[Orbito-sphenoidal expansive processes: an anatomopathological study of 82 cases]

PURPOSE

To describe the orbito-sphenoidal expansive processes diagnosed at the Anatomo-Pathological Laboratory of the Fundação Faculdade Federal de Ciências Médicas de Porto Alegre - Complexo Hospitalar Santa Casa de Porto Alegre during a period of 15 years, evaluating their relative frequencies among other tumoral processes.

METHODS

We performed a statistical analysis of all orbital tumors with anatomicopathological diagnosis from January 1968 to December 1982, comparing the frequency of orbital tumors with the total number of tumors diagnosed at this Laboratory in a period of 5 years.

RESULTS

Eighty-two cases were diagnosed of expansive processes involving the orbit in 15 years - 20.7% of the total (17 cases) affecting children (up to 14 years-old) and the remaining 79.3% (65 cases) affecting adults. Children presented more frequently optic nerve gliomas (4 of 6 cases 66.6%), retinoblastomas (4 cases - 100%) and rhabdomyosarcomas (3 of 4 cases - 75%). Less frequent diseases in children were optic nerve meningioma, neurofibroma, inflammatory pseudotumor, chronic dacryoadenitis, neuroma and chronic inflammatory process. The adult population presented more cases of basal cell carcinomas (18 cases), squamous cell carciomas (12 cases), meningiomas (10 cases), choroidal malignant melanoma (3 cases) and lacrimal gland tumors (7 cases). Tumors originated from bone or vascular structures, pseudo-tumors, and intraorbital epidermic cysts were also diagnosed, among others. Of a sum of 2,639 tumors diagnosed at this Laboratory in the time period of 5 years (1976 to 1980), there were 22 cases of orbital tumors, reaching a total of 0.8% of all cases.

CONCLUSIONS

The anatomicopathological study of these processes is somehow important to diagnose and to establish an adequate therapy. The incidence of the expansive processes involving the orbit allows an epidemiological characterization of the different medical services responsible for the treatment of eye diseases. Despite its lower frequencies when compared to the diagnosis from other branches of Anatomical Pathology, Eye pathology has developed considerably over the past few years, contributing to more accurate diagnosis and to a better understanding of mechanisms responsible for these processes.

Orbito-ocular lesions in Lagos

OBJECTIVE

we present a 10year retrospective clinicopathologic study of 135 cases of orbito-ocular lesions. The aim is to document pattern of orbito-ocular lesions, with their site, age and sex distribution.

MATERIALS AND METHODS

The materials consisted of slides, paraffin embedded tissue blocks and histology request forms of all orbito-ocular samples received at the Morbid Anatomy Department of Lagos University Teaching Hospital Idi-Araba Lagos between 1994 and 2003.

RESULTS

A total of 135 samples from 75(56%) males and 60(44%) females were analysed. The conjunctival, intraocular, orbital and eye lid lesions accounted for 27(20.1%), 75(55.5%), 18(13.4%) and 15(11%) cases respectively. The ages ranged from 20 days to 79 years with a mean age of 35 years. Sixty nine cases (51.1%) of all orbito-ocular lesions were seen in children of age 15 years and below. Squamous cell carcinoma was the commonest malignant conjunctival lesion (4 out of the 5 cases) occurring in adults with a mean age of 45 years. Retinoblastoma accounted for 46(85%) of all orbito-ocular malignancies with the peak in the 1-5year age group accounting for 37(80 %). Panophthalmitis, endophthalmitis and phthisis bulbi were common non neoplastic lesions requiring enucleation. Pseudotumour and rhabdomyosarcoma accounted for 5(27.8 %) and 4(22.2 %) cases respectively of all orbital lesions.

CONCLUSION

Retinoblastoma remains the commonest ocular malignancy while rhabdomyosarcoma was the commonest orbital malignancy with both occurring in childhood. Inflammatory lesions unfortunately are important orbito-ocular lesions requiring surgery in our environment.

Orbito-ocular neoplasms in Enugu, South-Eastern, Nigeria

BACKGROUND

Orbito-ocular neoplasms are important causes of ophthalmic morbidity and mortality. Various reports have shown that they occur more commonly among Africans than Caucasians. In this era of HIV pandemic, an increase in the frequency of AIDS-related orbito-ocular neoplasms has also been reported.

OBJECTIVE

This study was carried out to determine the pattern of orbito-ocular tumours in Enugu, South-Eastern Nigeria and to compare it with the findings from earlier studies in the same area, other parts of Nigeria and other countries.

METHODS

In a retrospective, non-comparative case series study the records of all the cases of orbito-ocular neoplasms seen in the Histopathology departments of the two tertiary multidisciplinary hospitals with major eye clinics in Enugu (ParkLane Specialist and University of Nigeria Teaching Hospitals) between January 2001 and August 2005 were analysed for types of tumours, frequency of occurrence, sex and age of patients.

RESULTS

A total of 43 cases were analysed. There were 17 males and 26 females (M: F-l:1.4). Retinoblastoma was the most commonly occurring neoplasm accounting for 25.6% of all the tumours; followed by squamous cell carcinoma of the conjunctiva which was seen in 5 (11.6%) of cases. Squamous papilloma and Burkitt's lymphoma each accounting for 9.3% of the tumours in the series were the third most commonly occurring ones.

CONCLUSION

In spite of the limitations of the study our findings suggest that the spectrum of orbito-ocular neoplasms has generally remained the same in Enugu, South-Eastern Nigeria as well as in other parts of the country.

Outcome of retinoblastoma in east Africa

We estimated the proportion of patients reaching a pediatric ophthalmology unit (Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital, CCBRT) or an oncology unit (ORCI) in east Africa and investigated presentation, histology, and treatment outcomes of patients with retinoblastoma. A 5-year retrospective study identified 91 patients, representing approximately 18% of the nationwide total. Mean lag time was 10 months (standard deviation (SD) = 17) and mean follow-up was 8 months (SD = 11, range 0-40, n = 91). Thirty months disease-free survival probability was 0.23 (standard error = 0.07). Outcomes for retinoblastoma in Africa remain poor. The data presented here suggest strategies for improving the outcomes, including encouraging earlier presentation and establishment of multi-disciplinary treatment centers.

Care of the child undergoing an examination under anesthesia for retinoblastoma

In conclusion, the welfare of the child is of paramount importance in the detection and treatment ofretinoblastoma. It is important for the parents to feel comfortable with the care their child is receiving since they are facing a lengthy course of therapy. Consequently, the family will require the support of the entire ambulatory surgical daycare team for years to come.

