Gray-white tumor nodules formed on the surface of the iris

Introduction Slit lamp examination, there are tumor cell colonies in the anterior chamber, the formation of pseudo anterior chamber empyema, post-corneal deposition, the formation of gray-white tumor nodules on the iris surface, can provide some clinical basis for the first-stage diagnosis of retinoblastoma. It can be seen in a circular or elliptical shape with clear boundaries, single or multiple hairs, white or yellow nodular bulges, uneven surface, different sizes, and new blood vessels or bleeding points. Tumors originate from the inner nuclear layer, and are called endogenous to the vitreous body. White lumps of turbidity can be seen in the vitreous. Those originating from the outer nuclear layer are prone to choroidal growth and are often exogenous. A solid flat detachment without cracking occurs.

Cause

Occurred in the nuclear layer of the retina, with a family genetic predisposition, mostly occurring under the age of 5, can be single or both eyes or at the same time, the disease is prone to intracranial and distant metastasis, often endangering the lives of children.

an examination

Related inspection

Fundus examination

It can be seen in a circular or elliptical shape with clear boundaries, single or multiple hairs, white or yellow nodular bulges, uneven surface, different sizes, and new blood vessels or bleeding points. Tumors originate from the inner nuclear layer, and are called endogenous to the vitreous body. White lumps of turbidity can be seen in the vitreous. Those originating from the outer nuclear layer are prone to choroidal growth and are often exogenous. A solid flat detachment without cracking occurs. According to medical history, age and clinical symptoms. X-ray film, B-ultrasound examination, and CT examination are helpful for diagnosis.

Determination of the activity of lactate dehydrogenase (LDH): When the LDH value in aqueous humor is higher than the serum median value, the ratio of the two is greater than 1.5, which strongly suggests that retinoblastoma may be.

Other: It can be used for isotope scanning, scleral transillumination, carcinoembryonic antigen and so on.

Differential diagnosis

Rb is generally easy to diagnose after progression to the third and fourth phases, but it is more difficult in the first and second phases. During this period, white reflective or yellow-white tissue blocks may appear in the posterior pupil of the lens called leukoria. In fact, there are many cases of white pupil. In the differential diagnosis, it should be noted that: abnormal development of the retina; fibrous hyperplasia after the lens; metastatic endophthalmitis; exudative retinitis (Coats disease): occurred in 7-8 years old The above male adolescents are mostly monocular and the progress of the disease is slow. Eye examination, the vitreous is rarely turbid, the retina is white exudative detachment, extensive telangiectasia and bleeding points and cholesterol crystals. Rb occurs mostly in infants under 5 years of age, vitreous opacity is more common, retinal detachment is solid, vascular engorgement and new blood vessels are mostly limited to the tumor area. In addition, X-ray photographs, CT and ultrasound diagnosis are significantly different, except for Coats disease.

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