Spontaneous regression of retinoblastoma

Importance of age in management of retinoblastoma of the first eye

The possible treatments of retinoblastoma are briefly discussed, and the different situations when one or two eyes are affected is stressed. The age at onset is an important factor in distinguishing between uni and bilateral cases. By an analysis of 59 cases it is shown that below the age of 12 months, the risk of bilaterality is above 90 per cent whereas above the age of 18 months the risk is almost zero. It is recommended that in retinoblastoma, uni- as well as bilateral cases, the possibility of a conservative treatment is seriously considered. Radiation is today the basic modality of treatment. The acute management by the mutilating enucleation is a procedure of the past.

Spontaneously regressing retinoblastomas, retinoma, or retinoblastoma group 0

A 5-year-old boy had a gray, translucent retinal mass containing calcified nodules and surrounded by retinal pigment clumping and atrophy. The eye was enucleated and the patient has remained well for seven years. Microscopic examination disclosed an intraretinal tumor composed of benign-appearing cells in a bed of well-vascularized ground substance with calcific foci. There was surrounding retinal pigment epithelial hyperplasia but no peripheral necrosis or signs of tumor regression. There were no mitoses, cellular pleomorphism, nuclear atypia, rosettes, or other characteristics of malignancy. Tumors with this typical fundus appearance have been termed spontaneously regressing retinoblastoma or retinoma. Although the tumor in this patient was histopathologically benign, it carries the same genetic risk as a retinoblastoma. A better term for this lesion, therefore, is retinoblastoma group 0.

Retinoblastoma in a 26-year-old adult

Retinoblastoma in a 26-year-old woman is reported clinicopathologically, and the difficulties in this clinical diagnosis are presented. Clinical and morphologic findings of this case suggest that rare embryonal retinal cells can persist and be subject to late malignant transformation.

Significance of retinoma and phthisis bulbi for retinoblastoma

Genetic counseling of retinoblastoma (RB) patients and their families is difficult and inaccurate. The data in this paper show that two ocular lesions, retinoma and phthisis bulbi, are associated with RB and can be useful in diagnosis and counseling. Phthisis bulbi is the end result of many conditions and can only be linked to RB if other evidence is present. Retinomas, on the other hand, have three distinctive clinical characteristics (irregular translucent retinal mass, calcification, and pigment epithelial disturbance) and quite accurately predict the presence of the RB gene. Recognition of the significance of retinoma and phthisis bulbi with respect to the RB gene is critical in genetic counseling. Of 34 individuals studied, 32 with retinoma and five with phthisis bulbi, two thirds had a family history of RB or RB in the other eye, and 23/37 of their offspring developed RB. The clinical course of RB in the six children known to be at risk on the basis of detection of the gene in the parent was significantly better than in 17 children that were symptomatic at the time of diagnosis.

Spontaneous regression of retinoblastoma in identical twins

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Spontaneous regression of bilateral retinoblastoma

A 24-year-old black man was found to have bilateral, spontaneously regressed retinoblastoma that had previously been misdiagnosed as post-traumatic chorioretinal scarring. His son and half-brother both had bilateral viable retinoblastoma. The ophthalmoscopic and fluorescein angiographic features of this patient's fundus lesions included a calcified, whitish mass located centrally in one of the scars and a fine residual vascularity in another of the fundus lesions. The authors review the pertinent literature on spontaneous regression of retinoblastoma.

Immune complexes in retinoblastoma

Thirteen patients with retinoblastoma were tested for circulating immune complexes using the Raji cell radioimmunoassay. Eight of 13 patients had statistically significantly increased levels of immune complexes.

Radiation treatment of retinoblastoma

In a series of 45 children with retinoblastoma, from the period 1953-1973, comprising 27 bilateral cases, 32 eyes were treated by irradiation. The different techniques of radiation are reviewed. In the present series small tumours were irradiated by local application of Stallard discs or Rosengren balls, while advanced cases were treated by external radiation. The results are discussed, and it is emphasized that the major factor of importance for the success of the treatment is the size of the tumour. Small tumours are cured, large ones are not. Future efforts must be directed towards early diagnosis. The treatment should be centralized in order to secure sufficient experience for the ophthalmologist and radiotherapist, as evaluation of the post- radiation fundus findings may present difficulties.