Malignant childhood proptosis: study of 104 cases
Sameer Bakhshi1, Preetpaul Singh, Nikhil Chawla
1Department of Medical Oncology, Dr B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India. sambakh@hotmail.com
Insights
Pediatric malignant proptosis is often caused by secondary tumors like retinoblastoma. Bilateral proptosis and specific blood count changes may indicate metastatic disease, suggesting hematologic work-up before invasive procedures.
Area of Science:
- Ophthalmology
- Pediatric Oncology
- Hematology
Background:
- Malignant proptosis in children is a serious condition requiring prompt diagnosis.
- Understanding the common causes and associated clinical features is crucial for effective management.
Purpose of the Study:
- To analyze the incidence and causes of malignant proptosis in pediatric cancer patients.
- To identify clinical and hematological factors associated with proptosis, particularly bilateral cases.
Main Methods:
- Retrospective analysis of children (<=18 years) with malignant proptosis.
- Data collected from July 2003 to December 2006 at a tertiary cancer center's ophthalmic tumor clinic.
Main Results:
- Proptosis incidence was 4.9% among pediatric cancer patients.
- Secondary tumors were the most common cause (59.6%), with retinoblastoma being the leading diagnosis (51%).
- Bilateral proptosis (13.5%) was predominantly linked to metastatic tumors and associated with altered hemogram parameters (lower hemoglobin/platelets, higher WBC).
Conclusions:
- Retinoblastoma and other secondary tumors are primary causes of malignant proptosis in children.
- Bilateral proptosis and specific hemogram findings warrant a hematologic work-up to rule out metastatic disease prior to imaging or biopsy.
Abstract:
Children < or =18 years with malignant proptosis enrolled in ophthalmic tumor clinic at a tertiary cancer center from July 2003 to December 2006 were retrospectively analyzed. The incidence of proptosis among the pediatric cancer patients was 4.9%. Secondary tumors accounted for majority of cases (n=62, 59.6%) with retinoblastoma (51%) being the commonest cause of proptosis. Fourteen (13.5%) patients presented with bilateral proptosis; all but one had metastatic tumor as underlying cause. Metastatic malignancies had significantly lower hemoglobin and platelet count and higher white blood count. Therefore, careful analysis of symptomatology, hemogram, and those with bilateral proptosis warrant a hematologic work-up before imaging studies and invasive orbital biopsy.
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