Diagnostic Challenges in Retinoblastoma with Panophthalmitis-Like Manifestation: A Case Report
Abstract
Purpose: To highlight the importance and challenges of diagnostic examination and modalities to diagnose retinoblastoma with varieties of manifestation such as panophthalmitis-like.
Case Report: A 4-year-old boy presented with red and swollen right eye since two days prior to admission. The position of the right eye was hypotrophy with restricted eye movement towards all directions and there was a presence of proptosis with edema, spasm, hyperemia with yellowish crust. Ultrasonography result came with severe anterior-posterior vitreous haziness with calcified mass suggesting an intraocular tumor of the right eye. Orbital CT-scan was performed and suggestive of panophthalmitis with superior palpebra abscess of the right eye. The inflammation was proposed due to prior intraocular surgery of cataract extraction and trabeculectomy that led to progression and worsening of the retinoblastoma, such invasive surgery led to atypical presentation of panopthalmitis-like. Patient initial visit was due to symptoms of leukocoria and squinting, but even though ocular ultrasonography was performed, the patient had failed to be diagnosed with retinoblastoma. Patient had CT scan and was confirmed of an intraocular mass with calcification inside the right eye with some palpebral abscess. MRI was performed to confirm the extension of the mass, which fortunately did not extend outside the eye. The patient then underwent chemo reduction therapy, before finally got enucleation with dermatofat graft surgery. Histologic examination confirmed the diagnosis of retinoblastoma. This case was an example of how sometimes clinical misdiagnosis among retinoblastoma can happen which can be due to inadequate diagnostic examination or atypical presentation. Preventing clinical misdiagnosis of retinoblastoma can improve the treatment and likelihood of survival of patients with retinoblastoma.
Conclusion: Clinical misdiagnosis of retinoblastoma can happen without adequate diagnostic tools and prowess which may result in mismanagement and/or delayed treatment leading to poorer prognosis of patient with retinoblastoma.
Full text article
References
Dimaras H, Corson TW. Retinoblastoma, the visible CNS tumor: A review. J Neurosci Res. 2019 Jan;97(1):29-44.
Sanders TE. Pseudoglioma: a clinico-pathologic study of fifteen cases. Trans Am Ophthalmol Soc 1950;48:575–614.
Ilyas S, Yulianti SR. Ilmu penyakit mata. Badan Penerbit Fakultas Kedokteran Universitas Indonesia. 2017.
Chawla B, Khurana S, Sen S, et al. Clinical misdiagnosis of retinoblastoma in Indian children. Br J Ophthalmol 2013-304321
Shields J. Diagnosis and management of in- traocular tumors. St Louis: Mosby; 1983. pp. 437–533
Stafford WR, Yanoff M, Parnell BL. Retinoblastomas initially misdiagnosed as primary ocular inflammations. Arch Ophthalmol. 1969 Dec;82(6):771–3.
Balmer A, Gailloud C, Munier F, Lendi B, Uffer S. Manifestations inhabituelles du ré-tinoblastome [Unusual presentation of retinoblastoma]. Klin Monatsbl Augenheilkd. 1994 May;204(5):313–5.
Ganesh RN, et al. Panophthalmitis masquerading as retinoblastoma— an eye opener. Comp Clin Pathol (2013) 22:523–527
Stafford WR, Yanoff M, Parnell BL. Retino- blastomas initially misdiagnosed as primary ocular inflammations. Arch Ophthalmol. 1969 Dec;82(6):771–3.
Mullaney PB, Karcioglu ZA, Huaman AM, al-Mesfer S. Retinoblastoma associated orbital cellulitis. Br J Ophthalmol. 1998 May;82(5): 517–21.
Walinjkar J, Krishnakumar S, Gopal L, Ra- mesh A, Khetan V. Retinoblastoma present- ing with orbital cellulitis. J AAPOS. 2013 Jun; 17(3):282–6.