Epidemiology of genetically determined cancer

Dominantly heritable susceptibility is known for virtually every cancer. Susceptibility is typically restricted to one or a few tumours. For some tumours there appear to be at least two different predisposing conditions. Some mutant gene carriers survive to old age without developing the expected tumour(s). Some cases are new germline mutations. None of the conditions is very common, because of natural selection against gene carriers. Two questions arise: What is inherited? What is the relationship between the hereditary and non-hereditary forms of the same tumour? Retinoblastoma is a prototypic tumour. Penetrance in humans is nearly complete by the age of five years in the heritable form, which usually affects both eyes. Rare cases in which there is a constitutional deletion of chromosomal band 13q14 permitted localization of the responsible gene. Tumour formation is clearly a rare event at the cellular level, suggesting the necessity of a second, somatic, event. The difference in ages at diagnosis between unilateral and bilateral cases also suggests that two somatic events occur in non-hereditary cases. One explanation is that the gene is recessive and the second event involves loss of the remaining normal allele by mutation, non-disjunction, deletion or somatic recombination. The normal allele may be regarded as anti-oncogenic.

Retinoblastoma epidemiology: does the evidence matter?

It has been proposed that retinoblastoma is 'caused' by two sequential mutations affecting the RB1 gene, but this is a rather outdated view of cancer aetiology that does not take into account a large amount of new acquisitions such as chromosomal and epigenetic alterations. Retinoblastoma remains probably the only cancer in which the rather simplistic 'two hit' mutational model is still considered of value, although cancer is known to be associated with genomic and microsatellite instability, defects of the DNA mismatch repair system, alterations of DNA methylation and hystone acethylation/deacethylation, and aneuploidy. Moreover, as it is shown herein, the predictions made by the 'two hit' model, are not fulfilled by the clinical and epidemiological data reported so far. Moreover, while the role of mutational events in cancer has been largely questioned in the more recent literature, no serious effort has been done to investigate the role of epigenetic alterations and aneuploidy in retinoblastoma. Through the analysis of the specialised literature and a set of original epidemiological and biological data concerning retinoblastoma, the authors illustrate the evidences arguing against the 'two hit' hypothesis and propose that epigenetic factors and aneuploidy play central roles in the disease.

Spectrum and presentation of pediatric malignancies in the HIV era: experience from Blantyre, Malawi, 1998-2003

BACKGROUND

Data on childhood cancers in Africa are sparse, particularly since the spread of HIV. We aimed to document the frequency of pediatric cancers presenting to a large central hospital in Malawi, detailing the presenting features, initial investigations, and HIV status of these children.

PROCEDURE

A retrospective audit of the spectrum and clinical presentation of cancers among children (<16 years) seen at Queen Elizabeth's Central Hospital (QECH), between 1998 and 2003.

RESULTS

Seven hundred seven children with cancer were seen, the number of cases per year increased over the time period; 50% (351) had Burkitt lymphoma, 13% (89) had retinoblastoma, and 9% (61) had Kaposi sarcoma, with a variety of other tumors comprising the remainder. Kaposi sarcoma markedly increased in frequency over time. Histological verification of diagnosis was available for 49% (348). The proportion of children with cancer who were tested for HIV increased over time, but varied by cancer type. Amongst those tested, the seroprevalence was 93% (52/56) for children with Kaposi sarcoma, 4% (11/289) for those with Burkitt lymphoma, 31% (8/26) for those with other non-Hodgkin lymphomas, 7% (1/15) for those with Hodgkin disease, and 5% (5/103) for those with other cancers.

CONCLUSIONS

The number of cases seen per year has increased over the study period for almost all cancers, but in particular for Kaposi sarcoma. Burkitt lymphoma remains the commonest pediatric tumor in Malawi. In the case of Burkitt lymphoma, non-Hodgkin lymphoma, and Kaposi sarcoma there is a significant difference in the presentation of HIV-seropositive and -seronegative children.

Clinical and epidemiological characteristics of retinoblastoma: correlation with prognosis in a Turkish pediatric oncology center

Advanced intraocular tumors and metastatic disease in retinoblastoma patients still occur frequently in developing countries. The aim of this retrospective study was to describe the clinical and epidemiological characteristics of patients with retinoblastoma and the effects of these features on disease prognosis in the authors' pediatric oncology unit as a developing country profile to define the problem. A retrospective chart review of 91 patients who presented to the unit between May 1996 and December 2003 was conducted in this study. Patients with unilateral disease presented at a median age of 24 months and those with bilateral disease at a median age of 9.5 months (p < .01). Most of the eyes with retinoblastoma (68.6%) had Reese-Ellsworth stage V disease. Metastatic disease was diagnosed in 19 (20.9%) patients. Cases with metastatic disease presented at a median age of 24 months and those without metastatic disease at a median age of 12.5 months (p < .05). In 31 patients (34.1%) there was a delay in diagnosis. The enucleation ratio in eyes with advanced intraocular stage was significantly higher than in eyes with early intraocular stage (57.9 vs. 3.8%) (p < .001). In patients with metastatic disease, tumor recurrence was more frequent than in the nonmetastatic patients (36.8 vs. 4.2%) (p < .01). Seven children (7.7%) died due to central nervous system (CNS) metastasis (p < .01). Advanced intraocular disease and distant metastases occur more frequently in Turkish children with retinoblastoma than in children in developed countries, causing a higher rate of enucleation and mortality. Late referral might account for the delayed diagnosis.

Retinoblastoma in children older than 5 years of age

BACKGROUND

Retinoblastoma is a malignant tumor of the embryonic neural retina. About 80% of cases are diagnosed before age 4, with a median age at diagnosis of 2 years.

OBJECTIVE

To determine characteristics and prognosis of retinoblastoma in children older than 5 years.

PROCEDURES

From 1986 to 2002, medical records of 16 patients out of 453 cases referred to Hospital do Câncer AC Camargo, São Paulo, Brazil.

RESULTS

Median age at diagnosis was 73.7 months (range 65-144) and there was an equal gender distribution. Fifteen patients presented with unilateral disease. The mean time between first symptoms and diagnosis was 9.6 months (range 0-48). Most cases were diagnosed in advanced stages and 15 eyes were enucleated. Eleven patients presented with intraocular tumor (1 Reese II and 10 Reese V) and five presented with extraocular disease (one CCG II and four CCG III). Twelve patients are still alive with a median follow-up of 92 months (range 65-199).

CONCLUSIONS

Because of its low incidence at this age, diagnosis of retinoblastoma is usually delayed due to low level of suspicion. Therefore, it is important that physicians are aware of this disease in order to perform an earlier diagnosis, and decrease treatment-related morbidity.

Does the evidence matter in medicine? The retinoblastoma paradigm

Retinoblastoma (Rb) is the most common intraocular malignant tumour in childhood, with an incidence of 1 in 15,000 live births. Complete information on this rare tumour can be easily accessed through the internet, although many aspect concerning the aetiology and pathogenesis of the disease, are still controversial. The "two hit" theory, formulated in 1971 to explain the variegated clinical expression of the disease, is based on the idea that single gene mutation may determine the development of cancer. However, this view does not take into account the most recent evidences showing the role of aneuploidy and chromosome instability in cancer. Also, a number of other genes and epigenetic mechanisms are involved in the genesis of retinoblastoma. More importantly, the "two hit" theory makes predictions, concerning the age distribution of the tumour, its mode of "transmission" (hereditary retinoblastoma), and its pathogenesis, which are not fulfilled by the clinical reality. Overall, the "two hit" theory represents a rather simplistic and outdated model to explain tumour development and clinical evolution of retinoblastoma.

