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East African Medical Journal

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Clinico-surgical histopathological findings of retinoblastoma cases treated at Kenyatta National Hospital

N Gichigo, MM Kariuki-Wanyoike, K Kimani

Abstract


Background: Retinoblastoma is a primitive embryonal anaplastic tumour composed of undifferentiated retinal elements. It is the most common primary, intraocular malignancy of childhood. After enucleation of the diseased eye, histopathological findings determine the secondary management of the patient. Histopathological spread of the disease is a major prognostic factor on survival of the patient.
Objectives: To determine the surgical and histopathological findings of retinoblastoma cases treated at the Kenyatta National Hospital between 1st January 2000 and 31st December 2004 and to correlate gross appearance of globe after enucleation, with histopathological report.
Design: Retrospective study.
Setting: Kenyatta National Hospital, Kenya’s largest referral and teaching hospital.
Subject: One hundred and sixty patients with clinically diagnosed and/or hystologicaly confirmed retinoblastoma.
Results: The mean duration of symptoms was ten and a half five months (SD 10.7) median eight months. White reflex was most common symptom in 53.3% of cases, orbital swelling in 39.4%, pain and redness in 15%, squint in 5% and 21.9% had other complaints. On examination, leucocoria was found in 38.8% of patients, enucleated sockets 37%, recurrent mass in the socket in 27.5%, proptosis 22.5%, orbital swelling in 20% while only 1.3% of patients had strabismus. Tumour was found to be grossly confined to the eye ball in 23.0% of operated eyes, clinically outside the eye ball in 14.3% of eyes while 12.4% of operated eyes had thickened optic nerves. Histologically, tumour was confined to the eye ball in 30% of operated eyes while tumour involved the optic nerve but resection margin free of tumour in 3% of eyes. Tumour had extended beyond the resection margin of the optic nerve in 21% of cases. Eleven point four percent had choroidal extension and 24% were reported as having extrascleral spread. The sensitivity of the surgeon’s finding at surgery, when compared to the histological findings was found to be 69.4% while the specificity was 69.6%. The accuracy was 69.5%. Conclusion: There was still late presentation of retinoblastoma in our set up that had been found in studies conducted previously. This was confirmed by the histological findings. There was inadequate documentation of surgical findings, poor record management and a non-comprehensive referral system.



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