Histopathological High-Risk Features and Clinical Outcomes in Retinoblastoma: A Prospective Observational Study from a Tertiary Eye Care Centre

Abstract

To evaluate the frequency of histopathological high-risk characters in enucleated eyes with retinoblastoma and find their correlation with clinical presentation, treatment characteristics and metastatic outcome. This was a prospective observational study of patients who were diagnosed to have intraocular retinoblastoma and underwent primary or secondary enucleation in a tertiary eye care center for a period of 18 months. Their clinical presentations, treatment and histopathological variables were recorded. Categorical variables were analysed using chi-square or Fisher exact tests; P<0.05 was considered statistically significant. Enucleated 50 eyes were included. Mean age at enucleation was 28.3±17.67 months (range 3 to 72); 25 patients (50%) were male. Leukocoria was the commonest presenting feature (47/50, 94%). Endophytic growth was present in 39 eyes (78%). Primary enucleation was performed in 19 eyes (38%) and secondary enucleation in 31 (62%). Histology showed differentiated tumour in 34 eyes (68%). Optic nerve invasion was identified in 36 eyes (72%): prelaminar 18 (36%), laminar 5 (10%) and retrolaminar 13 (26%). The optic nerve resection margin was involved in 4 eyes (8%). Choroidal invasion was massive in 29 eyes (58%), minimal in 15 (30%) and absent in 6 (12%). Orbital extension was found in3 patients during follow-up and 3 patients died from metastatic disease. Characteristic high-risk histopathological features were frequent in this cohort of advanced retinoblastoma. Systematic examination of enucleated specimens remains essential for risk stratification and postoperative management.