Outcomes in retinoblastoma, 1974?2005: The Children's Hospital, Westmead

BACKGROUND

To report the 31-year experience of outcomes in retinoblastoma from a single centre.

METHODS

A retrospective analysis of consecutive cases of retinoblastoma diagnosed and treated at the Westmead Children's Hospital, Sydney between 1974 and 2005 was performed. The subjects were analysed as two groups: those diagnosed between 1974 and 1989 (series alpha) and those diagnosed between 1990 and 2005 (series beta).

RESULTS

There were a total of 142 patients included in the study, with a median follow up of 72 months. There were 84 patients with unilateral disease and 58 patients (116 eyes) with bilateral disease. The total enucleation rate remained high throughout both series for those with unilateral disease: 89% (series alpha) and 95% (series beta). There was a reduction in enucleations performed for those with bilateral disease from 68.4% (series alpha) to 43.6% (series beta) (P < 0.025). There were no bilateral enucleations performed after 1995. Actuarial Kaplan-Meier curves showed that 56% of all preserved eyes had not recurred at a median follow up of 95 months and 78.1% had avoided enucleation. Overall 43% of preserved eyes attained a visual acuity better than or equal to 6/12 and 55% achieved a visual acuity better than 6/60. There were four deaths due to retinoblastoma. Five patients were diagnosed with a second non-ocular malignancy. The most common treatment-related complications were cataracts, facial deformity, sepsis and febrile neutropaenia.

CONCLUSIONS

The introduction of newer globe-preserving treatments for retinoblastoma was associated with equivalent visual outcomes, stable mortality rate and a greater number of short-term complications but avoided the late side-effects associated with external beam radiotherapy.

Retinoblastoma in Taiwan: the effect of a government-sponsored national health insurance program on the treatment and survival of patients with retinoblastoma

PURPOSE

To assess the effect of a government-sponsored national health insurance program that was implemented in Taiwan in March 1995 on the diagnosis and survival of patients with retinoblastoma.

PATIENTS AND METHODS

A retrospective chart review of 108 retinoblastoma patients who were treated at the Chang-Gung Medical Center, Taipei, Taiwan, from 1978 to 2003 was performed. Patients diagnosed and treated before March 1995 were compared with those treated after March 1995 in terms of annual number of cases, gender, laterality, age at onset, presenting signs, treatment modalities, and survival rate.

RESULTS

The average annual number of cases doubled from 3.3 to 6.5 after the implementation of the national health insurance program, and the age at diagnosis decreased from 29 to 21 months (P = .03). The most common presenting sign was leukocoria in both groups. The Kaplan-Meier survival rate at 5 years increased from 67% to 72%, an effect that was obvious in unilateral cases (70% to 83%) but not in bilateral cases (50% for both time periods).

CONCLUSIONS

The establishment of a government-sponsored national health insurance program in Taiwan allowed retinoblastoma to be diagnosed earlier, resulting in better survival rates, especially in unilateral cases.

Retinoblastoma incidence and survival in European children (1978-1997). Report from the Automated Childhood Cancer Information System project

Based on 2283 cases of retinoblastoma diagnosed in children aged 0-14 years, incidence and survival in Europe during the period 1978-1997 are described. Data were provided to the Automated Childhood Cancer Information System (ACCIS) from 60 paediatric and general cancer registries. During 1988-1997, the cumulative incidence of retinoblastoma in the ACCIS regions was found to be between 44.2 and 67.9 per million births. The highest incidence was seen in the first year of life. The age-standardised (World standard) incidence rate for the age-range 0-14 years was 4.1 per million. Approximately one-third of cases had bilateral tumours. Overall incidence increased over the period 1978-1997 by 1% per year, as derived from a model adjusted for sex, age group and type of registry (general or paediatric). The 5-year survival rate improved from 89% to 95% during the period covered by the study. This improvement was seen in both unilateral and bilateral cases but was significant only for the unilateral tumours. Survival was lower in the East region, although smaller differences were also observed between the other four regions (British Isles, North, South and West). Availability and quality of registration data on retinoblastoma need to be improved for effective evaluation of incidence and survival.

Retinoblastoma in New South Wales 1975 to 2001

PURPOSE

To examine the epidemiology of retinoblastoma in New South Wales (NSW), from 1975 to 2001, comparing the incidence with other parts of the developed world.

METHODS

Examination of medical files for patients presenting to NSW retinoblastoma treatment centers between 1975 and 2001. Comparisons to international data were made.

RESULTS

One hundred twenty-eight patients [63 (49.2%) male and 65 (51.8%) female] presented. The mean annual incidence of retinoblastoma in NSW was 8 per million children aged 0 to 6 years, per year.

CONCLUSIONS

The incidence of retinoblastoma in NSW is similar to other parts of the developed world.

Genotype-phenotype correlation analysis in retinoblastoma patients from India

BACKGROUND

Genetic analysis has a beneficial impact on retinoblastoma management enabling definite risk assessment. However, information regarding genotype-phenotype correlation in retinoblastoma is limited.

AIM

To analyze the retinoblastoma susceptibility gene for mutations in retinoblastoma patients and correlate the genotypes the phenotypes.

METHODOLOGY

Eleven retinoblastoma patients, who underwent molecular genetic studies were classified into high, moderate or low disease severity groups based on phenotype.

RESULTS

Seven patients had high disease severity and four moderate disease severity. Eleven truncating mutations were detected; six were in the N-terminus region of the retinoblastoma protein and two in the A/B pocket (p=0.03).

CONCLUSIONS

No significant association between mutation type and disease severity could be established in the present study. However a positive correlation between location of the mutations in certain domains of the retinoblastoma protein and disease severity was observed. To the best of our knowledge this is the first genotype-phenotype correlation study in retinoblastoma patients from India.

Parental age and risk of childhood cancers: a population-based cohort study from Sweden

BACKGROUND

Frequent germ line cells mutations were previously demonstrated to be associated with aging. This suggests a higher incidence of childhood cancer among children of older parents. A population-based cohort study of parental ages and other prenatal risk factors for five main childhood cancers was performed with the use of a linkage between several national-based registries.

METHODS

In total, about 4.3 million children with their parents, born between 1961 and 2000, were included in the study. Multivariate Poisson regression was used to obtain the incidence rate ratios (IRR) and 95% confidence interval (CI). Children <5 years of age and children 5-14 years of age were analysed independently.

