From Fungus haematodes to Retinoblastoma

Retinoblastoma is probably the only disease which received 40 different names until its official terminology which was adopted by the medical community in 1926. The official record of retinoblastoma was reported in 1597 by Petrus Pawius (ca. 1564-1617). The development of pathology during the 19th century gave to opportunity to clarify the histological characteristics of the disease. Although in the past retinoblastoma was considered a fatal disease, nowadays with modern treatment the prognosis is better.

Retinoblastoma: An overview of modern management

Retinoblastoma (RB) is an embryonic tumor originating from the retinal cells. RB is the most common intraocular cancer of childhood and accounts for 4% of all pediatric malignancies.

Genetic screening in Iranian patients with retinoblastoma

PurposeThe most common intraocular tumor in childhood, retinoblastoma, is largely associated with mutations in the RB1 gene. In the most comprehensive RB1 screening in Iran, we evaluated the RB1 mutations in 106 patients with retinoblastoma, including 73 bilateral (heritable) and 33 unilateral (sporadic) cases.Patients and methodsMutations were identified using amplification refractory mutation system (ARMS) PCR and direct sequencing of the 27 coding exons of RB1 and multiplex ligation-dependent probe amplification (MLPA).Results and ConclusionWe found 33 (31%) and 64 (60%) patients with sporadic unilateral and bilateral retinoblastoma, respectively as well as 9 (8.5%) cases with hereditary bilateral retinoblastoma. In total, we identified 52 causative RB1 mutations in 106 patients (global mutation rate of 49%). Of the 52 patients, 48 (92%) had sporadic and familial bilateral and 4 (8%) had sporadic unilateral RB. Therefore, the detection rate of RB1 mutations was 66% (48/73) and 12% (4/33) in bilateral and unilateral cases, respectively. Mutations were classified as nonsense in 31 (60%), missense in 1 (2%), large deletion in 11 (21%), small deletion in the 7 novel (15%) and splice site mutation in 2 (4%) patients with RB. Of 31 nonsense mutations, 23 (74%) occurred in the 11 Arginine codons of the RB1. Seven mutations (13%) were novel, and 45 (87%) had been previously reported. Thirty-three mutations were single-base substitutions leading to 31 nonsense amino acid changes and 2 splice site mutations in introns 12 and 16 of RB1. The altered 3D model structures of the RB1 novel mutant proteins are also predicted in this study.

Clinical presentation and treatment outcome of retinoblastoma in children of South Western China

To study the clinical presentation and treatment outcome among children in South Western China with retinoblastoma (RB) and to determine factors predictive of poor outcome.A retrospective review of children diagnosed with RB from 2006 to 2015 at West China Hospital was undertaken. Demographic and clinical characteristics and treatment outcomes were studied.A total of 253 patients (unilateral 80.2%, bilateral 19.8%) were studied. Twenty six patients (10.3%) were from minority ethnic groups of China. The median onset age was 21 months. Leukocoria was the most common presenting sign (71%). Tumors were intraocular in 91.3% cases, extraocular in 8.7% cases. Extraocular RB patients had a longer median lag period than intraocular patients (9 months vs 2 months, P < 0.0001). In the intraocular group, 89.5% were advanced group D or E diseases. Enucleation was the major treatment for intraocular RB. However, over 10 years, the enucleation rate decreased constantly while more patients received chemotherapy. The Kaplan-Meier survival probability was 87.8%, 81.4%, and 74.8% at 3 years, 5 years, and 10 years, respectively. On Cox regression analysis, extraocular RB (P = 0.0008) and treatment abandonment (P < 0.0001) were associated with poor outcome; bilateral RB (P = 0.0116) and advanced pathological grade pT4 (P = 0.0011) were associated with poor outcome of intraocular RB.Most RB patients from South Western China were diagnosed at advanced clinical stage. Delayed presentation is related to extraocular RB which is a risk factor for poor outcome. Chemotherapy increased the eye salvage but had no effects to overall survival. Education for parents and general physicians for the early signs of RB (such as leukocoria), therapeutic strategy and treatment outcomes of RB may promote early diagnosis, improve the compliance, and outcome.

Adult onset retinoblastoma

Retinoblastoma (RB) is the most common primary malignant intraocular tumor of childhood presenting usually before 5 years of age. RB in adults older than 20 years is extremely rare. A literature search using PubMed/PubMed Central, Scopus, Google Scholar, EMBASE, and Cochrane databases revealed only 45 cases till date. Over the past decade, there has been a significant increase in the number of such reports, indicating heightened level of suspicion among ophthalmologists. Compared to its pediatric counterpart, adult onset RB poses unique challenges in diagnosis and treatment. This article summarizes available literature on adult onset RB and its clinical and pathologic profile, genetics, association with retinocytoma, diagnostics, treatment, and outcomes.

Correlation of Insurance, Race, and Ethnicity with Pathologic Risk in a Controlled Retinoblastoma Cohort: A Children's Oncology Group Study

PURPOSE

To determine whether insurance status, race, and ethnicity correlate with increased retinoblastoma invasiveness as a marker of both risk and time to diagnosis.

DESIGN

Retrospective case-control study.

PARTICIPANTS

All 203 patients from the United States enrolled in the Children's Oncology Group (COG) trial ARET0332, a study of patients with unilateral retinoblastoma requiring enucleation.

MAIN OUTCOME MEASURES

All surgical specimens underwent pathologic review to determine the presence of well-defined histopathologic features correlating with a higher risk of disease progression. Insurance status, race, and ethnicity were compiled from the study record for each patient.

