Management of patients with retinoblastoma treated with vitrectomy due to misdiagnosis_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhao Hongshu ,  Wei Wenbin , Shi Jitong , Xu Xiaolin , Wang Yizhuo

Beijing Tongren Eye Center, Beijing key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China;

Corresponding author：

Wei Wenbin, Email: tr_weiwenbin@163.com

Keywords：

Retinoblastoma; Vitrectomy; Diagnostic errors

DOI：

10.3760/cma.j.cn511434-20210111-00012

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Objective To explore the clinical treatment of retinoblastoma (RB) after being treated with vitrectomy (PPV) due to misdiagnosis.Methods A retrospective case study. From July 2015 to July 2018, 5 cases and 5 eyes of RB children diagnosed by pathological examination at the Eye Center of Beijing Tongren Hospital were included in the study. Among them, there were 3 males with 3 eyes and 2 females with 2 eyes; all of them had monocular disease. The average age was 4.8±1.7 years old. At the first visit, the diagnosis was endophthalmitis in 2 eyes (40%, 2/5); vitreous hemorrhage in 3 eyes (60%, 3/5). All were treated with PPV. All children underwent slit lamp microscopy, orbital MRI and CT, and eye color Doppler ultrasound blood flow imaging. If there was no clear extraocular spread, the eyeball removal combined with artificial orbital implantation was performed; if there was clear extraocular spread, the modified orbital content enucleation operation was performed with part of the eyelid preserved. The average follow-up time after surgery was 34.6±7.9 months.Results Among the 5 eyes, 2 eyes (40%, 2/5) underwent eyeball enucleation combined with stage I artificial orbital implantation, and 3 eyes (60%, 3/5) with modified orbital content enucleation. There were 2 eyes of endogenous type (40%, 2/5), 1 eye of diffuse infiltration type (20%, 1/5), and 2 eyes of mixed type (40%, 2/5). The orbit spread in 3 eyes, the tumor invaded the optic nerve in 1 eye, and regional lymph node metastasis in 2 eyes. All children received systemic chemical therapy (chemotherapy). During the follow-up period, there were no new metastatic diseases and no deaths.Conclusions After RB misdiagnosis and PPV, surgical treatment should be performed as soon as possible. If there is no clear extraocular spread, eyeball removal or combined stage I orbital implantation should be performed. If there is clear extraocular spread, the orbital contents should be enucleated; Chemotherapy should be combined after surgery.

Citation： Zhao Hongshu, Wei Wenbin, Shi Jitong, Xu Xiaolin, Wang Yizhuo. Management of patients with retinoblastoma treated with vitrectomy due to misdiagnosis. Chinese Journal of Ocular Fundus Diseases, 2021, 37(5): 344-347. doi: 10.3760/cma.j.cn511434-20210111-00012 Copy

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4.	Chantada G, Doz F, Antoneli CB, et al. A proposal for an international retinoblastoma staging system[J]. Pediatr Blood Cancer, 2006, 47(6): 801-805. DOI: 10.1002/pbc.20606.
5.	Karcioglu ZA, Gordon RA, Karcioglu GL. Tumor seeding in ocular fine needle aspiration biopsy[J]. Ophthalmology, 1985, 92(12): 1763-1767. DOI: 10.1016/s0161-6420(85)34105-2.
6.	Shields CL, Honavar S, Shields JA, et al. Vitrectomy in eyes with unsuspected retinoblastoma[J]. Ophthalmology, 2000, 107(12): 2250-2255. DOI: 10.1016/s0161-6420(00)00427-9.
7.	Byrnes GA, Shields CL, Shields JA, et al. Retinoblastoma presenting with spontaneous hyphema and dislocated lens[J]. J Pediatr Ophthalmol Strabismus, 1993, 30(5): 334-336. DOI: 10.3928/0191-3913-19930901-17.
8.	Biewald E, Schlüter S, Bechrakis NE, et al. Long-term clinical results and management following vitrectomy in undetected retinoblastoma eyes[J]. Ocul Oncol Pathol, 2020, 6(4): 244-250. DOI: 10.1159/000505732.
9.	Chen R, Ye H, Liu S, et al. Head and eye trauma before retinoblastoma diagnosis[J]. Cancer Manag Res, 2019, 11: 10269-10274. DOI: 10.2147/CMAR.S217920.
10.	Shields JA, Shields CL, Materin M. Diffuse infiltrating retinoblastoma presenting as a spontaneous hyphema[J]. J Pediatr Ophthalmol Strabismus, 2000, 37(5): 311-312.
11.	Kaliki S, Taneja S, Palkonda VAR. Inadvertent intraocular surgery in children with unsuspected retinoblastoma: a study of 14 cases[J]. Retina, 2019, 39(9): 1794-1801. DOI: 10.1097/IAE.0000000000002214.

