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Photo Essay
September 2002

Rapid Growth of Retinoblastoma in a Premature Twin

Arch Ophthalmol. 2002;120(9):1232-1233. doi:10.1001/archopht.120.9.1232

A PEDIATRIC ophthalmologist (C.J.K.) performed biweekly examinations on dizygotic twins born at 26 weeks' gestation to survey for retinopathy of prematurity. There was no family history of retinoblastoma or other eye diseases. Twin A, a male, developed threshold disease and underwent laser treatment. Twin B, a female, had disease that regressed without the need for laser intervention. At 3 months of age, the pediatric ophthalmologist found twin B to have a solid elevation in the macula of 3 to 4 disc diameters in the right eye. This lesion had not been noted on examination 2 weeks earlier. A B-scan by a retina specialist (M.S.R.) detected elevation with a possible calcific component. On referral to a retinoblastoma specialist (D.H.A.), the infant was confirmed to have one retinoblastoma centered directly in the fovea. The horizontal diameter of the lesion was 3.94 mm; the vertical diameter, 3.39 mm; the height, 2.0 mm; and the distance from the edge of the tumor base to the edge of the optic disc, 2.2 mm. The area of the tumor base was 11.1 mm2 and was computer calculated based on digital fundus photography (Figure 1). The infant underwent placement of a radioactive ruthenium plaque 13 days after the examination in the retinoblastoma clinic. On fundoscopic examination under anesthesia in the operating room before placement of the plaque, the tumor was measured again. The horizontal diameter was 5.1 mm; the vertical diameter,4.33 mm; the height, 2.0 mm; and the distance from the edge of the tumor base to the edge of the optic disc, 1.84 mm. The area of the tumor base was now 18.1 mm2 (Figure 2).

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