RESULTS

There was no significant result for children 5-14 years of age. For children <5 years of age, maternal age were associated with elevated risk of retinoblastoma (oldest age group's IRR = 2.39, 95%CI = 1.17-4.85) and leukaemia (oldest age group's IRR = 1.44, 95%CI = 1.01-2.05). Paternal age was significantly associated with leukaemia (oldest age group's IRR = 1.31, 95%CI = 1.04-1.66). For central nervous system cancer, the effect of paternal age was found to be significant (oldest age group's IRR = 1.69, 95%CI = 1.21-2.35) when maternal age was included in the analysis.

CONCLUSION

Our findings indicate that advanced parental age might be associated with an increased risk of early childhood cancers.

[Leucocoria in childhood]

BACKGROUND

There are a number of conditions in infants and young children which produce a white reflex in the pupillary area, termed leucocoria. In cases of leucocoria, retinoblastoma has to be excluded without delay.

METHODS

We analysed data from consecutive children who were presented to our hospital because of leucocoria between January 1999 and June 2005. The analysis was performed by methods of descriptive statistics.

RESULTS

Leucocoria was found in 83 eyes of 58 children. Leucocoria was caused in most cases by congenital cataract (35 %), followed by malformations (18 %) (persistent hyperplastic primary vitreous, coloboma, disc anomaly, combined developmental abnormalities), hereditary vitreoretinal disorders (13 %), retinopathy of prematurity (12 %), trauma-associated diseases (8 %). Five children suffered from retinoblastoma (6 %). Following in frequency were inflammatory disorders (5 %) and Coats' disease (2 %).

DISCUSSION

Several ocular conditions of childhood can clinically cause leucocoria. Knowledge of the clinical features that serve to differentiate retinoblastoma from simulating lesions may assist the clinician in arriving at the correct diagnosis.

Retinoblastoma in Nepal: a clinical profile of 30 cases

To determine the clinical profile of retinoblastoma and to provide baseline data for further studies on this subject. Prospective evaluation of 30 consecutive patients with retinoblastoma admitted at the B. P. Koirala Lions Center for Ophthalmic Studies, Kathmandu, Nepal, between October 1998 and July 2000 was carried out. Age, sex, laterality and time from onset of symptoms to diagnosis (lag time) were noted. Ancillary tests were undertaken to rule out metastasis. Male to female ratio was 1.1:1 and the median age of presentation was 3.1 years. Of 30 cases, 23 (76.6%) had unilateral involvement. Leukocoria was the presenting sign in 13 cases (43.3%) and fungating mass in 10 cases (33.3%). In 11 (36.7%), the latency period from onset of symptoms to diagnosis was 6-12 months. In bilateral cases, advanced disease was treated surgically and the fellow eye was treated with cryotherapy, photocoagulation and chemotherapy. Histopathological examination of 21 (70.0%) enucleated/exenterated cases revealed a poorly differentiated type of retinoblastoma. This is the first study of retinoblastoma from Nepal. Early diagnosis of this disease when it is localized to the eye is important to salvage the life of the child. An informational program directed toward the public in general, as well as careful screening of any white pupillary reflex by the pediatrician and/or primary health worker will encourage and support early diagnosis.

Retinoblastoma in Turkey: survival and clinical characteristics 1981-2004

BACKGROUND

In this study, the authors aim to describe the survival and clinical characteristics of 141 retinoblastoma cases treated at Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey, between 1981 and 2004.

METHOD

The authors retrospectively analyzed the clinical records of 141 children (177 eyes) diagnosed with retinoblastoma and treated between 1981 and 2004. Information on gender, laterality, age at diagnosis, presenting signs, spread of tumor, treatment modality, survival rate, and family history were collected.

RESULTS

A total of 105 cases (74.5%) were unilateral and 36 cases (25.5%) were bilateral. The mean age overall at the time of diagnosis was 25 months; in unilateral cases, 29 months; and in bilateral cases, 16 months. The most common presenting signs were leukocoria (116 cases, 82%), strabismus (14 cases, 10%) and proptosis (11 cases, 8%). A total of 28 cases had orbital extension, nine patients had central nervous system invasion, and five cases exhibited bone marrow involvement. In total, 16 patients (11%) had a family history of retinoblastoma. One case developed a secondary neoplasm. The 3 year cumulative survival rate of 141 patients was 89.69% (unilateral, 90.74%; bilateral 87.35% P = 0.9371, P > 0.05, log rank test).

CONCLUSION

The study's survival rate was similar to developed countries. The success in higher survival rates is based on the authors multidisciplinary team approach done by the same group and the support of the authors' clinic and government in sponsoring the medical insurance of all patients.

Tobacco Use in Adult Long-term Survivors of Retinoblastoma

A significant risk of lung cancer was identified among hereditary, but not nonhereditary, retinoblastoma (Rb) patients. Tobacco use was investigated to determine whether differences in smoking prevalence might explain the lung cancer excess and to characterize smoking patterns in adult survivors of Rb. Subjects were 441 hereditary and 395 nonhereditary 1-year survivors of Rb, age >or=18 years, who responded to a telephone survey about current health behavior, including tobacco use. Response rates were 76% for hereditary and 73% for nonhereditary survivors. We compared patterns and predictors of current tobacco use among hereditary and nonhereditary survivors with other childhood cancer survivor studies and the U.S. population. Hereditary Rb survivors currently smoke cigarettes significantly less frequently than nonhereditary survivors (16. 8% versus 24.3%), although among current smokers, age at smoking initiation (17 years old) and average cigarettes (1.5 packs) smoked daily are similar. Predictors of current and ever cigarette smoking include nonhereditary Rb, older age, being female, less education, and use of other tobacco products. Rb survivors smoke cigarettes significantly less than the U.S. population (rate ratio, 0.63; 95% confidence interval, 0.5-0.8 for males; rate ratio, 0.75; 95% confidence interval, 0.6-0.9 for females), but Rb survivors have comparable smoking rates with other childhood cancer survivors. Smoking did not account for the increased risk of lung cancer among hereditary Rb patients, and this may point to an enhanced sensitivity to the carcinogenic effects of tobacco. Adult survivors of Rb should be encouraged to stop smoking.

Familial risks for eye melanoma and retinoblastoma: results from the Swedish Family-Cancer Database

No systematic population-based studies have been conducted on familial eye cancers. Reliable data on familial risks are important for clinical counselling and cancer genetics. The current analysis was based on the nation-wide Swedish Family-Cancer Database on 10.5 million individuals, containing families with parents and offspring. Cancer data were retrieved from the Swedish Cancer Registry from the years 1958 to 2002, including 3636 patients with any type of eye cancer. Familial risk for offspring was defined using the standardized incidence ratio (SIR), adjusted for many variables. Ocular melanoma was detected in two parent-offspring pairs, but the SIR of 3.90 was not significant. Parental upper aerodigestive tract (2.05), left-sided colon (1.83) and male non-medullary thyroid (6.98) cancers showed an association with ocular melanoma, albeit some with a borderline significance. The SIR for leukaemia was increased when parents were diagnosed with eye melanoma. There was no evidence for the association of ocular melanoma with cutaneous melanoma. The SIR for ocular melanoma was 1.76 when a sister was diagnosed with breast cancer, but there was no increase when a mother was diagnosed with breast cancer. When both a child and the parent presented with retinoblastoma, the SIR was 900. The parents of children with retinoblastoma had an excess of small intestinal and rectal cancers and Hodgkin's disease. The present findings were based on a limited number of cases, but they display a complex and heterogeneous pattern of familial associations in ocular melanoma, including an association with breast cancer through a putative recessive mechanism.

