The correct answer is D.
This 5-month-old baby most likely has retinoblastoma due to his young age and clinical findings of leukocoria, poor red reflex, relative afferent pupillary defect, and calcified retinal masses in his eye. In the figure shown above, there are also multiple tumors present in posterior pole OD and an amelanotic large endophytic mass OS.
There are a few known risk factors for systemic metastasis of retinoblastoma such as invasion beyond lamina cribrosa of the optic nerve, >2mm invasion of choroid, orbital extension, and anterior chamber involvement. A review by Finger et al. also mentions bilaterality of the tumor, age of treatment, and age of diagnosis . They found the highest risk factors of metastasis to be invasion of the orbit, optic nerve, and uvea.
- This answer is incorrect because the presence of calcification is a classic feature of retinoblastomas. However, they do not indicate metastatic potential
- The pathology of retinoblastoma shows formation of Flexner-Winterseiner rosettes, which indicate retinal differentiation rather than aggressive behavior or metastasis.
- In the review by Finger et al. shows that patients with tumors in both eyes have a higher risk for metastasis, possibly due to the larger tumor volume and therefore a higher chance to metastasize, or could be due to genetic differences.
Finger, P. T., Harbour, J. W., & Karcioglu, Z. A. (2002). Risk Factors for Metastasis in Retinoblastoma. Survey of Ophthalmology, 47(1), 1–16. doi:10.1016/s0039-6257(01)00279-x
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