RESULTS

On institutional pathologic review, nonprivate insurance, nonwhite race, and Hispanic ethnicity all correlated significantly with a greater rate of high-risk pathologic findings. Hispanic ethnicity remained a significant predictor on multivariate analysis. On central pathologic review, these correlations remained but did not reach statistical significance. The differences in results from institutional versus central pathologic reviews appeared to be due to a higher likelihood of patients in minority groups of being misclassified as high risk by institutional pathologists.

CONCLUSIONS

In this controlled study population of patients with retinoblastoma who had central pathologic review, our findings suggest a higher rate of more advanced disease associated with nonprivate insurance, nonwhite race, and Hispanic ethnicity; these findings may be due to delays in diagnosis for these groups. Future work should use direct methods to study the impact of other variables, including English-language proficiency and socioeconomic status. Further effort also should focus on where in the diagnostic process potential delays exist, so that interventions can be designed to overcome barriers to care for these groups. In addition, potential systematic differences in pathologic reads based on demographic variables deserve further study.

Sporadic Retinoblastoma and Parental Smoking and Alcohol Consumption before and after Conception: A Report from the Children's Oncology Group

Background

Retinoblastoma is the most frequent tumor of the eye in children and very little is known about the etiology of non-familial (sporadic) retinoblastoma. In this study we examined whether parental tobacco smoking or alcohol consumption (pre- or post-conception) contribute to the two phenotypes (bilateral or unilateral) of sporadic retinoblastoma.

Methods

Two large multicenter case-control studies identified 488 cases through eye referral centers in the United States and Canada or through the Children’s Oncology Group. Controls (n = 424) were selected from among friends and relatives of cases and matched by age. Risk factor information was obtained via telephone interview. We employed multivariable logistic regression to estimate the effects of parental tobacco smoking and alcohol consumption on retinoblastoma.

Findings

Maternal smoking before and during pregnancy contributed to unilateral retinoblastoma risk in the child: year before pregnancy conditional Odds Ratio (OR), 8.9; 95% confidence interval (CI) 1.5–51, and unconditional OR, 2.4; 95% CI, 1.3–4.7; month before or during pregnancy, conditional OR, 3.3; 95% CI, 0.5–20.8, and unconditional OR, 2.8; 95% CI, 1.1–7.0. No association was found for maternal or paternal alcohol consumption.

Conclusion

The results of this study indicate that maternal active smoking during pregnancy may be a risk factor for sporadic retinoblastoma. Our study supports a role for tobacco exposures in embryonal tumors.

Retinoblastoma

Retinoblastoma is the most common primary intraocular malignancy of childhood. It typically presents with leukocoria or strabismus. In later stages of the disease, the child may exhibit proptosis, buphthalmos, or hypopyon. The pathognomonic molecular aberration is a loss of function mutation in the RB1 gene on chromosome 13q. The degree of tumor involvement within the eye is defined by its group. Grouping was historically done with Reese-Ellsworth System. Recent therapeutic advances have led to the development of a new grouping system, the International Classification of Retinoblastoma (ICRB). In cases of extraocular extension and metastatic disease, the degree of tumor involvement outside of the eye is defined by its stage. Retinoblastoma is staged using the International Retinoblastoma Staging System (IRSS). Children with intraocular retinoblastoma have an excellent overall and ocular survival. In order to avoid the morbidity of enucleation and external beam radiation, treatments for isolated intraocular retinoblastoma have progressively moved toward targeted local modalities. Patients with extraocular involvement, such as those with trilateral retinoblastoma, have a poorer prognosis. The majority of these higher stage patients are now able to be cured with combination chemotherapy.

The Incidence of Trilateral Retinoblastoma: A Systematic Review and Meta-Analysis

PURPOSE

To estimate the incidence of trilateral retinoblastoma in patients with retinoblastoma.

DESIGN

Systematic review and meta-analysis.

METHODS

We searched Medline and Embase for scientific literature published between January 1966 and July 2015 that assessed trilateral retinoblastoma incidence. We used a random-effects model for the statistical analyses.

RESULTS

We included 23 retinoblastoma cohorts from 26 studies. For patients with bilateral retinoblastoma the unadjusted chance of developing trilateral retinoblastoma across all cohorts was 5.3% (95% confidence interval [CI]: 3.3%-7.7%); the chance of pineal trilateral retinoblastoma was 4.2% (95% CI: 2.6%-6.2%) and the chance of nonpineal trilateral retinoblastoma was 0.8% (95% CI: 0.4%-1.3%). In patients with hereditary retinoblastoma (all bilateral cases, and the unilateral cases with a family history or germline RB1 mutation) we found a trilateral retinoblastoma incidence of 4.1% (95% CI: 1.9%-7.1%) and a pineal trilateral retinoblastoma incidence of 3.7% (95% CI: 1.8%-6.2%). To reduce the risk of overestimation bias we restricted analysis to retinoblastoma cohorts with a minimum size of 100 patients, resulting in adjusted incidences of 3.8% (95% CI: 2.4%-5.4%), 2.9% (95% CI: 1.9%-4.2%), and 0.7% (95% CI: 0.3%-1.2%) for any, pineal, and nonpineal trilateral retinoblastoma, respectively, among patients with bilateral retinoblastoma. Among hereditary retinoblastoma we found an adjusted trilateral retinoblastoma incidence of 3.5% (95% CI: 1.2%-6.7%) and a pineal trilateral retinoblastoma incidence of 3.2% (95% CI: 1.4%-5.6%).

