An 18-month-old child with unilateral retinoblastoma undergoes enucleation. Histopathology shows invasion of the optic nerve up to but not reaching the surgical cut end and no choroidal invasion. According to the International Classification for Intraocular Retinoblastoma, this is classified as:
- A Group E ✓
- B Group A
- C Group C
- D Group D
Explanation
The International Classification of Retinoblastoma (ICRB, Murphree/Children's Oncology Group) groups eyes from A (small tumors far from fovea/disc) to E (extensive tumors with catastrophic features). Group E includes eyes with neovascular glaucoma, opaque media from hemorrhage/tumor, orbital cellulitis-like presentation, or anterior segment involvement—these are typically enucleated. The finding of optic nerve invasion to (but not beyond) the cut end of the optic nerve and choroidal involvement are important histopathological risk factors for metastasis requiring adjuvant systemic chemotherapy. Pre-laminar optic nerve invasion alone without cut-end involvement carries a lower systemic risk.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.