Retinoblastoma pathophysiology

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


Retinoblastoma is a neoplasm which is caused by the inactivation of RB1 gene, a tumor suppressor gene, located on the long arm of the chromosome 13. Mutation in both alleles of the RB1 gene is necessary for the inactivation of the gene. This disorder may occur in the familial or sporadic form. (Rb) gene product limits the cell progression from the G1 phase to the S phase of the cell cycle. Loss of this active, functional protein (Rb) causes cell cycle dysregulation and subsequent overgrowth and tumor formation.




Associated Conditions

Gross Pathology

These growth patterns are described in the table below:

Growth patterns Features
  • Most common type
  • Mixed components of endophytic and exophytic are seen
Diffuse Infiltrative
Gross pathology of retinoblastoma, Case courtesy of A.Prof Frank Gaillard,, rID: 9461

Microscopic Pathology

  • The most differentiated part is formed from a bouquet-like aggregates of cells called fleurettes, where mitoses or necrosis are not present.
  • The rosettes are composed of cells with varying degrees of differentiation.
  • There are two types of rosettes:
    • Flexner–Wintersteiner rosette: Composed of a ring of cells surrounding a clear center resembling the subretinal space.
    • Homer Wright rosette: Comprises of a rim of cells with a lumen filled by cytoplasmic prolongations of the tumor cells.
  • Retinoblastoma may be classified according to the degree of differentiation to well/poor-differentiated.
    • Well-differentiated tumor is > 50% Homer-Wright (HW) rosettes.
    • Poor-differentiated tumor is < 50% Flexner-Wintersteiner (FW) rosettes.



  1. Dunn JM, Phillips RA, Becker AJ, Gallie BL (September 1988). "Identification of germline and somatic mutations affecting the retinoblastoma gene". Science. 241 (4874): 1797–800. PMID 3175621.
  2. Dunn JM, Phillips RA, Zhu X, Becker A, Gallie BL (November 1989). "Mutations in the RB1 gene and their effects on transcription". Mol. Cell. Biol. 9 (11): 4596–604. PMC 363605. PMID 2601691.
  3. Garber JE, Offit K (January 2005). "Hereditary cancer predisposition syndromes". J. Clin. Oncol. 23 (2): 276–92. doi:10.1200/JCO.2005.10.042. PMID 15637391.
  4. Goodrich, David W.; Wang, Nan Ping; Qian, Yue-Wei; Lee, Eva Y.-H.P.; Lee, Wen-Hwa (1991). "The retinoblastoma gene product regulates progression through the G1 phase of the cell cycle". Cell. 67 (2): 293–302. doi:10.1016/0092-8674(91)90181-W. ISSN 0092-8674.
  5. Knudson AG (April 1971). "Mutation and cancer: statistical study of retinoblastoma". Proc. Natl. Acad. Sci. U.S.A. 68 (4): 820–3. PMC 389051. PMID 5279523.
  6. Friend SH, Bernards R, Rogelj S, Weinberg RA, Rapaport JM, Albert DM, Dryja TP (1986). "A human DNA segment with properties of the gene that predisposes to retinoblastoma and osteosarcoma". Nature. 323 (6089): 643–6. doi:10.1038/323643a0. PMID 2877398.
  7. Fabian ID, Rosser E, Sagoo MS (2018). "Epidemiological and genetic considerations in retinoblastoma". Community Eye Health. 31 (101): 29–30. PMC 5998388. PMID 29915469.
  8. Clark, Robin D.; Avishay, Stefanie G. (2015). "Retinoblastoma: Genetic Counseling and Testing": 77–88. doi:10.1007/978-3-662-43451-2_8.
  9. Tse, Brian C.; Brennan, Rachel C.; Rodriguez-Galindo, Carlos; Wilson, Matthew W. (2015). "Non-ocular Tumors": 201–208. doi:10.1007/978-3-662-43451-2_19.
  10. Das D, Bhattacharjee K, Barthakur SS, Tahiliani PS, Deka P, Bhattacharjee H, Deka A, Paul R (May 2014). "A new rosette in retinoblastoma". Indian J Ophthalmol. 62 (5): 638–41. doi:10.4103/0301-4738.129786. PMC 4065523. PMID 24881618.
  11. Singh, Arun (2015). Clinical ophthalmic oncology : retinoblastoma. Heidelberg: Springer. ISBN 978-3-662-43451-2.
  12. Kashyap S, Sethi S, Meel R, Pushker N, Sen S, Bajaj MS, Chandra M, Ghose S (February 2012). "A histopathologic analysis of eyes primarily enucleated for advanced intraocular retinoblastoma from a developing country". Arch. Pathol. Lab. Med. 136 (2): 190–3. doi:10.5858/arpa.2010-0759-OA. PMID 22288967.
  13. Chévez-Barrios, Patricia; Eagle, Ralph C.; Marback, Eduardo F. (2015). "Histopathologic Features and Prognostic Factors": 167–183. doi:10.1007/978-3-662-43451-2_16.
  14. Odashiro AN, Pereira PR, de Souza Filho JP, Cruess SR, Burnier MN (April 2005). "Retinoblastoma in an adult: case report and literature review". Can. J. Ophthalmol. 40 (2): 188–91. doi:10.1016/S0008-4182(05)80032-8. PMID 16049534.
  15. Zhang Z, Shi JT, Wang NL, Ma JM (2012). "Retinoblastoma in a young adult mimicking Coats' disease". Int J Ophthalmol. 5 (5): 625–9. doi:10.3980/j.issn.2222-3959.2012.05.16. PMC 3484701. PMID 23166876.
  16. Yousef YA, Istetieh J, Nawaiseh I, Al-Hussaini M, Alrawashdeh K, Jaradat I, Sultan I, Mehyar M (September 2014). "Resistant retinoblastoma in a 23-year-old patient". Oman J Ophthalmol. 7 (3): 138–40. doi:10.4103/0974-620X.142597. PMC 4220401. PMID 25378879.
  17. Takahashi T, Tamura S, Inoue M, Isayama Y, Sashikata T (February 1983). "Retinoblastoma in a 26-year-old adult". Ophthalmology. 90 (2): 179–83. PMID 6856254.