CONCLUSION

The estimated incidence of trilateral retinoblastoma is lower than what is reported in previous literature, especially after exclusion of small cohorts that were subject to overestimation bias in this context.

Retinoblastoma and ambient exposure to air toxics in the perinatal period

We examined ambient exposure to specific air toxics in the perinatal period in relation to retinoblastoma development. Cases were ascertained from California Cancer Registry records of children diagnosed between 1990 and 2007 and matched to California birth certificates. Controls were randomly selected from state birth records for the same time period. We chose 27 air toxics for the present study that had been listed as possible, probable, or established human carcinogens by the International Agency for Research on Cancer. Children (103 cases and 30,601 controls) included in the study lived within 5 miles of an air pollution monitor. Using logistic regression analyses, we modeled the risk of retinoblastoma due to air toxic exposure, separately for exposures in pregnancy and the first year of life. With a per interquartile range increase in air toxic exposure, retinoblastoma risk was found to be increased with pregnancy exposure to benzene (OR=1.67, 95% CI: 1.06, 2.64) and other toxics which primarily arise from gasoline and diesel combustion: toluene, 1,3-butadiene, ethyl benzene, ortho-xylene, and meta/para-xylene; these six toxics were highly correlated. Retinoblastoma risk was also increased with pregnancy exposure to chloroform (OR=1.35, 95% CI: 1.07, 1.70), chromium (OR=1.29, 95% CI: 1.04, 1.60), para-dichlorobenzene (OR=1.24, 95% CI: 1.04, 1.49), nickel (OR=1.48, 95% CI: 1.08, 2.01), and in the first year of life, acetaldehyde (OR=1.62, 95% CI: 1.06, 2.48). Sources of these agents are discussed.

Ocular malignant tumors. Review of the Tumor Registry at a tertiary eye hospital in central Saudi Arabia

OBJECTIVE

To present the epidemiologic profile and magnitude of ocular malignant tumors (MT) representative of the Saudi population from the Tumor Registry (TR) at King Khaled Eye Specialist Hospital (KKESH).

METHODS

This study evaluated the demographic information, clinical features including tumor laterality, ocular tissue of origin, and diagnosis of patients from the TR registry between 1983 and 2012 at KKESH, Riyadh, Kingdom of Saudi Arabia. The incidence of MT among Saudi adults (>/= 15 years old), and children (<15 years old) was estimated.

RESULTS

The TR recorded 4,146 neoplasms (2,509 [60.5%] benign tumors, and 1,637 [39.5%] MT). The incidence of MT in children was 3.6 per million/year (M/Y), and 2.4/M/Y for adults. Retinoblastoma (Rb) (n=763, 91%) was the most common ocular malignancy in children. In adults, the most common MT was squamous cell carcinoma (SCC) (n=363, 45.8%), basal cell carcinoma (BCC) (n=186, 23%), uvealmelanoma (n=94, 11.9%), sebaceous gland carcinoma (n=54, 6.8%), lymphomas (orbital, adnexal) (n=46, 5.8%), and others (n=53, 6.8%). The Rb (7.7/M/Y in <5 years old Saudi children) was less frequent than that reported in some Gulf countries, but higher than that reported from the West. The SCC was less frequent in countries with comparable sun exposure than in other continents, but the incidence remained unchanged over 3 decades. There was a significant increase in BCC between 1983-1992 and 2003-2012.

CONCLUSION

The rates of all cancers remained stable over 3 decades except BCC, which showed a significant rise.

Germline retinoblastoma without inherited gene mutation: a case report

Retinoblastoma is the most common primary ocular malignancy in childhood and can occur as a germline or somatic mutation. Recent studies have suggested a higher incidence of retinoblastoma in Hispanic children as compared to non-Hispanic white children of the same ages. We report the ocular findings of a 20 years old Hispanic male with a history of bilateral retinoblastoma. Although screening is currently performed with the red reflex test, analysis of current literature suggests the need to reassess screening recommendations for retinoblastoma.

Prenatal exposure to traffic-related air pollution and risk of early childhood cancers

Exposure to air pollution during pregnancy has been linked to the risk of childhood cancer, but the evidence remains inconclusive. In the present study, we used land use regression modeling to estimate prenatal exposures to traffic exhaust and evaluate the associations with cancer risk in very young children. Participants in the Air Pollution and Childhood Cancers Study who were 5 years of age or younger and diagnosed with cancer between 1988 and 2008 were had their records linked to California birth certificates, and controls were selected from birth certificates. Land use regression-based estimates of exposures to nitric oxide, nitrogen dioxide, and nitrogen oxides were assigned based on birthplace residence and temporally adjusted using routine monitoring station data to evaluate air pollution exposures during specific pregnancy periods. Logistic regression models were adjusted for maternal age, race/ethnicity, educational level, parity, insurance type, and Census-based socioeconomic status, as well as child's sex and birth year. The odds of acute lymphoblastic leukemia increased by 9%, 23%, and 8% for each 25-ppb increase in average nitric oxide, nitrogen dioxide, and nitrogen oxide levels, respectively, over the entire pregnancy. Second- and third-trimester exposures increased the odds of bilateral retinoblastoma. No associations were found for annual average exposures without temporal components or for any other cancer type. These results lend support to a link between prenatal exposure to traffic exhaust and the risk of acute lymphoblastic leukemia and bilateral retinoblastoma.

