Retinoblastoma or Neuroblastoma: an imaging polemic issues

Abstract

Both retinoblastoma and neuroblastoma are common childhood malignancy, which classified as malignant round cell tumors, but have different diagnostic, therapeutic, prognostic criteria and metastases pattern. A case was evaluated with an imaging examination resembled neuroblastoma metastatic process but was diagnosed as retinoblastoma. A 2-years-old boy came with chief complaint swollen right eye. Prior history was itchy and increasingly swollen right eye, decreased vision and gradually increases pain. There was no sign of leukocoria. Histopathology result confirmed malignant round cell tumor. Axial contrast-enhanced head CT image, depicted right intra orbital mass, 1.9x2x1.8 cm in size as well as mass in the right frontoparietal region which pushed the right frontal lobe, accompanied by erosion and periosteal reaction in the surrounding bone with meningeal and soft tissue involvement. In this case, although there was no leukocoria as the diagnostic criteria for retinoblastoma, we still found intraorbital and pineal body mass also malignancies in several long bones. The diagnosis of trilateral retinoblastoma has been established followed by retinoblastoma’s chemotherapy regiment, which showed good response, in spite of discrepancy in retinoblastoma’s metastases pattern. A complete systemic workup includes CT scan examination needs to be perform in order to help the clinicians determine the diagnosis of orbital mass with malignant round cell histopathology.