1. Broaddus E, Topham A, Singh AD. Survival with retinoblastoma in the USA: 1975-2004[J]. Br J Ophthalmol, 2009, 93(1): 24-27. DOI: 10.1136/bjo.2008.143842.
2. Canadian Retinoblastoma Society. National retinoblastoma strategy Canadian guidelines for care: stratégie thérapeutique du rétinoblastome guide clinique canadien[J]. Can J Ophthalmol, 2009, 44(Suppl 2): S1-88. DOI: 10.3129/i09-194.
3. Shen T, Liu R, Lin J, et al. Pars plana vitrectomy and evisceration resulting in death due to misdiagnosis of retinoblastoma in children: a review of 3 cases[J/OL]. Medicine (Baltimore), 2015, 94(32): e1338[2015-08-01]. https://pubmed.ncbi.nlm.nih.gov/26266382/. DOI: 10.1097/MD.0000000000001338.
4. Chantada G, Doz F, Antoneli CB, et al. A proposal for an international retinoblastoma staging system[J]. Pediatr Blood Cancer, 2006, 47(6): 801-805. DOI: 10.1002/pbc.20606.
5. Karcioglu ZA, Gordon RA, Karcioglu GL. Tumor seeding in ocular fine needle aspiration biopsy[J]. Ophthalmology, 1985, 92(12): 1763-1767. DOI: 10.1016/s0161-6420(85)34105-2.
6. Shields CL, Honavar S, Shields JA, et al. Vitrectomy in eyes with unsuspected retinoblastoma[J]. Ophthalmology, 2000, 107(12): 2250-2255. DOI: 10.1016/s0161-6420(00)00427-9.
7. Byrnes GA, Shields CL, Shields JA, et al. Retinoblastoma presenting with spontaneous hyphema and dislocated lens[J]. J Pediatr Ophthalmol Strabismus, 1993, 30(5): 334-336. DOI: 10.3928/0191-3913-19930901-17.
8. Biewald E, Schlüter S, Bechrakis NE, et al. Long-term clinical results and management following vitrectomy in undetected retinoblastoma eyes[J]. Ocul Oncol Pathol, 2020, 6(4): 244-250. DOI: 10.1159/000505732.
9. Chen R, Ye H, Liu S, et al. Head and eye trauma before retinoblastoma diagnosis[J]. Cancer Manag Res, 2019, 11: 10269-10274. DOI: 10.2147/CMAR.S217920.
10. Shields JA, Shields CL, Materin M. Diffuse infiltrating retinoblastoma presenting as a spontaneous hyphema[J]. J Pediatr Ophthalmol Strabismus, 2000, 37(5): 311-312.
11. Kaliki S, Taneja S, Palkonda VAR. Inadvertent intraocular surgery in children with unsuspected retinoblastoma: a study of 14 cases[J]. Retina, 2019, 39(9): 1794-1801. DOI: 10.1097/IAE.0000000000002214.

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Management of patients with retinoblastoma treated with vitrectomy due to misdiagnosis

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