Retinoblastoma in Turkey: results from a tertiary care center in Ankara

PURPOSE

To evaluate the presentation patterns and results of management of retinoblastoma at a tertiary care center in Ankara, Turkey, with special emphasis on globe conservation rate in unilateral and bilateral intraocular retinoblastoma.

METHODS

Patients were grouped according to the International Classification of Retinoblastoma. For intraocular retinoblastoma, group E and some group D eyes underwent primary enucleation. Secondary enucleation was performed after failure of chemoreduction, focal treatments, external beam radiotherapy (EBRT), and intra-arterial chemotherapy used in various combinations. For extraocular retinoblastoma cases, treatment consisted of enucleation/exenteration or orbital biopsy, high-dose chemotherapy, and EBRT to the orbit and metastatic sites.

RESULTS

During the study period from October 1998 to May 2010, 165 of 192 (85.9%) patients had intraocular disease and 27 (14.1%) patients had extraocular disease. In total, primary or secondary enucleation was performed in 70 of 94 eyes with unilateral retinoblastoma (74.5%) and in 34 of 142 eyes with bilateral retinoblastoma (23.9%). The overall globe conservation rate was 69.6%. Only one patient in the intraocular retinoblastoma group died of metastatic retinoblastoma to the central nervous system. Twenty of 27 patients (74.1%) with extraocular retinoblastoma were found to have metastasis to the central nervous system, bone, bone marrow, and/or lymph nodes. At a mean follow-up of 28.0 months (median: 12 months; range: 1 to 120 months), survival was 33.3% despite intensive treatment.

CONCLUSIONS

The overall risk of enucleation was 75% in eyes with unilateral retinoblastoma and 24% in eyes with bilateral retinoblastoma. Extraocular retinoblastoma carries a 75% risk of systemic metastasis and 67% risk of death.

[Familial retinoblastoma in the experience of the Department of Ophthalmology and Ocular Oncology in Kraków]

In this retrospective study we analyzed over 300 patients with diagnosed retinoblastoma treated in the Department of Ophthalmology and Ocular Oncology in Kraków in 1967-2011. Nine families (parents and offspring) with diagnosed familial retinoblastoma present in at least two generations were analyzed. A review of the age of onset, diagnosis and recurrence rate of tumors as well as the long-term results of applied therapy and advantages of prophylactic ophthalmic screening in children at high risk of familial retinoblastoma was performed. The results of our observations showed that in offspring the tumors were diagnosed earlier, and the therapy outcomes were better as compared to the group of Parents. We conclude that these observations were associated with performed genetic screening, early prophylactic ophthalmic examination of children born in families with diagnosed retinoblastoma and chemoreduction treatment.

Perinatal characteristics and retinoblastoma

PURPOSE

The etiology of retinoblastoma remains poorly understood. In the present study, we examined associations between perinatal factors and retinoblastoma risk in California children.

METHODS

We identified 609 retinoblastoma cases (420 unilateral, 187 bilateral, and 2 with laterality unknown) from California Cancer Registry records of diagnoses 1988-2007 among children < 6 years of age. We randomly selected 209,051 controls from California birth rolls. The source of most study data was birth certificates. Multivariable logistic regression was used to examine associations between retinoblastoma and perinatal characteristics.

RESULTS

Bilateral retinoblastoma was associated with greater paternal age [for fathers over 35, crude odds ratio (OR) = 1.73, 95 % confidence interval (CI) 1.20, 2.47] and with twin births (OR = 1.93, 95 % CI 0.99, 3.79). Among unilateral cases, we observed an increased risk among children of US-born Hispanic mothers (OR = 1.34, 95 % CI 1.01, 1.77) while a decreased risk was observed for infants born to mothers with less than 9 years of education (OR = 0.70, 95 % CI 0.49, 1.00), a group that consisted primarily of mothers born in Mexico. We observed that maternal infection in pregnancy with any STD (OR = 3.59, 95 % CI 1.58, 8.15) was associated with bilateral retinoblastoma.

CONCLUSIONS

This study supports the findings of previous investigations reporting associations between parental age, HPV infection, and retinoblastoma.

Parental diet and risk of retinoblastoma resulting from new germline RB1 mutation

We conducted a case-control study of sporadic bilateral retinoblastoma, which results from a new germline RB1 mutation, to investigate the role of parents' diet before their child's conception. Parents of 206 cases from nine North American institutions and 269 controls participated; of these, fathers of 184 cases and 223 controls and mothers of 204 cases and 260 controls answered a food frequency questionnaire administered by phone about their diet in the year before the child's conception. Cases provided DNA for RB1 mutation testing. We assessed parents' diet by examining 19 food groups. Father's intake of dairy products and fruit was associated with decreased risk and cured meats and sweets with increased risk. Mother's intake was not associated with disease for any food group. Considering analyses adjusted for the other food groups significantly associated with disease, energy intake, and demographic characteristics as well as more fully adjusted models, the associations with father's dairy products and cured meat intake were the most robust. In the fully adjusted, matched analysis, the odds ratios per daily serving were 0.70 (95% confidence interval (CI) 0.49-1.00, P = 0.047) for dairy products and 5.05 (CI 1.46-17.51, P = 0.01) for cured meat. The pattern of associations with paternal but not maternal diet is consistent with the fact that 85% of new germline RB1 mutations occur on the father's allele. As few human data exist on the role of diet in any condition resulting from new germ-cell mutation, additional studies will be needed to replicate or refute our findings.

Are children with birth defects at higher risk of childhood cancers?

