Universal College of Medical Sciences- Teaching Hospital, Bhairahawa, Nepal.
Nepal J Ophthalmol. 2021 Jan;13(25):91-97. doi: 10.3126/nepjoph.v13i1.31139.
Mortality resulting from the metastasis of retinoblastoma is uncommon in the developed world, however it still constitutes a major problem in developing countries like Nepal. The cases of retinoblastoma with increased risk of metastasis even after enucleation can be predicted from the histopathological examination of the enucleated specimen. We conducted this study aiming to assess the frequency and spectrum of high-risk histological features in enucleated specimens of retinoblastoma.
Forty-two specimens of primary enucleation done for treatment of retinoblastoma received in the Department of Pathology at UCMS from 1st January 2016 to 31st December 2018 were included in the study. All slides were reviewed for high-risk histological features along with tumor differentiation, tumor extension, necrosis, and staging. Correlation of high-risk histological features with age and tumor size was calculated using unpaired t-test and correlation with tumor differentiation, necrosis and staging was done using Pearson Chi square test.
The median age at enucleation was 24 months. All patients had endophytic lesion with a mean tumor size of 1.8cm. One or more high-risk histological features were identified in 30.9% (13/42). The most common high-risk histological feature was retrolaminar optic nerve invasion (10/12, 71.4%). Statistically significant correlation of high risk histological features was noted with tumor size (p=0.011) and AJCC stage of tumor (p=0.0001).
Complete histopathological evaluation of retinoblastoma requires searching for high-risk histological features, the presence of which will guide the clinician in timely planning for subsequent neoadjuvant therapy.
在发达国家，视网膜母细胞瘤转移导致的死亡率并不常见，但在尼泊尔等发展中国家仍是一个主要问题。即使在眼球摘除术后，仍有发生转移风险增加的视网膜母细胞瘤病例，这些病例可以通过对眼球摘除标本的组织病理学检查来预测。本研究旨在评估高危组织学特征在眼球摘除标本中的发生频率和分布。
本研究纳入了 2016 年 1 月 1 日至 2018 年 12 月 31 日期间在 UCMS 病理科接受治疗的 42 例原发性眼球摘除标本。所有切片均进行了高危组织学特征的评估，包括肿瘤分化、肿瘤延伸、坏死和分期。采用配对 t 检验计算高危组织学特征与年龄和肿瘤大小的相关性，采用皮尔逊卡方检验计算高危组织学特征与肿瘤分化、坏死和分期的相关性。
眼球摘除的中位年龄为 24 个月。所有患者均为内生性病变，平均肿瘤大小为 1.8cm。30.9%（13/42）的患者存在 1 种或多种高危组织学特征。最常见的高危组织学特征是视神经后鞘侵犯（10/12，71.4%）。高危组织学特征与肿瘤大小（p=0.011）和 AJCC 肿瘤分期（p=0.0001）显著相关。
视网膜母细胞瘤的完整组织病理学评估需要寻找高危组织学特征，其存在将指导临床医生及时计划后续新辅助治疗。
