00:01
How do we pick it up?
Classically, actually,
parents are taking pictures
of little Susie or little Sammy.
00:10
And they notice that when they
do the flash photography,
one eye looks red,
that's the normal red reflex,
you're looking at the retina,
it's very vascularized.
00:19
And the other pupil
doesn't look red,
it looks white.
00:22
And they look at the picture
to go, "That's weird."
They take the child in
to the doctor,
and there is leukocoria.
00:30
There is
whiteness of the pupil,
because we're seeing a tumor
lurking behind,
and it's obscuring the retina.
00:37
So you don't get that
red reflex.
00:39
So leukocoria,
that's what's indicated here,
in the green square
through the pupil
is one of the major ways
that we pick this up
because it's usually
not very painful.
00:50
It's usually doesn't have
much other symptoms.
00:51
And usually,
it's affecting a little kid
before they're two years old,
and they can't tell you,
"Gee, I'm seeing
something in my eye."
They may have because of the
growth of the tumor strabismus.
01:02
So they may have deviation
of the axis of the eye.
01:05
They may have
decreased vision
but again,
it's hard to see in a child
before they're able to tell you
what they can and cannot see.
01:13
There may or may not be ocular
inflammation as the tumor grows,
it may obstruct
normal fluid drainage,
or may incite as tumor necrosis,
focal inflammation.
01:23
You can have
vitreous hemorrhage.
01:25
The tumor may have focal necrosis
and bleed into the vitreous.
01:29
And because of tumor expansion,
you may develop anisocoria.
01:33
So, if you compress
some of the cranial nerves,
oculomotor nerve III,
you may have a dissymmetry
in the size of the pupil,
so anisocoria.
01:44
What does it look like?
So if we actually look
what is that leukocoria,
we see this vascularized tumor, blob
of white tan tissue
that sitting there obscuring a lot
of the back of the retina.
02:00
Pathologically summit.
It's just a really beautiful thing.
02:03
I have to say that the histology
of these tumors is quite lovely.
02:08
Of course, lovely to a pathologist
is very different
than lovely to
the rest of the world.
02:12
But in any event,
retinoblastoma has very
characteristic organization,
the cells of this tumor are
nerve neural crest derived.
02:21
They are neurons
that have differentiated.
02:24
And they frequently will
join in form little rosettes.
02:30
So what is shown is an example
of a Homer-Wright rosette.
02:34
I don't know who Homer was,
I don't know who Wright was,
but they got to name
this accumulation of the cells
that is part of the diagnosis
of retinoblastoma.
02:42
So we see these
small blue round nuclei,
frequently around a
central zero zone of neuropil,
the pink in the middle
is neuropil.
02:51
You can also get
a different kind of rosette,
which tends to have
a more central area of clearing
and these are the
Flexner-Wintersteiner rosette.
03:01
Again, small round blue cells,
all organized into little rings.
03:07
And these are part of the classic
diagnosis for retinoblastoma.
03:12
So when you become an
ophthalmologic pathologist,
you will love these two
and add pictures on your wall.
03:17
With that we'll close
on tumors of the eye.