Birth defects may influence the risk of childhood cancer development through a variety of mechanisms. The rarity of both birth defects and childhood cancers makes it challenging to study these associations, particularly for the very rare instances of each. To address this limitation, the authors conducted a record linkage-based cohort study among Texas children born between 1996 and 2005. Birth defects in the cohort were identified through the Texas Birth Defects Registry, and children who developed cancer were identified by using record linkage with Texas Cancer Registry data. Over 3 million birth records were included; 115,686 subjects had birth defects, and there were 2,351 cancer cases. Overall, children with a birth defect had a 3-fold increased risk of developing cancer (incidence rate ratio (IRR) = 3.05, 95% confidence interval (CI): 2.65, 3.50), with germ cell tumors (IRR = 5.19, 95% CI: 2.67, 9.41), retinoblastomas (IRR = 2.34, 95% CI: 1.21, 4.16), soft-tissue sarcomas (IRR = 2.12, 95% CI: 1.09, 3.79), and leukemias (IRR = 1.39, 95% CI: 1.09, 1.75) having statistically significant elevated point estimates. All birth defect groups except for musculoskeletal had increased cancer incidence. Untangling the strong relation between birth defects and childhood cancers could lead to a better understanding of the genetic and environmental factors that affect both conditions.

Trends in incidence of childhood cancer in Canada, 1992-2006

INTRODUCTION

Cancer is the leading cause of disease-related death in children aged 1 to 14 years in Canada. Despite the importance to public health of childhood cancer, there have been few reports on Canadian trends published in the peer-reviewed literature. This study examines childhood cancer trends by age, sex, and province of residence using the most current cancer registration data.

METHODS

Data from the population-based Canadian Cancer Registry were used to compute incidence trends in primary cancers diagnosed between 1992 and 2006 in children (0-14 years) for the 12 major diagnostic groups of the International Classification of Childhood Cancer, 3rd Edition.

RESULTS

Between 1992 and 2006, incidence rates for all cancers remained stable, although trends varied by cancer type. We observed a significant decrease in retinoblastoma in boys for the entire period (-6.5% per year) and an increase in leukemia from 1992 to 1999 (+3.5% per year). In girls, there was a significant decrease in renal tumours from 1998 to 2006 (-5.7% per year) and an increase in hepatic tumours from 1997 to 2006 (+8.1% per year). Differences by age and province were also apparent. Some caution should be exercised when interpreting trends involving a small number of cases per year and those with wide 95% confidence intervals.

CONCLUSIONS

Our findings suggest an ongoing need for population-based surveillance and etiologic research.

Retinoblastoma

Retinoblastoma is an aggressive eye cancer of infancy and childhood. Survival and the chance of saving vision depend on severity of disease at presentation. Retinoblastoma was the first tumour to draw attention to the genetic aetiology of cancer. Despite good understanding of its aetiology, mortality from retinoblastoma is about 70% in countries of low and middle income, where most affected children live. Poor public and medical awareness, and an absence of rigorous clinical trials to assess innovative treatments impede progress. Worldwide, most of the estimated 9000 newly diagnosed patients every year will die. However, global digital communications present opportunities to optimise standards of care for children and families affected by this rare and often devastating cancer. Parents are now leading the effort for widespread awareness of the danger of leucocoria. Genome-level technologies could make genetic testing a reality for every family affected by retinoblastoma. Best-practice guidelines, online sharing of pathological images, point-of-care data entry, multidisciplinary research, and clinical trials can reduce mortality. Most importantly, active participation of survivors and families will ensure that the whole wellbeing of the child is prioritised in any treatment plan.

Analysis of retinoblastoma age incidence data using a fully stochastic cancer model

Retinoblastoma (RB) is an important ocular malignancy of childhood. It has been commonly accepted for some time that knockout of the two alleles of the RB1 gene is the principal molecular target associated with the occurrence of RB. In this article, we examine the validity of the two-hit theory for RB by comparing the fit of a stochastic model with two or more mutational stages. Unlike many such models, our model assumes a fully stochastic stem cell compartment, which is crucial to its behavior. Models are fitted to a population-based dataset comprising 1,553 cases of RB for the period 1962-2000 in Great Britain (England, Scotland and Wales). The population incidence of RB is best described by a fully stochastic model with two stages, although models with a deterministic stem cell compartment yield equivalent fit; models with three or more stages fit much less well. The results strongly suggest that knockout of the two alleles of the RB1 gene is necessary and may be largely sufficient for the development of RB, in support of Knudson's two-hit hypothesis.

Patterns of Retinoblastoma in Zimbabwe: 2000-2009

OBJECTIVE

To document the pattern of retinoblastoma in children in Zimbabwe for the period 2000-2009.

DESIGN

Retrospective study.

METHODS

Analysis of data from the Zimbabwe National Cancer registry and records of patients admitted to the Paediatric Oncology unit. Data collected from cancer registry were basis of diagnosis, age and gender. Data from the patients medical records included clinical presentation, time to diagnosis and treatment.

SETTINGS

The Zimbabwe National Cancer Registry and Paediatric Oncology Unit at Parirenyatwa Tertiary Hospital.

