title: Clinical spectrum of diffuse infiltrating retinoblastoma in 34 consecutive eyes.
abstract: OBJECTIVE
  To evaluate the clinical features and management of diffuse infiltrating retinoblastoma.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Thirty-four eyes in 32 patients.
  
  
  METHODS
  The patients' records were reviewed for patient and tumor features, ocular management, histopathologic findings, and patient survival.
  
  
  METHODS
  Clinical features, tumor management, and patient survival.
  
  
  RESULTS
  Of 1507 patients with retinoblastoma, only 32 (2%) were classified with diffuse infiltrating retinoblastoma. The mean age at diagnosis was 4 years (range 1.5-16 years). The referring diagnoses included retinoblastoma (26 eyes, 76%), uveitis (3, 9%), Coats disease (1, 3%), trauma (1, 3%), and unspecified retinal problem (3, 9%). The anterior segment displayed tumor seeds on the corneal endothelium (8, 24%), cornea stromal edema (3, 9%), pseudohypopyon (11, 32%), hyphema (3, 9%), iris neovascularization (17, 50%), and iris tumor nodules (6, 18%). The posterior segment revealed extensive ill-defined retinoblastoma infiltrating the retina for a mean basal diameter of 20 mm and overall flat growth, sometimes with undulating retinal thickening. Overlying extensive vitreous tumor seeds (31, 91%) and vitreous hemorrhage (8, 24%) were noted. Calcification was present on ultrasonography (27/34, 79%) and computed tomography (8/9, 89%). Enucleation was performed for all 34 eyes, and there were no cases of metastases at 47 months follow-up.
  
  
  CONCLUSIONS
  Diffuse infiltrating retinoblastoma can masquerade as uveitis or unexplained hyphema or keratic precipitates. Suspicion for retinoblastoma is important.
  
  
  BACKGROUND
  The authors have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. carol.shields@shieldsoncology.com
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Fariba
authors.initials: F
authors.lastname: Ghassemi
authors.forename: Samuray
authors.initials: S
authors.lastname: Tuncer
authors.forename: Archana
authors.initials: A
authors.lastname: Thangappan
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009366:Neoplasm Seeding; D019572:Retinal Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D012175:Retinoblastoma / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D014792:Visual Acuity / Q000502:physiology