflex
- Ophthalmoscopic examination:
- Presents with one or multiple nodular, white or cream colored masses often associated with increased vascularization.
- Both undifferentiated and differentiated elements may be present. Undifferentiated elements appear as collections of small, round cells with hyperchromatic nuclei; differentiated elements include Homer Wright rosettes(a type of rosette in which differentiated tumor cells surround the neuropil), Flexner-Wintersteiner rosettes( is a spoke and wheel shaped cell formation ),and fleurettes from photoreceptor differentiation.
- On imaging, they are generally characterised by a heterogeneous retinal(posterior chamber) mass with calcifications, necrotic components, and increased vascularisation on Doppler ultrasound/enhancement on CT/MRI.
- MR evaluation avoids the ionizing radiation of CT and is more sensitive for detection of extraocular extension of disease, perineural spread into the optic nerve and involvement of the subarachnoid space.