Retinoblastoma Case 1: Tumor Board Presentation from Brenda Gallie, MD
Photo #1 - Histopathologic slides from Case #2
Subject: Retinoblastoma cases
Date: Sun, 22 Oct 2000 16:45:30 -0400
From: Brenda Gallie
Dear List Members
We have two difficult cases that would be useful to get comments on treatment.
Case 1
Murphree group D1 and D2 retinblastoma presenting 4 years ago. The child was treated with chemotherapy (Vincristine, Carboplatin, etoposide) with cyclosporine for 7 cycles and laser and cryotherapy. after one year, the D2 eye was enucleated. The D1 eye was successfully treated. In april 2000 the child fell on his jaw. Swelling did not decrease and in August 2000 a biopsy revealed a primitive blast cell tumor. The child's germline mutation is known and the tumor showed loss of heterozygosity for the mutation. Bone marrow, bone biopsy, scan and LP are all normal. We are treating the child with the same chemotherapy at higher chemotherapy doses. After one cycle of chemotherapy the jaw mass decreased dramatically. Surgical resection of the jaw with reconstruction is scheduled, instead of the alternate of jaw irradiation. After 6 cycles of chemotherapy, stem cell transplant is planned. Comments on treatment?
Date: Sun, 22 Oct 2000 16:45:30 -0400
From: Brenda Gallie
Dear List Members
We have two difficult cases that would be useful to get comments on treatment.
Case 1
Murphree group D1 and D2 retinblastoma presenting 4 years ago. The child was treated with chemotherapy (Vincristine, Carboplatin, etoposide) with cyclosporine for 7 cycles and laser and cryotherapy. after one year, the D2 eye was enucleated. The D1 eye was successfully treated. In april 2000 the child fell on his jaw. Swelling did not decrease and in August 2000 a biopsy revealed a primitive blast cell tumor. The child's germline mutation is known and the tumor showed loss of heterozygosity for the mutation. Bone marrow, bone biopsy, scan and LP are all normal. We are treating the child with the same chemotherapy at higher chemotherapy doses. After one cycle of chemotherapy the jaw mass decreased dramatically. Surgical resection of the jaw with reconstruction is scheduled, instead of the alternate of jaw irradiation. After 6 cycles of chemotherapy, stem cell transplant is planned. Comments on treatment?
Photo #2 - Histopathologic slides from Case #2
Case 2
Unilateral Murphree group D2 with large seeding from a <1/2 the volume of the eye tumor nasal to the optic nerve. Enucleation revealed gross choroidal invasion with tumor deep into scleral lamelae but no obvious extraocular tumor. The optic nerve is completely clear and there was no evidence of glaucoma. We propose chemotherapy with cyclosporine, and either orbital radiation or orbital carboplatin, with followup bone marrow and orbital imaging. Comments on treatment?
Thanks!
Brenda Gallie, MD
Unilateral Murphree group D2 with large seeding from a <1/2 the volume of the eye tumor nasal to the optic nerve. Enucleation revealed gross choroidal invasion with tumor deep into scleral lamelae but no obvious extraocular tumor. The optic nerve is completely clear and there was no evidence of glaucoma. We propose chemotherapy with cyclosporine, and either orbital radiation or orbital carboplatin, with followup bone marrow and orbital imaging. Comments on treatment?
Thanks!
Brenda Gallie, MD
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