RESULTS

196 patients with retinoblastoma were registered at the cancer registry over the study period. The diagnosis was confirmed histologically on 89% of the cases and in 7% the diagnosis was based on clinical grounds. The age ranged from less than one month to 7 years with median age of 24 months. Males were 111 (56%) with male:female ratio of 1.3:1. Forty three patients (84%) had unilateral and 8 (16%) bilateral disease. Medical records were retrieved from only 54 /196 cases (27.5%). The commonest clinical presentation was proptosis 35/54 (65%). Leucocoria was present in 14/54 (26%). Time interval between first symptoms and diagnosis ranged from less than one month to 24 months with mean duration of 7.7 months (SD = 6.9). Enucleation was performed on 33/ 54 (61%), exenteration on 20/54 (37%) chemotherapy was given to 34/54 (63%) and only 6/54 (11%) received radiotherapy.

CONCLUSION

Retinoblastoma is the third commonest registered malignancy of childhood in Zimbabwe, characaterised by late presentation and poor access to therapy.

Retinoblastoma Registry report--Hospital Kuala Lumpur experience

Retinoblastoma is a childhood ocular cancer. The aim of this paper is to describe the clinical and epidemiological characteristics of patients with retinoblastoma in a major paediatric ophthalmology center in the country. Retrospective information was collected through the retinoblastoma registry. Late presentation with advanced staging is a major problem.

Compliance in retinoblastoma

OBJECTIVE

To evaluate disease is advanced, compliance in retinoblastoma.

METHODS

This is a retrospective descriptive study of patients of retinoblastoma registered at our cancer center from June 2003-February 2007 to study compliance.

RESULTS

Sociodemographic data of 177 patients revealed rural:urban ratio of 2:1, median age 36 months (unilateral disease) and 24 months (bilateral disease); median symptom duration 7.2 months. Overall, 84/141 evalued cases took adequate therapy; follow-up could be achieved in 67/141 (47.5%) cases in comparison to 92.4% in Hodgkin's lymphoma (p=0.001), 62.8% in acute myeloid leukemia (p=0.036) and 72.7% in non Hodgkin's lymphoma (p=0.001). There was no significant impact of any sociodemographic factors on compliance. Amongst those offered enucleation upfront for intraocular disease, it was accepted in 86/93 (92.5%) eyes.

CONCLUSION

This is one of the largest studies in relation to sociodemographic factors and clinical spectrum, and the only study from Asia evaluating compliance with recommended therapy in retinoblastoma. In order to improve ocular and patient salvage rates in Asian countries, exact causes for poor compliance in retinoblastoma need to be closely examined through a prospective study.

Retinoblastoma presenting as metastasis

OBJECTIVE

The purpose of this study was to evaluate the frequency of metastatic retinoblastoma on initial presentation.

DESIGN

Prospective study.

PLACE AND DURATION OF STUDY

Supra Regional Centre for Retinoblastoma, Department of Ophthalmology, Khyber Teaching Hospital Peshawar Pakistan from 1st July 1999 to 31st January 2003.

METHODS

Data was collected from 80 registered Retinoblastoma patients admitted and examined under anaesthesia for tumours assessment. Diagnosis was supported with the help of CT scan and confirmed by histopathology of the enucleated specimen for evidence of optic nerve invasion by the tumour.

RESULTS

Twenty (25%) patients were presenting as Metastasis on initial presentation. Mean age was 3.5 years, range was 7 months to 12 years. Out of these 20 patients with metastasis, 10 were male and 10 were female. Eighteen (90%) of them were from lower socio-economic group.

CONCLUSION

Failure in early diagnosis of retinoblastoma, advance age and unilateral disease are associated with extraocular spread; this tragic scenario can be prevented best be early detection and prompt treatment plan implementation.

[Neurofibromatosis type 1--own experiences]

PURPOSE

Neurofibromatosis type 1 is one of the most common inherited syndromes. The aim of this study was to evaluate eye symptoms on this disease.

MATERIAL AND METHODS

52 patients with neurofibromatosis type 1 were observed (28 males and 24 females), age between 3 and 49 years old (mean 21). The patients were divided into five groups depending on the age: 0-10 years old, 11-20 years old, 21-30 years old, 31-40 years old and older than 40 years. Frequency of the eye symptoms was estimated in each group.

RESULTS

The eye sings were observed in 69.2%. Frequency of the eye symptoms were higher in the older groups. After 21th years of age ophthalmological signs were observed in all patients. The most common were café-au-lait spots on the lids, Lisch nodules on the iris, changes in CNS, especially gliomas of the optic pathway, nodular neurofibromas in the orbit region.

CONCLUSIONS

Eye signs of the disease may be noticed in the most patients with NF 1. After 21th years of age ophthalmological symptoms are observed in all patients. The frequency of typical well known for NF 1 signs were different and characteristic for each age group.

Retinoblastoma in NWFP, Pakistan

BACKGROUND

Retinoblastoma is a malignant intraocular tumour of childhood, if not detected early, it results in loss of eye as well as life. The Objective was to study the pattern of presentation of Retinoblastoma in order to detect the disease at an earlier stage. It was conducted at Supra Regional Referral Centre for Retinoblastoma, Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, Pakistan from 1st July 1999 to 30th September 2002.

METHODS

Seventy patients were registered and admitted for diagnostic evaluation. After initial interview a proforma was filled about history of disease. Examination under anaesthesia included indirect ophthalmoscopy with indentation. B-scan of the eye and CT scan of the Orbit was done when required.

RESULTS

Forty (57.14%) patients presented with Leukocoria; other presentation included hyphaema, strabismus, proptosis, 56.48% patients presented in stage VB (Rees Elsworth classification).

CONCLUSION

Early detection through better understanding of presenting features of the disease and application of diagnostic skills can reduce the advanced stage of Retinoblastoma.

