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| {{CMG}}; {{AE}} {{Simrat}} {{Sahar}} | | {{CMG}}; {{AE}} {{Simrat}} {{Sahar}} |
| ==Overview== | | ==Overview== |
| Retinoblastoma must be differentiated from other diseases that cause [[leukocoria]] such as [[congenital]] [[cataract]], persistent fetal vasculature, [[Coats disease]], [[coloboma]] of [[choroid]] or [[optic disc]], [[toxocariasis]], [[astrocytic]] [[hamartoma]], [[retinopathy of prematurity]], [[vitreous hemorrhage]], [[uveitis]], [[retinal dysplasia]], and [[medulloepithelioma]].<ref name="wiki">Retinoblastoma. Wikipedia(2015) https://en.wikipedia.org/wiki/Retinoblastoma#cite_note-30 Accessed on October 2, 2015</ref>
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| ==Differential diagnosis== | | ==Differential diagnosis== |
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| * | | * |
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| Differentiating features of some common and less common differential diagnosis are:
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| {| style="border: 0px; font-size: 90%; margin: 3px; width: 800px;" align="center"
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| | valign="top" |
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| |+
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease/Condition}}
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Age of presentation }}
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Risk factors }}
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Unilateral/bilateral }}
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differentiating Signs/Symptoms }}
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Axial length }}
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| ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Imaging findings }}
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Retinoblastoma
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *< 3 years of age in 90%
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Family history
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Unilateral/bilateral
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Leukocoria
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Normal
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *USG:Intraretinal/subretinal mass with calcification
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Congenital Cataract
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Presents at birth
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| *Lens opacification rare in retinoblastoma
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Fundus examination reveals lens opacification
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| *Ultrasound shows increased echogenicity of lens
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Coats disease (exudative retinitis or retinal telangiectasis)
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Most cases are unilateral
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| *Mean age at presentation is 6 years
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| *More common in males
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Fundus examination: lesion appears more yellow-colored (versus chalky white-gray in retinoblastoma); telangiectatic and aneurysmal retinal vessels are characteristic of Coats disease but uncommon in retinoblastoma
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| *Spectral domain optical coherence tomography may be helpful in distinguishing Coats disease from retinoblastoma
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| *Ophthalmic ultrasound: can be misleading because calcification can also be seen in Coats disease
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Persistent fetal vasculature (formerly known as persistent hyperplastic primary vitreous)
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Associated with a micro-ophthalmic eye (a small, malformed eye)
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| *Often associated with a cataract (rare in retinoblastoma)
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| *Congenital (retinoblastoma uncommonly presents at birth)
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| *Dragging of the ciliary processes on exam
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Measurement of axial length using fundus examination and ultrasound shows short axial length in persistent fetal vasculature
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Retinopathy of prematurity (ROP)
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Generally occurs in premature children given high-dose oxygen
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| *Can result in total retinal detachment
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Fundus examination: reveals gliotic-appearing retina, which is different from the retinal detachment associated with retinoblastoma
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| |-
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| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Ocular toxocariasis
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Generally causes vitreoretinal traction and ocular inflammation not seen in retinoblastoma
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Fundus examination reveals the characteristic signs
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| |}
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| {| class="wikitable"
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| |+Differentiating ocular cysticercosis from other ocular lesions
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| !Disease
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| !Prominent clinical feature
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| !Radiological findings
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| |-
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| |Ocular cysticercosis
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| * Diagnosis made usually between 8-16 years (rarely in adulthood)
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| * Wide range of symptoms from being [[asymptomatic]] to [[Decreased visual acuity|decreased vision]] and [[strabismus]].
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| * [[Decreased visual acuity]] at initial presentation has a poor prognosis. <ref name="urlHow to Diagnose and Manage Coats’ Disease">{{cite web |url=https://www.reviewofophthalmology.com/article/how-to-diagnose-and-manage-coatsand8217-disease-42782 |title=How to Diagnose and Manage Coats’ Disease |format= |work= |accessdate=}}</ref>
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| * [[Fundus (eye)|Fundus examination]] reveals vascular lesions and [[Exudate|exudates]].
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| * [[Fluorescein angiography]] is the best method to visualize the lesions.