Huang S, Rutar T, Bloomer M, Crawford JB. Analysis of clinical misdiagnoses in children treated with enucleation. Arch Ophthalmol. 2010 Aug;128(8):1009-13.
Howard GM, Ellsworth RM. Differential diagnosis of retinoblastoma: a statistical survey of 500 children. II. Factors relating to the diagnosis of retinoblastoma. Am J Ophthalmol 1965; 60: 618-621
de Leon JM, Walton DS, Latina MA, Mercado GV. Glaucoma in retinoblastoma. Semin Ophthalmol. 2005 Oct-Dec;20(4):217-22.
Moazed K, Albert D, Smith TR. Rubeosis iridis in “pseudogliomas.” Surv Ophthalmol 1980; 25: 85-90
Silva CT, Brockley CR, Crum A, Mandelstam SA: Pediatric ocular sonography. Semin Ultrasound CT MR.2011;32:14– 27.
Aironi VD, Gandage SG. Pictorial essay: B-scan ultrasonography in ocular abnormalities. Indian Journal of Radiology and Imaging. 2009;19(2):109-115
de Graaf P, Göricke S, Rodjan F, Galluzzi P, Maeder P, Castelijns JA, et al. Guidelines for imaging retinoblastoma: imaging principles and MRI standardization. Pediatr Radiol. 2012 Jan;42(1):2–14.
Smirniotopoulos JG, Bargallo N, Mafee MF. Differential Diagnosis of Leukokoria: Radiologic-Pathologic Correlation. Radiographics 1994; 14:1059–79.
McCarthy M, et al. Comfort First: an evaluation of a procedural pain management programme for children with cancer. Psychooncology. 2013; 22:775–782.
Smirniotopoulos JG, Bargallo N, Mafee MF. Differential Diagnosis of Leukokoria: Radiologic-Pathologic Correlation. Radiographics 1994; 14:1059–79.
S. Canturk, I. Qaddoumi, V. Khetan et al., “Survival of retinoblastoma in less-developed countries impact of socioeconomic and health-related indicators,” The British Journal of Ophthalmology, vol. 94, no. 11, pp. 1432–1436, 2010
Shields CL, et al. The International Classification of Retinoblastoma predicts chemoreduction success. Ophthalmology. 2006; 113:2276–2280
Kaliki S, Srinivasan V, Gupta A, Mishra DK, Naik MN. Clinical Features Predictive of High-Risk Retinoblastoma in 403 Asian Indian Patients: A Case-Control Study. Ophthalmology. 2015
Murphree AL. Intraocular retinoblastoma: the case for a new group classification. Ophthalmology clinics of North America. 2005; 18:41–53
Kim JW. Retinoblastoma: evidence for postenucleation adjuvant chemotherapy. International ophthalmology clinics. 2015; 55:77–96.
Zhao J, Dimaras H, Massey C, et al: Pre-enucleation chemotherapy foreyes severely affected by retinoblastoma masks risk of tumor extension andincreases death from metastasis. J Clin Oncol 29:845-851, 2011
Mallipatna AC, Sutherland JE, Gallie BL, Chan H, Heon E. Management and outcome of unilateral retinoblastoma. J AAPOS. 2009; 13:546–550
Orbital Dermis-Fat Graft Transplantation: Results in Primary and Secondary Implantation Turk J Ophthalmol 2015; 45: 65-70
Shields CL, Shields JA. Editorial: chemotherapy for retinoblastoma. Med Pediatr Oncol. 2002;38:377-378.
Shields CL, De Potter P, Himelstein BP, et al. Chemoreduction in the initial management of intraocular retinoblastoma. Arch Ophthal- mol. 1996;114:1330-1338.
Shields CL, Shields JA, De Potter P, et al. The effect of chemoreduction on retinoblastoma-induced retinal detachment. J Pediatr Oph- thalmol Strabismus. 1997;34:165-169.
Authors
Copyright (c) 2025 Rino Nugrahaputra, Julie Dewi Barliana

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.