[Lack of biological exchange in assisted reproductive techniques]

There is a clear dividing line in the group of actions aimed at solving sterility, and the techniques aimed at generating embryos to be transferred to a womb. The dividing line is now clearly established by science. The growing alarm among paediatricians raised by the higher risk of malformations and diseases in children when generated in vitro, with respect to those normally engendered, is leading to the need to clearly establish the consequences of in vitro technologies and informing society in an honest way. Two types of lack of exchange of information, cellular and molecular, cause the detected defects. In the fi rst place it is clear that both gametes should recognize each other when adequately mature and in the appropriate natural environment. In vitro technologies force these conditions and either one or both gametes might be impaired and consequently negative effects for the child might be caused. In the second place both embryo and maternal womb are deprived of that early mother-child communication facilitating implantation.

Clinico-pathologic study of 70 enucleations

OBJECTIVE

To assess patients' history, demographic charactertics, cause for enucleation and orbital implant trends.

METHODS

A cross-sectional descriptive case study of 70 patients who underwent enucleation for various reasons between January 2004 to June 2007 at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar were reviewed. The patients' history, demographic characteristics, cause for enucleation after histopathology and the type of orbital implant were analyzed.

RESULTS

Seventy eyes of patients who underwent enucleation were reviewed. The male patients were 62.85% and female 37.14%. The most common age group involved was paediatric in 51.42%. Retinoblastoma was the most common indication for enucleation in 42.85% of children followed by choroidal melanoma in 17.14%, painful blind eye in 11.42% and phthisis bulbi in 8.57% in adults. Enucleation with orbital implant was done in 45.71%, with dermofat graft in 34.28% and no implant in 20%. The most common complication being erosion in 21.87% and excessive discharge in 15.62%.

CONCLUSIONS

Males were the usual victims. Majority of patients were of paediatric age group. The most common indications for enucleation was retinoblastoma in children and choroidal melanoma and painful blind eye in adults.

Acetylcholinesterase and HHV-8 in squamous cell carcinoma and retinoblastoma

Acetylcholinesterase (AChE) and human herpesvirus type 8 (HHV-8) antigens were studied in tissue sections from 56 squamous cell carcinomas (SCC) and five retinoblastomas (Rb). Approximately 62.5% of SCC and 80% of Rb showed positive staining for AChE. AChE staining in tumors was much higher than in normal control tissue. However, only 21.4% of SCC and 60% of Rb contained HHV-8 antigens. Of the 56 SCC, 17.9% were positive for both AChE and HHV-8 antigens, whereas 60% Rb were positive for both markers. The co-existence of AChE and HHV-8 antigens may play a role in the development of SCC and Rb. A possible mechanism for the development of these tumors is discussed.

Familial retinoblastoma in developing countries

BACKGROUND

Although screening for familial retinoblastoma has been shown to be beneficial we suspected that such screening programs may be less than optimal in developing countries (DC).

METHODS

Retrospective cohort study comparing patients with familial retinoblastoma from five centers in DC (Argentina, Brazil, Turkey, Jordan, and Venezuela) versus a reference center in the USA.

RESULTS

Ninety-two (32 from the USA and 60 from DC) patients were included. Forty-one (44.6%) patients avoided enucleation, 42 (45.7%) had 1 eye removed, and 9 (9.8%) underwent bilateral enucleation. Eleven (11.9%) had major pathology risk factors at enucleation. There were no cases of metastatic disease at diagnosis. Detection via screening was significantly less common in DC than in the USA (23.3% vs. 71.8%, P < 0.0001). Patients in DC were diagnosed at a significantly later age and with more advanced intraocular disease that led to increased risk of bilateral enucleation. Patients detected by screening in DC were significantly younger at diagnosis, had less advanced intraocular disease, better ocular preservation rates and survival results than those whose retinoblastoma was not detected via early screening. Five-year pEFS was 0.92 for the patients treated in the USA and 0.81 for the patients in DC (P = 0.42). Seven events occurred (extraocular relapse four in patients from DC and second malignancies in three).

CONCLUSIONS

Patients with familial retinoblastoma are less likely to be diagnosed by screening in DC and had higher morbidity and mortality caused by recurrent extraocular retinoblastoma.

Retinoblastoma: a recent experience at the National University Hospital, Singapore

INTRODUCTION

Retinoblastoma is a very rare disease. There were 30 cases of retinoblastoma diagnosed and treated at National University Hospital (NUH).

MATERIALS AND METHODS

A retrospective chart review was performed on the medical records of 30 patients who were diagnosed with retinoblastoma between 1995 and 2008 at the Department of Paediatrics, National University Hospital, Singapore.

RESULTS

The median age at diagnosis was 1.6 years (range, 0-5.9) with a median follow-up of 1.8 years (range, 0.1 to 11.6). The median time from presenting signs to the time of diagnosis was 5.2 months (range, 0-25.2). Common presenting signs of retinoblastoma were identified; the most common of which were leukocoria (50.0%), squinting (13.3%), poor vision (10.0%), strabismus (6.6%) and unknown (33.3%). Of the 30 patients, 10 were from Singapore whilst the other 20 patients were from the surrounding countries. Twelve patients had bilateral disease at the time of diagnosis, while 18 had unilateral disease. Staging information was available in 27 patients. Enucleation was performed in 25 of 30 patients. Radiation therapy was given in 3 patients in 1995 (bilateral disease), 2001 (bilateral disease) and 2003 (unilateral disease). At the time of analysis, 19 patients were alive with no evidence of disease. Overall 5-year survival for the cohort was 88.1% [95% confidence interval (CI), 88.0-100] and event-free survival for the whole cohort was 74.2% (95% CI, 55.8-92.6).

