Incidental detection of retinoblastoma from accidental trauma in children

BACKGROUND: To report a case series of patients who were diagnosed with retinoblastoma (RB), which was preceded by trauma, in a large multicenter cohort and to investigate the incidence, clinical characteristics, and causes of RB misdiagnosis. METHODS: The medical records of consecutive patients with RB between 2006 and 2015 were retrospectively reviewed. Characteristics of trauma patients, including their age at initial trauma, site of trauma, sex, and RB laterality, were analyzed. RESULTS: Among 3780 patients, 30 (0.8%) experienced systemic or ocular trauma prior to the detection of RB. The median age was 20.7 months, and the median follow-up time was 6 years. There were 2 eyes in stage A, 2 in stage B, 3 in stage C, 12 in stage D, and 15 in stage E. The remaining 2 eyes had extraocular RB. A total of 20 patients experienced ocular trauma, 9 patients experienced head trauma, and 1 patient experienced trauma in other body parts. RB was suspected or detected in 22 patients (73.3%) at the time of primary trauma occurrence, and 8 patients (26.7%) were misdiagnosed with RB during their first visit. Among them, all experienced blunt ocular trauma, and enucleation was performed in 7 patients in which 1 patient died. CONCLUSIONS: Less than 1% of the patients experienced systemic or ocular trauma before RB was detected. The majority were unilateral and in advanced stages. Differential diagnoses that are not trauma-related must always be considered, and comprehensive examinations must be conducted before diagnostic and therapeutic intraocular procedures are initiated.