Diagnóstico molecular del retinoblastoma: epidemiología molecular y consejo genético

BACKGROUND AND OBJECTIVE

Retinoblastoma, a prototype of hereditary cancer, is the most common intraocular tumor in children and a potential cause of blindness from therapeutic eye ablation, second tumors in germ line mutation carriers, and even death when untreated. The molecular scanning of RB1 in search of germ line mutations in 213 retinoblastoma patients from Spain, Cuba, Colombia and Serbia, has led to the detection of 106 mutations whose knowledge is important for genetic counselling and characterization of phenotypic-genotypic relations.

PATIENTS AND METHOD

Mutational study (PCR-sequentiation and microsatellites analysis) in patients with retinoblastoma, from Spain, Cuba, Colombia and Serbia.

RESULTS

45% of mutations, including most of the frame shift (FS), missense (MS) and splicing (SP), were new, while all nonsense mutations (NS) corresponded to hypermutable sites in RB1. Germ line mutations were found in 22% of unilateral sporadic patients. The incidence of SP plus MS mutations in this group of patients was greater (p = 0.018) than in bilateral patients. The frequency of SP mutations was higher (p = 0.0003) in Spain and France than in Germany and United Kingdom, while the incidence of NS mutations was lower (p = 0.0006). SP mutations were associated with the low penetrance phenotype and were also overrepresented (p = 0.018) in patients with delayed retinoblastoma onset.

CONCLUSIONS

Mutational scanning of unilateral patients is important for genetic counselling and may help decipher the molecular mechanisms leading to low penetrance or expressivity. The functional characterization of mutations associated with low-penetrance or expressivity phenotypes and the molecular classification of tumors using multiple expression profiling is important for a better understanding of the retinoblastoma pathogenesis.

More aggressive bone marrow screening in retinoblastoma patients is not indicated: the memorial Sloan-Kettering cancer center experience

BACKGROUND

Bone marrow involvement in retinoblastoma patients is rare in the more industrialized nations. The purpose of the current study was to determine the frequency of bone marrow involvement in our series of retinoblastoma patients and to investigate whether the use of four bone marrow aspirates (BMA) and two bone marrow biopsies (BMB) has greater sensitivity for the detection of metastatic disease compared to what has been previously reported.

METHODS

Retrospective analysis of the charts of 54 patients with retinoblastoma was performed. We performed 265 BMA, 134 BMB (4 aspirates and 2 biopsies per evaluation), and 67 lumbar punctures (LPs) in 54 patients with retinoblastoma.

RESULTS

There were no patients found with bone marrow or cerebrospinal fluid (CSF) involvement at the time of the initial diagnosis. Although no patient died of distant metastases, two patients developed metastatic disease at recurrence, involving the bone marrow and other sites. For these two patients all four aspirates and two biopsies were positive for disease at the time of recurrence.

CONCLUSIONS

Despite the use of four BMA and two BMB (as opposed to one bone marrow aspirate that is routinely performed in other centers), the detection of patients with metastatic disease was similar to what has been previously reported. Based on these data more aggressive evaluation of the bone marrow in retinoblastoma patients with clinically limited disease using four aspirates and two biopsies cannot be supported.

Molecular studies of loss of heterozygosity in Chinese sporadic retinoblastoma patients

BACKGROUND

Retinoblastoma, an embryonic neoplasm of retinal origin, is the most common and severe intra-ocular tumor affecting infants and young children.

METHODS

Loss of heterozygosity (LOH) on chromosome 13 was investigated in 16 Chinese sporadic RB patients, using 14 microsatellite markers spanning the complete chromosome 13, to determine whether those alterations different from the alteration of RB1 gene on 13q14 may play a role in the development of RB. Loss of RB1 allele is commonly encountered in sporadic RB. Microdissected RB tissues and their matched blood DNAs were analyzed for PCR-based LOH by using fluorescence-based DNA sequencing technology.

RESULTS

Of 16 RB cases, 13 showed LOH on chromosome 13. The frequency of LOH on 13q14 was about 75% (12/16), consistent with other reports. Investigation of parental origin of lost RB1 alleles showed that, in all these cases, the paternal alleles were preferentially lost. Aside from the RB1 locus, other regions with the frequency of LOH above 30% in these tumors were D13S265, D13S158, D13S170, D13S218, D13S285 and D13S159. In particular, the D13S265 locus at 13q31-32 showed the highest rate of allele loss (64%, 9/14 informative cases), suggesting the presence of 1 or several genes whose loss of function may contribute to the development of RB. Comparison of the genotypic characteristics of 3 sites of frequent LOH (D13S153, D13S263 and D13S265) with the clinicopathological phenotype, respectively, showed that LOH of each locus was preferentially associated with a significantly younger age at diagnosis of RB.

CONCLUSIONS

LOH analysis at some specific loci on chromosome 13 may be of a value in RB patients as diagnostic markers.

RB1 gene mutation up-date, a meta-analysis based on 932 reported mutations available in a searchable database

Background

Retinoblastoma, a prototype of hereditary cancer, is the most common intraocular tumour in children and potential cause of blindness from therapeutic eye ablation, second tumours in germ line carrier's survivors, and even death when left untreated. The molecular scanning of RB1 in search of germ line mutations lead to the publication of more than 900 mutations whose knowledge is important for genetic counselling and the characterization of phenotypic-genotypic relationships.

Results

A searchable database (RBGMdb) has been constructed with 932 published RB1 mutations. The spectrum of these mutations has been analyzed with the following results: 1) the retinoblastoma protein is frequently inactivated by deletions and nonsense mutations while missense mutations are the main inactivating event in most genetic diseases. 2) Near 40% of RB1 gene mutations are recurrent and gather in sixteen hot points, including twelve nonsense, two missense and three splicing mutations. The remainder mutations are scattered along RB1, being most frequent in exons 9, 10, 14, 17, 18, 20, and 23. 3) The analysis of RB1 mutations by country of origin of the patients identifies two groups in which the incidence of nonsense and splicing mutations show differences extremely significant, and suggest the involvement of predisposing ethnic backgrounds. 4) A significant association between late age at diagnosis and splicing mutations in bilateral retinoblastoma patients suggests the occurrence of a delayed-onset genotype. 5) Most of the reported mutations in low-penetrance families fall in three groups: a) Mutations in regulatory sequences at the promoter resulting in low expression of a normal Rb; b) Missense and in-frame deletions affecting non-essential sequence motifs which result in a partial inactivation of Rb functions; c) Splicing mutations leading to the reduction of normal mRNA splicing or to alternative splicing involving either true oncogenic or defective (weak) alleles.

