Pathologic comparisons of enucleated eyes with retinoblastoma after superselective ophthalmic arterial chemotherapy with or without intravenous chemotherapy

Abstract

Aim: To describe and compare pathologic findings in eyes enucleated after superselective ophthalmic arterial chemotherapy (SOAC) or SOAC with intravenous chemotherapy (IVC) for retinoblastoma.

Methods: Medical records between January 1^st, 2014 and June 30^th, 2017 were retrospectively analyzed, and pathologic findings were recorded. This study included 36 eyes from 22 (61.1%) male and 14 (38.9%) female patients. Nineteen of 36 (52.8%) eyes received SOAC (mean=3, range=1-7) as primary treatment, and 17 of 36 (47.2%) eyes received SOAC (mean=3.7, range=1-10) after IVC (mean=6.1, range=2-11). Tumor extension including choroidal invasion (n=9, 25%), optic nerve invasion (n=5, 13.9%) and anterior segment invasion (n=5, 13.9%) were recorded.

Results: Histopathologic evidence of ischemic damage in the retina and choroid was found in 28 (77.8%) eyes. Thrombosed blood vessels were identified in 9 (25%) eyes, including orbital artery in the retrobulbar orbit (n=1), intrascleral vessels (n=4), and chorioretinal vessels (n=6). Fibrotic changes were found in extraocular muscles (n=5, 13.9%) and optic nerve (n=5, 13.9%). Varying degrees of scleral degeneration were found in all eyes. In statistical analysis, there was no significant difference in clinical and pathologic changes between SOAC group and SOAC with IVC group except for optic nerve invasion (P=0.047).

Conclusion: SOAC for retinoblastoma can result in ocular toxicity, and SOAC with IVC do not increase the toxicity but reduced the incidence of optic nerve invasion.

Keywords: chemotherapy; pathology; retinoblastoma.

Figure 1. Fundus photograph and pathology of enucleated eyes (Hematoxylin and eosin stain)

A: Fundus photograph of a patient after the 3^rd SOAC, severe chorioretinal atrophy involves posterior pole with retinal vascular sheathing and optic nerve is covered by VH; B: Pathology of severe retinal necrosis with pigment dispersion (original magnification×100); C: Atrophic retina with neurepithelium layer loss (original magnification×100); D: Intimal thickening is seen in an orbital artery (original magnification×400); E: Pathology of fibrotic degeneration of extraocular muscle, the cells lose their regular striated pattern (original magnification×100); F: Pathology of intravascular calcification (original magnification×100).