CONCLUSION

In our limited experience, the importance of collaboration and standardisation of the staging system, raising awareness and education of primary healthcare providers and parents are strongly stressed.

Retrospective analysis of 58 children with retinoblastoma”

We performed a retrospective analysis of 58 children with retinoblastoma seen at the University of Illinois at Chicago between 1960 and 1982. Our findings showed an almost equal distribution by sex, a predominance (69%) of white patients, and a common presenting symptom (70%) of leukocoria, with (22%) or without (48%) strabismus. Unilateral involvement was noted in 35 patients (60%). Of the 23 (40%) bilaterally affected children, 19 had simultaneous involvement at the time of diagnosis. All bilateral and 90% of the unilateral cases were diagnosed before age five years. Family history was positive for retinoblastoma in five bilateral and one unilateral case. At the time of diagnosis, 35 patients had stage V disease (Reese-Ellsworth classification, Table 1). Depending on the stage of disease treatment included enucleation, radiation, and chemotherapy. Mortality was 25% from 1960 to 1974, and zero thereafter.

A 12-year epidemiological review of retinoblastoma in Omani children

AIM

To describe the epidemiology of retinoblastoma (RB) in Omani children.

METHOD

The National Cancer Registry, hospital records, and treatment abroad registers were reviewed to identify the characteristics of Omani children diagnosed with RB between 1990 and 2002.

RESULTS

Twenty-nine children (12 male and 17 female) were diagnosed with RB. The age-adjusted incidence was 4.04/million/year in children < 15 years and 8.33/million/year in children < 5 years. The mean age at diagnosis was 32.2 months (33.8 months for unilateral RB and 13.2 months for bilateral RB). 75% had unilateral tumors and 25% had bilateral tumors. The five-year survival rate for RB was 89%. None of the patients had a family history of RB.

CONCLUSION

The incidence of RB in Oman is at par with other countries. A definite female preponderance exists in the Omani population. The proportion of unilateral RB cases is unusually high among Omani children. The five-year survival rate is almost at par with that reported in the West. Genetic studies and further longitudinal studies of surviving RB cases could further enhance the knowledge of the epidemiology of RB in Oman.

Malignant childhood solid tumours in Benin City, Nigeria

BACKGROUND

Tumours are uncommon in childhood; malignancies are even more uncommon. Yet malignancies are among the leading causes of childhood death in many parts of the world. The pattern of these tumours in Benin City Nigeria, however, is not known.

OBJECTIVE

To describe the pattern and histological types of childhood tumours in a Nigerian teaching hospital.

METHODS

All histologically diagnosed cases of malignant solid tumours in children less than 15 years of age seen over a 10 year at the University of Benin Teaching Hospital (UBTH) Benin City of southern Nigeria were analysed in order to determine their histological patterns.

RESULTS

Eighty-four cases of malignant tumours were seen during the 10-year period (1993 to 2002) in children less than 15 years of age at the UBTH Benin City. Forty-nine (50.3%) cases occurred in males and 35 (41.7%) in females. There was a decline in the frequency of childhood cancer with increasing age. The histological types, in descending order of frequency, were lymphoma 28(33.3%), nephroblastoma 18 (21.4%), retinoblastoma, rhabdomyosarcoma 12 (14.3%) each, and carcinoma 9 (10.7%). The head and neck region was the commonest location for all the various histological types (except tumours arising from tissues specific to other regions e.g. nephroblastoma). About 40% of all tumours occurred in the head and neck compared to 32% that occurred in the abdomen.

CONCLUSION

Malignant childhood solid tumour pattern in Benin City Nigeria is similar to that observed in other third world countries.

Childhood cancer among twins and higher order multiples

Although several studies have found no change or a decreased risk of childhood cancer in twins, few have controlled for potential confounders such as birth weight. We examined the association of birth plurality and childhood cancer in pooled data from five U.S. states (California, Minnesota, New York, Texas, and Washington) using linked birth-cancer registry data. The data, excluding children with Down syndrome or who died before 28 days of life, included 17,672 cases diagnosed from 1980 to 2004 at ages 28 days to 14 years and 57,966 controls with all cases and controls born from 1970 to 2004. Analyses were restricted to children weighing Collapse

Key Words

• childhood cancer
• twins
• multiple birth
• case-control
• pooled data

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MESH Headings

• Adolescent
• Case-Control Studies
• Child
• Child, Preschool
• Diseases in Twins/epidemiology
• Female
• Humans
• Infant
• Infant, Newborn
• Kidney Neoplasms/epidemiology
• Logistic Models
• Male
• Multiple Birth Offspring
• Neoplasms/epidemiology
• Registries
• Retinal Neoplasms/epidemiology
• Retinoblastoma/epidemiology
• Risk Factors
• United States/epidemiology
• Wilms Tumor/epidemiology

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Grants

• R01CA717450 NCI NIH HHS
• R01 CA092670-04 NCI NIH HHS
• U58 DP000783 NCCDPHP CDC HHS
• R01CA92670 NCI NIH HHS
• R01 CA092670 NCI NIH HHS
• T32 CA099936-04 NCI NIH HHS
• N01 CN005230 NCI NIH HHS
• R01 CA071745-04 NCI NIH HHS
• T32 CA099936 NCI NIH HHS

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