Retinoblastoma differential diagnosis: Difference between revisions

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*Fundus examination reveals the characteristic signs
*Fundus examination reveals the characteristic signs
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{| class="wikitable"
|+Differentiating ocular cysticercosis from other ocular lesions
!Disease
!Prominent clinical feature
!Radiological findings
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|Ocular cysticercosis
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* Diagnosis made usually between 8-16 years (rarely in adulthood)
* Wide range of symptoms from being [[asymptomatic]] to [[Decreased visual acuity|decreased vision]] and [[strabismus]].
* [[Decreased visual acuity]] at initial presentation has a poor prognosis. <ref name="urlHow to Diagnose and Manage Coats’ Disease">{{cite web |url=https://www.reviewofophthalmology.com/article/how-to-diagnose-and-manage-coatsand8217-disease-42782 |title=How to Diagnose and Manage Coats’ Disease |format= |work= |accessdate=}}</ref>
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* [[Fundus (eye)|Fundus examination]] reveals vascular lesions and [[Exudate|exudates]].
* [[Fluorescein angiography]] is the best method to visualize the lesions.
* [[CT]] and [[MRI]] are reserved for atypical cases.<ref name="urlHow to Diagnose and Manage Coats’ Disease">{{cite web |url=https://www.reviewofophthalmology.com/article/how-to-diagnose-and-manage-coatsand8217-disease-42782 |title=How to Diagnose and Manage Coats’ Disease |format= |work= |accessdate=}}</ref>
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|[[Retinal detachment]]
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* Most common presenting symptoms are [[photophobia]] and [[floaters]]
* [[Visual field defect|Visual field defects]] (described as curtain falling from periphery to the center)<ref name="urlManagement of retinal detachment: a guide for non-ophthalmologists">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405853/ |title=Management of retinal detachment: a guide for non-ophthalmologists |format= |work= |accessdate=}}</ref>
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* [[Ophthalmoscope]] is not reliable in detecting retinal detachment as there might be associated [[hemorrhage]]
* [[Ultrasound]] can be used to identify and localize the detachment.<ref name="urlManagement of retinal detachment: a guide for non-ophthalmologists">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2405853/ |title=Management of retinal detachment: a guide for non-ophthalmologists |format= |work= |accessdate=}}</ref>
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|Hyperthyroid Ophthalmopathy
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* The hallmark is [[Exophthalmos|Eye protrusion]], [[photophobia]], [[lacrimation]] and later in the disease, diminished eye motility.<ref name="urlThyroid Ophthalmopathy - EyeWiki">{{cite web |url=http://eyewiki.aao.org/Thyroid_Ophthalmopathy |title=Thyroid Ophthalmopathy - EyeWiki |format= |work= |accessdate=}}</ref>
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* [[Ultrasonography]]: inflamed thickened [[extraocular muscles]].
* [[CT]]: shows [[inflamed]] muscle and free tendon from [[inflammation]]
* [[MRI]]: shows periorbital fat expansion, increased water content of the muscles as a result of the [[inflammation]].<ref name="urlThyroid Ophthalmopathy - EyeWiki">{{cite web |url=http://eyewiki.aao.org/Thyroid_Ophthalmopathy |title=Thyroid Ophthalmopathy - EyeWiki |format= |work= |accessdate=}}</ref>
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|[[Retinoblastoma]]
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* The most prominent sign is [[leukocoria]], followed by [[strabismus]]
* The patient also may present with [[buphthalmos]], [[Cloudy cornea (patient information)|corneal clouding]] and eye tearing.<ref name="urlc.ymcdn.com">{{cite web |url=https://c.ymcdn.com/sites/www.covd.org/resource/resmgr/VDR_1-1/VDR1-1_article_Kollodge_Web.pdf+ |title=c.ymcdn.com |format= |work= |accessdate=}}</ref>
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* [[Ultrasound]]: can detect the [[tumor]] as a result of the [[Calcification|calcifications]] inside.
* [[MRI|MRI:]] assess [[Sella turcica|sellar]] and [[Parasellar and suprasellar disorders|parasellar]] regions .. it can also detect extraocular spread of the [[tumor]].<ref name="urlc.ymcdn.com">{{cite web |url=https://c.ymcdn.com/sites/www.covd.org/resource/resmgr/VDR_1-1/VDR1-1_article_Kollodge_Web.pdf+ |title=c.ymcdn.com |format= |work= |accessdate=}}</ref>
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{| class="wikitable"
![[Image:Coats-disease-of-the-eye.jpg|center|300px|thumb|MRI of the orbit showing Coats disease - Case courtesy of Dr Michael Sargent, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/6089]]
![[Image:Retinal-detachment-1.jpg|center|300px|thumb|MRI of the orbit showing retinal detachment - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/3134]]
![[Image:Retinoblastoma-3.jpg|center|300px|thumb|MRI of the orbit showing retinoblastoma - Case courtesy of https://radiopaedia.org/. From the case https://radiopaedia.org/cases/11877]]
![[Image:Thyroid-orbitopathy-severe-2.jpg|center|300px|thumb|CT head showing hyperthyroid-induced orbitopathy - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/4854]]
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Revision as of 20:50, 22 August 2017