Conclusion

The analysis of RB1 gene mutations logged in the RBGMdb has shown relevant phenotype-genotype relationships and provided working hypothesis to ascertain mechanisms linking certain mutations to ethnicity, delayed onset of the disease and low-penetrance. Gene profiling of tumors will help to clarify the genetic background linked to ethnicity and variable expressivity or delayed onset phenotypes.

Genomic imprinting and assisted reproductive technology: connections and potential risks

Assisted reproductive technology (ART) has become the standard of care for the treatment of many types of infertility. As a result, the numbers of children born after ART worldwide has escalated dramatically, and attention has turned to the potential risks of these procedures to the health and development of the children. In addition to the well-established risks of multiple gestations, recent reports have suggested a link between ART and rare disorders of imprinting including Beckwith-Wiedemann syndrome and Angelman syndrome. Here we review molecular mechanisms of genomic imprinting, consider how ART procedures could influence imprinting of gametes and embryos, and review the reports connecting imprinting disorders to ART. We highlight the importance of long-term follow-up of children born after ART, and emphasize the need for an improved understanding of the mechanisms of imprinting at the molecular level so that methods to prevent disruption of this critical epigenetic process can be developed.

Clinical presentation of retinoblastoma in Eastern Nepal

BACKGROUND

The purpose of the present study was to determine modes of presentation of retinoblastoma and the association between proptosis with orbital extension and histopathologically detectable optic nerve infiltration by the tumour.

METHODS

Clinical records and histopathological reports of patients with retinoblastoma were studied retrospectively. The work was undertaken at a tertiary care hospital in eastern Nepal during the period from September 1995 to August 2002.

RESULTS

A total of 43 patients with retinoblastoma were studied. Among them unilateral involvement was found in 39 patients (90.70%) and bilateral involvement in four patients (9.30%). The mean age of presentation was 3.04 +/- 1.80 years (95% confidence interval = 2.49-3.59). The commonest mode of presentation was proptosis with orbital extension in 19 eyes (40.42%) followed by leucokoria in 14 eyes (29.78%). Histopathological reports of 42 eyes (one patient died shortly after admission and did not have an autopsy) confirmed the diagnosis of retinoblastoma and revealed that the optic nerve cut section had been infiltrated in 18, of which 16 had the clinical finding of proptosis with orbital extension. This was statistically significant (relative risk = 21.33, P < 0.001).

CONCLUSION

The commonest mode of presentation of retinoblastoma in Nepal is proptosis. Presence of proptosis with orbital extension is associated with optic nerve cut end infiltration by the tumour. The diagnosis or presentation of retinoblastoma in Nepal is delayed and there is tremendous scope for improvement in its management.

[Genomic retinoblastoma perspectives: implications of tumor supressor gene RB1]

In order to define the molecular and cellular bases of the development of retinoblastomas it is necessary to know its etiology, and to apply the advances in genome technology to this kind of neoplasia. Retinoblastomas are childhood tumors of the eye with an average incidence of one case in every 15,000-20,000 live births, which occur in sporadic and hereditary forms. The sporadic form appears regularly as a unilateral tumor, while in the familial form of the disease, tumors may be unilateral and bilateral. This neoplasia is characterized by leukocoria, strabism, and heterochromia. The retinoblastoma gene (RB1) is a molecular marker of retinoblastoma tumors. This gene is located in chromosome 13q14.2 and encodes a nuclear phosphoprotein (pRB) of 110 KDa, which plays a major role in cell proliferation control through cell cycle-regulated phosphorylation/dephosphorylation cycles of this protein. The RB1 gene is mainly affected by point mutations, which occur most frequently in exons 3, 8, 18 and 20. At the end of the last century, DNA technology has improved notably, allowing for its application to the study of a vast array of diseases. The aim of this work is to show the molecular aspects involved in retinoblastoma which are currently deciphering; this is possible thanks to new technology platforms that have been developed. This will allow us in a near future, to offer tests for the early diagnoses, prognoses, and the determination of individual predisposition towards this neoplasia.

Estimating the incidence of retinoblastoma in Texas

The purpose of this study was to estimate the number of retinoblastoma cases anticipated each year in various urban and rural areas in Texas. We obtained the most recent data on the number of live births in Texas from the Texas Department of Health. Using those data and the retinoblastoma incidence rate of 1 in 15,000 live births, we estimated that 26 cases of the disease will be diagnosed in Texas each year. Nearly half of those cases will occur in infants in rural areas of the state. We compared those values with data from the Texas Cancer Registry. Primary care physicians, particularly in rural areas of Texas, must screen patients for retinoblastoma and consider arrangements for rapid referral when the diagnosis is suspected.

Primary head and neck cancers in North Eastern Nigeria

BACKGROUND

To document the pattern of primary head and neck cancers in North Eastern Nigeria.

STUDY DESIGN

A record-based study of primary head and neck cancers histologically diagnosed at the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, North Eastern Nigeria between 1987 and 2002.

RESULTS

A total of 317 cases (20 cases per year) were diagnosed. The most common cancer sites were the oral cavity (15.1%) and nasopharynx (11.7%). Carcinomas (68.4 %) were the most common cancers reported, mostly affecting the oral cavity (20.3%). Carcinomas were associated with farmers, kola nut chewers and tobacco users in this region, while kaposi sarcoma was the only cancer associated with HIV-positive patients. The overall mean duration of symptoms for cancers was 29.1+/-62.2 months. The mean duration for carcinomas was longer than for sarcomas (p>0.05) and lymphomas (p= 0.05). 81 % of the staged cancers reported in the stage IV; while treated cancers required primary radiotherapy (51 %) or an adjuvant radical surgery and chemotherapy (9.4%).

CONCLUSION

Intra-oral carcinomas were the most common histological types of cancers in the head and neck. The delay before and the cancer stage at presentation may be due to the lack of cancer management facilities and manpower in most of the hospitals in the region.

Clinicopathological study of head and neck cancers in Ilorin, Nigeria

Eighty-nine cases of head and neck cancers were studied over a 5-year period (1997--2001) at the University of Ilorin Teaching Hospital, Nigeria. The most common cancer affecting the head and neck region was carcinoma which constituted 70.8% of all the cases studied. It was followed by the lymphomas and blastomas which accounted for 20.2% and 9%, respectively. The nose/paranasal sinuses were the most common site of primary cancer (18%) followed by thyroid (12.4%), nasopharynx (11.3%) and larynx (4.5%). Other sites include a hypopharynx (3.4%), eye (2.2%), palate (2.2%), tongue (2.2%), skin (1.1%), lip (1.1%), salivary gland (1.1%), oropharynx (1.1%). Cervical lymph node metastasis with unknown primary lesion was seen in 10.1%. The peak age incidence was in the fifth decade of life. The improvement in locoregional control of head and neck cancers over the last decades does not appear to modify the final survival of these patients. It is crucial to understand as accurately as possible the risk factors for these malignancies in order to improve primary prevention.

