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{{Retinoblastoma}}
{{Retinoblastoma}}
{{CMG}}{{AE}}{{Simrat}}
{{CMG}}; {{AE}} {{Simrat}} {{Sahar}}
==Overview==
==Overview==
Common physical examination findings of retinoblastoma include white reflex or loss of red eye reflex, strabismus, proptosis, anisocoria, orbital cellulitis, hyphema, heterochromia iridis, poor vision, unilateral mydriasis, rubeosis iridis, vitreous hemorrhage, and fundocopic examination with findings of chalky white -gray retinal mass.
[[Patient|Patients]] with retinoblastoma usually appear normal. [[Physical examination]] of [[Patient|patients]] is usually remarkable for [[leukocoria]], [[strabismus]], and [[proptosis]], particularly in advanced cases.
==Eyes==
Other findings on [[physical examination]] of retinoblastoma include [[anisocoria]], [[orbital cellulitis]], [[hyphema]], [[heterochromia iridis]], poor [[visual acuity]], unilateral [[mydriasis]], [[rubeosis iridis]], [[vitreous]] [[hemorrhage]], and findings of intrinsic [[calcification]] on [[Fundoscopy|fundoscopic examination]].
Abnormalities of the head/hair may include ___
==Physical Examination==
*Nystagmus
===General Appearance===
*Strabismus or cross eyed or wall eyed
*[[Child|Children]] with retinoblastoma are generally well-appearing.
*Anisocoria
*[[Child|Children]] may appear [[Cachexia|cachectic]] in advanced cases.<ref name="pmid6703986">{{cite journal |vauthors=MacKay CJ, Abramson DH, Ellsworth RM |title=Metastatic patterns of retinoblastoma |journal=Arch. Ophthalmol. |volume=102 |issue=3 |pages=391–6 |date=March 1984 |pmid=6703986 |doi= |url=}}</ref>
*Proptosis
===Vital Signs===
*Poor vision
*[[Vital signs]] of [[Patient|patients]] with retinoblastoma are usually within normal limits.
*Orbital cellulitis
===Skin===
*Hyphema
*[[Skin]] [[Physical examination|examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
*Heterochromia iridis
===HEENT===
*Unilateral mydriasis
*[[Hypertelorism]] in case of concurrent [[13q deletion syndrome]]<ref name="pmid22337189">{{cite journal| author=Mehta M, Sethi S, Pushker N, Kashyap S, Sen S, Bajaj MS et al.| title=Retinoblastoma. | journal=Singapore Med J | year= 2012 | volume= 53 | issue= 2 | pages= 128-35; quiz 136 | pmid=22337189 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22337189  }} </ref>
*Rubeosis iridis
*[[Leukocoria]] (white reflex or cat's [[eye]] reflex)
*Red, painful eye with glaucoma
*[[Strabismus]] or when both [[Eye|eyes]] do not look to the same direction
*Vitreous hemorrhage
*[[Periorbital edema|Periorbital swelling]]
*White reflex or cat's eye reflex
*[[Anisocoria]] or inequality of [[pupils]]
*Ocular examination (staging examination under general anaesthesia) can be easily performed using a surgical or binocular handheld slit lamp microscope, and includes anterior segment evaluation (cornea, anterior chamber and iris).<ref name="pmid22337189">{{cite journal| author=Mehta M, Sethi S, Pushker N, Kashyap S, Sen S, Bajaj MS et al.| title=Retinoblastoma. | journal=Singapore Med J | year= 2012 | volume= 53 | issue= 2 | pages= 128-35; quiz 136 | pmid=22337189 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22337189  }} </ref> Ocular examination is followed by indirect opthalmoscopy with indentation under full mydriasis
*[[Proptosis]]
to examine the entire retina.
{|
*Ophthalmoscopic exam may be abnormal with findings of chalky white-gray retinal mass
|[[image:Retinoblastoma leukocoria.jpeg|thumb|400px|leukocoria, Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 9462]]
*The diagnosis of retinoblastoma is usually made during a dilated indirect ophthalmoscopic examination, performed under anesthesia. The characteristic finding is a chalky, white-gray retinal mass with a soft, friable consistency.<ref name="pmid2201000">{{cite journal| author=Abramson DH| title=Retinoblastoma 1990: diagnosis, treatment, and implications. | journal=Pediatr Ann | year= 1990 | volume= 19 | issue= 6 | pages= 387-95 | pmid=2201000 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2201000  }} </ref>
<br style="clear:left" />
*The fundoscopic examination may show retinal detachment with retinal vessels visible behind the lens and may show vitreous and/or subretinal seeding. Intrinsic tumor calcification, tumor microvasculature, may also be seen. This examination permits complete visualization of the retina, identification of multifocal tumors and/or vitreous or subretinal seeding.
|-
*The red reflex: checking for a normal reddish-orange reflection from the eye's retina with an ophthalmoscope or retinoscope from approximately 30 cm / 1 foot, usually done in a dimly lit or dark room.
|}
*The corneal light reflex / Hirschberg test: checking for symmetrical reflection of beam of light in the same spot on each eye when a light is shined into each cornea, to help determine whether the eyes are crossed.
*Decreased [[visual acuity]]
*Eye examination: checking for any structural abnormalities.
*[[Slit lamp]] [[examination]] may show:
*Bryan Shaw helped develop a smart-phone app that can detect leukocoria in photos.
**[[Orbital cellulitis]]
**[[Hyphema]]
**[[Heterochromia iridis]]
**[[Rubeosis iridis]]
**Red, painful [[eye]] with [[glaucoma]]
**[[Vitreous hemorrhage]]
*[[Ophthalmoscopy|Funduscopic examination]] may show:
**Small [[Tumor|tumors]]: Round glazed elevations of the [[retina]] with gray-white hew which develop surrounding the serous [[retinal detachments]]
**Large [[Tumor|tumors]]: Intrinsic [[calcification]] and a white color with seeding into the [[Retina|subretinal]] and or the [[vitreous]] space
*[[Patient|Patients]] with [[13q deletion syndrome]] may present with:<ref name="ClarkAvishay2015">{{cite journal|last1=Clark|first1=Robin D.|last2=Avishay|first2=Stefanie G.|title=Retinoblastoma: Genetic Counseling and Testing|year=2015|pages=77–88|doi=10.1007/978-3-662-43451-2_8}}</ref>
**[[Hypertelorism]]
**Flat [[nasal bridge]]
**Small [[mouth]] and [[nose]]
**High arched or [[cleft palate]]
**[[Micrognathia]]
**[[Microcephaly]]
{|
|[[image:Retinoblastoma-fundoscopy-photo.jpeg|thumb|400px|Retinoblastoma [[fundoscopy]], Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 9460]]
<br style="clear:left" />
|-
|}
===Neck===
*[[Neck]] [[Physical examination|examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Lungs===
*[[Pulmonary examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Heart===
*[[Cardiovascular]] [[examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Abdomen===
*[[Abdominal examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Back===
*[[Human back|Back]] [[examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Genitourinary===
*[[Genitourinary system|Genitourinary]] [[examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Neuromuscular===
*[[Neuromuscular]] [[examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
===Extremities===
*[[Limb (anatomy)|Extremities]] [[examination]] of [[Patient|patients]] with retinoblastoma is usually normal.
*[[Simian crease]] in the [[Hand|palms]] and a broad [[thumb]] may be present in [[13q deletion syndrome]].
 