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| * [[CT]] and [[MRI]] are reserved for atypical cases.<ref name="urlHow to Diagnose and Manage Coats’ Disease">{{cite web |url=https://www.reviewofophthalmology.com/article/how-to-diagnose-and-manage-coatsand8217-disease-42782 |title=How to Diagnose and Manage Coats’ Disease |format= |work= |accessdate=}}</ref>
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| |-
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| |[[Retinal detachment]]
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| * Most common presenting symptoms are [[photophobia]] and [[floaters]]
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| * [[Visual field defect|Visual field defects]] (described as curtain falling from periphery to the center)<ref name="urlManagement of retinal detachment: a guide for non-ophthalmologists">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405853/ |title=Management of retinal detachment: a guide for non-ophthalmologists |format= |work= |accessdate=}}</ref>
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| * [[Ophthalmoscope]] is not reliable in detecting retinal detachment as there might be associated [[hemorrhage]]
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| * [[Ultrasound]] can be used to identify and localize the detachment.<ref name="urlManagement of retinal detachment: a guide for non-ophthalmologists">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405853/ |title=Management of retinal detachment: a guide for non-ophthalmologists |format= |work= |accessdate=}}</ref>
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| |-
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| |Hyperthyroid Ophthalmopathy
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| * The hallmark is [[Exophthalmos|Eye protrusion]], [[photophobia]], [[lacrimation]] and later in the disease, diminished eye motility.<ref name="urlThyroid Ophthalmopathy - EyeWiki">{{cite web |url=http://eyewiki.aao.org/Thyroid_Ophthalmopathy |title=Thyroid Ophthalmopathy - EyeWiki |format= |work= |accessdate=}}</ref>
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| * [[Ultrasonography]]: inflamed thickened [[extraocular muscles]].
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| * [[CT]]: shows [[inflamed]] muscle and free tendon from [[inflammation]]
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| * [[MRI]]: shows periorbital fat expansion, increased water content of the muscles as a result of the [[inflammation]].<ref name="urlThyroid Ophthalmopathy - EyeWiki">{{cite web |url=http://eyewiki.aao.org/Thyroid_Ophthalmopathy |title=Thyroid Ophthalmopathy - EyeWiki |format= |work= |accessdate=}}</ref>
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| |-
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| |[[Retinoblastoma]]
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| * The most prominent sign is [[leukocoria]], followed by [[strabismus]]
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| * The patient also may present with [[buphthalmos]], [[Cloudy cornea (patient information)|corneal clouding]] and eye tearing.<ref name="urlc.ymcdn.com">{{cite web |url=https://c.ymcdn.com/sites/www.covd.org/resource/resmgr/VDR_1-1/VDR1-1_article_Kollodge_Web.pdf+ |title=c.ymcdn.com |format= |work= |accessdate=}}</ref>
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| * [[Ultrasound]]: can detect the [[tumor]] as a result of the [[Calcification|calcifications]] inside.
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| * [[MRI|MRI:]] assess [[Sella turcica|sellar]] and [[Parasellar and suprasellar disorders|parasellar]] regions .. it can also detect extraocular spread of the [[tumor]].<ref name="urlc.ymcdn.com">{{cite web |url=https://c.ymcdn.com/sites/www.covd.org/resource/resmgr/VDR_1-1/VDR1-1_article_Kollodge_Web.pdf+ |title=c.ymcdn.com |format= |work= |accessdate=}}</ref>
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| |}
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| {| class="wikitable"
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| ![[Image:Coats-disease-of-the-eye.jpg|center|300px|thumb|MRI of the orbit showing Coats disease - Case courtesy of Dr Michael Sargent, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/6089]]
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| ![[Image:Retinal-detachment-1.jpg|center|300px|thumb|MRI of the orbit showing retinal detachment - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/3134]]
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| ![[Image:Retinoblastoma-3.jpg|center|300px|thumb|MRI of the orbit showing retinoblastoma - Case courtesy of https://radiopaedia.org/. From the case https://radiopaedia.org/cases/11877]]
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| ![[Image:Thyroid-orbitopathy-severe-2.jpg|center|300px|thumb|CT head showing hyperthyroid-induced orbitopathy - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/4854]]
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|
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| |}
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| ==References== | | ==References== |
| {{reflist|2}} | | {{reflist|2}} |