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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]

Overview

Retinoblastoma must be differentiated from other diseases that cause leukocoria such as congenital cataract, persistent fetal vasculature, Coats disease, coloboma of choroid or optic disc, toxocariasis, astrocytic hamartoma, retinopathy of prematurity, vitreous hemorrhage, uveitis, retinal dysplasia, and medulloepithelioma.[1]

Differential diagnosis

Retinoblastoma must be differentiated from other diseases that cause leukocoria. The common causes of leukocoria in children include:[1]

Less common causes of leukocoria include:

Differentiating features of some common and less common differential diagnosis are:

Disease/Condition Differentiating Signs/Symptoms Differentiating Tests
Congenital Cataract
  • Presents at birth
  • Lens opacification rare in retinoblastoma
  • Fundus examination reveals lens opacification
  • Ultrasound shows increased echogenicity of lens
Coats disease (exudative retinitis or retinal telangiectasis)
  • Most cases are unilateral
  • Mean age at presentation is 6 years
  • More common in males
  • Fundus examination: lesion appears more yellow-colored (versus chalky white-gray in retinoblastoma); telangiectatic and aneurysmal retinal vessels are characteristic of Coats disease but uncommon in retinoblastoma
  • Spectral domain optical coherence tomography may be helpful in distinguishing Coats disease from retinoblastoma
  • Ophthalmic ultrasound: can be misleading because calcification can also be seen in Coats disease
Persistent fetal vasculature (formerly known as persistent hyperplastic primary vitreous)
  • Associated with a micro-ophthalmic eye (a small, malformed eye)
  • Often associated with a cataract (rare in retinoblastoma)
  • Congenital (retinoblastoma uncommonly presents at birth)
  • Dragging of the ciliary processes on exam
  • Measurement of axial length using fundus examination and ultrasound shows short axial length in persistent fetal vasculature
Retinopathy of prematurity (ROP)
  • Generally occurs in premature children given high-dose oxygen
  • Can result in total retinal detachment
  • Fundus examination: reveals gliotic-appearing retina, which is different from the retinal detachment associated with retinoblastoma
Ocular toxocariasis
  • Generally causes vitreoretinal traction and ocular inflammation not seen in retinoblastoma
  • Fundus examination reveals the characteristic signs
Differentiating ocular cysticercosis from other ocular lesions
Disease Prominent clinical feature Radiological findings
Ocular cysticercosis
Retinal detachment
Hyperthyroid Ophthalmopathy
Retinoblastoma
MRI of the orbit showing Coats disease - Case courtesy of Dr Michael Sargent, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/6089
MRI of the orbit showing retinal detachment - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/3134
MRI of the orbit showing retinoblastoma - Case courtesy of https://radiopaedia.org/. From the case https://radiopaedia.org/cases/11877
CT head showing hyperthyroid-induced orbitopathy - Case courtesy of A.Prof Frank Gaillard, https://radiopaedia.org/. From the case https://radiopaedia.org/cases/4854

References

  1. ↑ 1.0 1.1 Retinoblastoma. Wikipedia(2015) https://en.wikipedia.org/wiki/Retinoblastoma#cite_note-30 Accessed on October 2, 2015
  2. ↑ 2.0 2.1 "How to Diagnose and Manage Coats' Disease".
  3. ↑ 3.0 3.1 "Management of retinal detachment: a guide for non-ophthalmologists".
  4. ↑ 4.0 4.1 "Thyroid Ophthalmopathy - EyeWiki".
  5. ↑ 5.0 5.1 "c.ymcdn.com".
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