==References==
==References==
<references/>
{{reflist|2}}
 
​
==See also==
*[[Eye cancer]]
*[[Eye examination]]
 
{{Nervous tissue tumors}}
 
[[Category:Ophthalmology]]
[[Category:Types of cancer]]
[[Category:hereditary cancers]]
[[Category:Oncology stub]]


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Latest revision as of 23:59, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Sahar Memar Montazerin, M.D.[3]

Overview

Patients with retinoblastoma usually appear normal. Physical examination of patients is usually remarkable for leukocoria, strabismus, and proptosis, particularly in advanced cases. Other findings on physical examination of retinoblastoma include anisocoria, orbital cellulitis, hyphema, heterochromia iridis, poor visual acuity, unilateral mydriasis, rubeosis iridis, vitreous hemorrhage, and findings of intrinsic calcification on fundoscopic examination.

Physical Examination

General Appearance

Vital Signs

Skin

HEENT

leukocoria, Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 9462


Retinoblastoma fundoscopy, Case courtesy of A.Prof Frank Gaillard, Radiopaedia.org, rID: 9460


Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ MacKay CJ, Abramson DH, Ellsworth RM (March 1984). "Metastatic patterns of retinoblastoma". Arch. Ophthalmol. 102 (3): 391–6. PMID 6703986.
  2. ↑ Mehta M, Sethi S, Pushker N, Kashyap S, Sen S, Bajaj MS; et al. (2012). "Retinoblastoma". Singapore Med J. 53 (2): 128–35, quiz 136. PMID 22337189.
  3. ↑ Clark, Robin D.; Avishay, Stefanie G. (2015). "Retinoblastoma: Genetic Counseling and Testing": 77–88. doi:10.1007/978-3-662-43451-2_8.

​

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