Analysis of the RB1 gene in children with retinoblastoma having residential connections to West Cumbria, England

Six of eight cases of retinoblastoma previously identified as having a residential association with West Cumbria, England, in which the Sellafield nuclear installation is situated, were examined for the presence of a constitutional RB1 mutation. No mutations were detected, thus providing strong evidence against an environmental or occupational genotoxic effect causing germline mutations in the parents of these children.

Imprinting diseases and IVF: Danish National IVF cohort study

BACKGROUND

The aim of this study was to compare the frequency of imprinting diseases in children born after IVF with the incidence in naturally conceived children.

METHODS

All singleton children born in Denmark from January 1, 1995 through December 31, 2001 were stratified into children born without and after IVF, and were followed from birth until the end of 2002 in the National Register of Patients and the Central Register of Psychiatric Diseases, which include all discharge diagnoses from somatic and psychiatric hospitals/clinics, respectively. Included in the study were malignancies, mental, behavioural and neurological diseases, congenital syndromes, and developmental disturbances. Only diagnosis codes potentially relevant for imprinting diseases were included.

RESULTS

During the 7-year study period, 442,349 singleton non-IVF and 6052 IVF children were born. Mean follow-up time was 4.5 and 4.1 years for the two groups, respectively, corresponding to 2 million and 25 000 follow-up years. In the IVF/non-IVF cohort, we detected 0/72 children with cancer, 47/3766 with mental diseases, 72/3654 neurological diseases, 4/287 congenital syndromes and 96/6727 developmental disturbances, in a total of 219/14,506 clinical outcomes. The number of children with specific imprinting diseases in the non-IVF group was 54: 44 kidney cancers, five retinoblastoma, three Prader-Willi syndrome and two Russel-Silver syndrome. Anticipating the same occurrence in IVF children, the total expected number was calculated to be 0.74. The observed number in the IVF group was 0. We found a significantly increased risk of cerebral palsy in the IVF group, with a rate ratio (RR) (IVF:non-IVF) of 1.8 [95% confidence interval (CI) 1.2-2.8; P < 0.01], and of sleeping disturbances, with an RR 2.0 (95% CI 1.2-3.3). The incidence rate of childhood cancers, mental diseases, congenital syndromes and developmental disturbances was equal in the two groups.

CONCLUSIONS

We found no indication of an increased risk of imprinting diseases after IVF, but an 80% increased risk of cerebral palsy. We observed equal frequencies of childhood cancers, mental diseases, congenital syndromes and developmental disturbances in the two groups. Danish register data do not support reports of an increased risk of imprinting diseases after IVF.

Age-specific incidence of inherited versus sporadic cancers: a test of the multistage theory of carcinogenesis

Knudson [Knudson, A. G. (1971) Proc. Natl. Acad. Sci. USA 68, 820-823] suggested that progression of retinoblastoma follows from two mutational events. Individuals who inherit one mutated gene copy should follow an age-onset pattern set by only a single rate-limiting step for transformation, whereas normal individuals should follow an age-onset pattern set by two rate-limiting events. Knudson's analysis of inherited and sporadic cases of retinoblastoma supported this prediction. However, retinoblastoma has a peculiar age-onset pattern concentrated in early life, because the retinal tissue completes most of its cell division by 5 years of age. Here, I compare age-specific incidences of inherited and sporadic forms of colon cancer, a much more typical form of human cancer. My simple mathematical analysis based on multistage theory explains the observed differences in age-onset patterns between inherited and sporadic cases. I also analyze recent retinoblastoma data and provide a mathematical analysis and interpretation. My analysis supports Knudson's two-hit theory but is much simpler and easier to understand than the original mathematical theory, which was based on a complicated model of cell division in the retina. My simpler theory for retinoblastoma makes clear the common basis for understanding multistage progression in tissues as different as the retina and colon.

Trilateral retinoblastoma: a literature review, 1971-2004

This study analyzes modern views on the history, variants, age at diagnosis of trilateral retinoblastoma, median time from retinoblastoma to trilateral retinoblastoma, the largest size and percentage of trilateral retinoblastoma among retinoblastoma cases, functions of pineal gland, genetics, ocular and intracranial histology, diagnosis, treatment, therapy results, survival rates and frequency of screening of trilateral retinoblastoma.

In vitro fertilization and childhood retinoblastoma

AIMS

To estimate the frequency of childhood retinoblastoma among children conceived by in vitro fertilization (IVF).

METHODS

Using the United Kingdom-based General Practice Research Database (GPRD), we identified all live births, cases of retinoblastoma and IVF procedures occurring between January 1989 and December 2001.

RESULTS

We identified 0 cases of retinoblastoma among 176 children conceived by IVF (Risk = 0/176, one-sided 97.5% CI 0, 0.02) and 24 cases of retinoblastoma diagnosed before age 5 years among 358,094 children not conceived by IVF (6.7 cases per 100,000 births [95% CI 4.5, 10]).

CONCLUSIONS

These data provide some reassurance that children born as a result of IVF are not at markedly increased risk of retinoblastoma.

A multicentre report from the Mexican Retinoblastoma Group

BACKGROUND

Retinoblastoma (RB) is a relatively uncommon tumour in childhood. The incidence of retinoblastoma in Mexico is probably higher than the incidence reported worldwide, however there is not enough information about the characteristics of this illness in Mexico. This report aims to present the results of a multicentre clinical survey of RB in Mexico.

METHODS

A retrospective study was carried out on all RB cases treated in 16 institutions during the last six years. The variables analysed were age at diagnosis, sex, affected eyes, treatment modalities, and pathological staging. Overall survival was obtained.

RESULTS

The authors analysed 500 cases; age range was 0-182 months. There were 364 unilateral cases (72.8%). Enucleation was performed in 84.9% of the patients. The St Jude's staging was: 7.4% stage I, 52.8% stage II, 18.0% stage III, 11.4% stage IV, 7.2% not evaluated, and 3.2% missing data. Chemotherapy was used in 74.4% of the patients. Disease free survival was 89% at 73 months follow up.

CONCLUSIONS

The paper presents a great number of cases and pioneers multicentre studies in paediatric ophthalmology and oncology in this country. Given the great number of patients in advanced stages and the variability on treatment schemes, it is evident that it is mandatory to work in a cooperative group and develop a national early detection programme as well as a treatment protocol which include all specialists involved in the care of patients with RB.

Retinoblastoma in Victoria, 1976-2000: changing management trends and outcomes

PURPOSE

To describe changes in the management of retinoblastoma in Victoria and to review the effect of newer, conservative treatments on preservation of eyes, visual outcome and mortality by comparing a similar group of patients treated over successive time intervals.

