Histopathologic Complications Seen Post-Intra-Arterial Chemo

Wednesday, July 13, 2011 (Last Updated: 07/15/2011)

WEDNESDAY, July 13 (HealthDay News) -- Though retinoblastoma can be controlled by intra-arterial chemotherapy (IAC), histopathology demonstrates that ocular complications, including thromboembolic events, can occur, according to a study published online July 11 in the Archives of Ophthalmology.

Ralph C. Eagle Jr., M.D., from the Wills Eye Institute in Philadelphia, and colleagues described histopathologic findings for eight eyes enucleated after IAC for retinoblastoma. Enucleation was done for tumor viability, neovascular glaucoma, anaphylactic reaction from IAC, and continual retinal detachment with poor tumor visualization. The cases that were judged clinically for complete tumor regression (two eyes) and viable tumor (five eyes) were confirmed after histopathology.

The investigators found that retinoblastoma response varied from minimal (one eye), moderate (one eye), and extensive (four eyes) to complete regression (two eyes). The retinoblastoma showed viable vitreous seeds (four eyes), optic nerve invasion (three eyes), which reached the lamina cribrosa in two eyes, and choroidal invasion (one eye). Ischemic atrophy involving the outer retina and choroid was evident on histopathology of four eyes. Histopathological evidence of massive outer retinal and choroidal atrophy was found in one eye, along with orbital vascular occlusion and subendothelial smooth muscle hyperplasia. Intravascular birefringent foreign materials, such as cellulose fibers, synthetic fabric fibers, or of unknown composition, stimulated a granulomatous inflammatory response within occluded blood vessels of five eyes. Thrombosed blood vessels were detected in five eyes, and involved ciliary arteries in the retrobulbar orbit (all five eyes), and one scleral emissarial canal, one small choroidal vessel, and one central retinal artery.

"Retinoblastoma can be controlled with IAC, but histopathology of enucleated eyes reveals that ocular complications, including thromboembolic events, can occur," the authors write.

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Specialties Ophthalmology
Hematology & Oncology

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