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Alec Lee Amram, Grecia Rico, Jonathan W Kim, Dan Gombos, Patricia Chevez-Barrios; Vitreous and Subretinal Seeds in Retinoblastoma: Clinicopathologic Correlation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):855.
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© ARVO (1962-2015); The Authors (2016-present)
Vitreous seeding has been recognized as the strongest predictor of retinoblastoma treatment failure. Recently, intravitreal chemotherapy injection has led to improved outcomes for these patients. Munier et al recently proposed a new clinical classification scheme for retinoblastoma with vitreous seeds; Francis et al was then able to demonstrate a significant difference in regression between seed classes. Here we describe the first correlation of this clinical classification scheme with histopathological features.
We reviewed enucleated eyes with retinoblastoma from the Retinoblastoma Center of Houston that had clinical and macroscopic photographs and routinely processed, hematoxylin and eosin stained slides from 2010-2015 to identify those with vitreous and subretinal seeds. Immunohistochemistry with CD68 was used to evaluate for the presence of macrophages. Eyes were classified by clinical and macroscopic tumor seed type and cellular components were correlated within each category.
14 of 138 eyes reviewed had adequate vitreous or subretinal seeds and clinical/macroscopic photos. Clinically identified “dust” seeds (Type 1) represent individual viable tumor cells and macrophages. Clinically “sphere” seeds (Type 2) represent two histological types: 1. Macroscopically gray/translucent spheres are composed of non-necrotic, mitotically active retinoblastoma cells. 2. Macroscopically gray spheres with a white/yellow center are composed of an outer rim of viable cells with a center of necrotic material. Both sphere types contain a pole of dispersing single, viable cells. “Cloud” seeds (Type 3) are composed of necrotic debris with few scattered macrophages and rare viable cells.
Spheres with translucent centers may represent the most aggressive vitreous seed subtype as they contain multiple layers of viable tumor cells and shed single cells. In contrast, the overall lack of response to treatment seen in “cloud” seeds is likely due to an absence of replicating tumor cells. Knowledge of the composition of retinoblastoma seed types should help guide treatment and anticipate clinical response in trials that focus on the safety, efficacy, and outcomes of novel retinoblastoma therapy.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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