METHODS

A retrospective analysis of all cases of retinoblastoma diagnosed and treated in Victoria between 1956 and 2000 was conducted. Historical data on 77 cases previously published by O'Day et al. was used for the period 1956-1976 (series 1). Data on 88 cases recorded in the Royal Children's Hospital (Melbourne) Retinoblastoma Database was used for the period 1976-2000. The latter group was subdivided into those treated between 1976 and 1989 (series 2), prior to the advent of modern eye saving treatments, and those treated subsequent to their introduction from 1990 to 2000 (series 3).

RESULTS

In unilateral retinoblastoma, final enucleation rates for 1956-1976 (series 1) and 1976-1989 (series 2) were almost identical, being 98% and 97% of affected eyes, respectively (P = 1.00). Despite the newer treatments used after 1990 (series 3), 88% of affected eyes were still enucleated, representing a statistically similar outcome to series 2 (P = 0.33). In bilateral retinoblastoma, primary enucleation of the more involved eye was similar for series 1 (84%) and 2 (80%) but series 3 (41%) was substantially less than series 2 (P = 0.04) following the increased use of conservative treatments. In series 3, 59% of more involved eyes were treated conservatively compared with 16% (P = 0.007) and 20% (P = 0.04) for series 1 and 2, respectively. Despite attempts at eye salvage, the failure rate was higher in series 3 (29%) yielding a final enucleation rate of 70%, which represented a modest downward trend in the numbers of eyes finally enucleated; 84% (series 1), 73% (series 2) and 70% (series 3) (test for trend, P = 0.33). Bilateral enucleation rates were significantly lower, from 36% and 30% in series 1 and 2, respectively, to 7% in series 3 (test for trend, P = 0.02). As a consequence, more eyes were preserved over time, being 20/50 (40%) in series 1, 15/30 (50%) in series 2 and 21/34 (62%) in series 3. Comparison of visual outcome was hampered by incomplete data in series 1 but it appeared series 2 and 3 achieved better visual acuities with 67% and 62% of preserved eyes in bilateral cases measuring equal to or better than 6/12. Mortality rates in all series were low, being 7.8% in series 1, 4.5% in series 2 and nil in series 3.

CONCLUSIONS

Following the introduction of new conservative treatments, there has been an increase in preservation of eyes and improved visual outcome, and a dramatic decrease in numbers of bilateral enucleations without adversely affecting survival.

Incidence of retinoblastoma from 1958 to 1998 in Northern Europe: advantages of birth cohort analysis

PURPOSE

To assess change in incidence of retinoblastoma in Northern Europe and to compare commonly used methods for calculating its incidence against birth cohort analysis.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Individual and pooled data of 291 Swedish and 174 Finnish children diagnosed with retinoblastoma between 1958 and 1998.

MAIN OUTCOME MEASURES

Incidence per 1 million children younger than 5 years of age (37 812 035 person- years at risk) and per 100 000 live births (7 152 265 live-born children at risk).

METHODS

Data were from Swedish and Finnish Cancer Registries and corresponding national referral centers for retinoblastoma. Incidence was calculated both by standard analysis per children younger than 5 years of age and per live births, and by birth cohort analysis. Curves were smoothed with robust, locally weighted regression. Linear regression was used to fit pooled data.

RESULTS

The number of new retinoblastoma cases per year ranged from 0 to 13 (1-13 per birth cohort) in Sweden and from 0 to 10 in Finland (1-9 per birth cohort). The mean incidence was 11.8 (95% confidence interval [CI], 10.5-13.1) and 11.2 (95% CI, 9.4-13.0) per 1 million children younger than 5 years of age in Sweden and Finland, respectively, and 6.7 (95% CI, 5.9-7.5) and 6.2 (95% CI, 5.3-7.2) per 100 000 live births, respectively. Analysis based on year of diagnosis suggested moderate increase in incidence since 1990, but by birth cohort analysis, incidence rates were stable for both countries. The pooled incidence by birth cohort was 6.0 (95% CI, 5.4-6.6) per 100 000 live births, corresponding to 1 in 16 642 (95% CI, 15 105-18 528) live births.

CONCLUSIONS

The data suggest that the incidence of retinoblastoma is stable in Northern Europe. Analysis based on birth cohort is recommended for future epidemiologic studies, because it minimizes the effect of variable age at diagnosis of this developmental cancer and results in less variable incidence rates than standard analysis based on year of diagnosis.

Clinical trial of fundoscopy under general anesthesia for pediatric outpatients with retinoblastoma

Retinoblastoma brings suffering, particularly to children. Formerly management during fundoscopy for children in Japan saw children's movements restricted with a blanket held by their parents or by nurses. This situation was sad, and the performance of the fundoscopy was limited because the children were crying and moving during the examination. After we received letters from the families of such children, we decided to introduce day-care general anesthesia for fundoscopy. After we investigated the current status of the treatment of retinoblastoma in leading countries, we carried out a trial of day-care general anesthesia for fundoscopy in 70 pediatric patients with retinoblastoma. We have now finished this first trial of day-care anesthesia, and we expect that discharge from hospital to places a longer distance away will be feasible.

[Malignant solid tumours in Brazzaville children: epidemiological and anatomo-pathological aspects]

In this retrospective study over six years the authors report 65 malignant solid tumours of the children under the age of 15 years old. The average age was 7.9 years with a peak of frequency between 5 and 9 years. There was a male prevalence with a sex-ratio of 1.3. The most frequent histological types were: lymphoma of Burkitt (52%), retinoblastoma (20%), nephroblastoma (9%) and malignant tumours of the soft tissues (6%). The malignant solid tumours of the child are relatively rare and histologically very diversified.

Incidence of eye cancer in Taiwan: an 18-year review

PURPOSE

To describe the incidence and histologic patterns of eye cancers in Chinese in Taiwan.

METHODS

Beginning in 1979, cases of cancer in Taiwan were reported to the Taiwan National Cancer Registry. Information on all Chinese patients diagnosed with eye malignancies under the International Classification of Disease, Ninth Revision, site 190, was retrieved for analysis from the data bank of the Taiwan National Cancer Registry.

RESULTS

In all, 733 cases with primary eye cancers were identified from 1979 to 1996, an 18-year period. The average annual age-standardized incidence of eye cancers was 2.46 per million population (2.57 for male and 2.33 for female). For cases less than 15 years of age, the most common eye malignancy was retinoblastoma (86.0%), followed by rhabdomyosarcoma (3.9%) and lymphoma (2.8%). For cases 15 years of age or older, the most common eye malignancy was melanoma (28.6%), followed by squamous cell sarcoma (21.0%) and lymphoma (20.8%).

CONCLUSIONS

The time trends of the incidence of eye cancers were relatively stable over the 18-year period in Taiwan. Retinobalstoma, melanoma, and lymphoma were the three most common eye cancers in this Chinese population.