Misdiagnosis in Retinoblastoma Presenting with Leukocoria

1. Diah Ekawati
2. Lumongga Simangunsong

1. Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Purpose: To report a case of misdiagnosis of retinoblastoma presenting with leukocoria which has complete diagnosis workup.

Method: Case report. Slit lamp, funduscopy and ultrasound examination was performed before the surgeon decided to perform enucleation
Result : Patient was a 1 year and 9 months old baby boy presented with a sudden whitish reflex in the black part of his left eye and looked like cat's eye. Patient's birth and developmental history was in normal limit. The IOP of his left eye was decreased by palpation, anterior chamber was deep, pupil was white. Funduscopy examination revealed total retinal detachment. The ultrasound B scan examination at the first visit revealed echo spike on vitreous anterior, media and posterior, and total retinal detachment. At the second visit, ultrasound B scan examination revealed suspicious of mass at superonasal site. The third ultrasound B scan examination performed very high amplitudes echoes in vitreous. The surgeon assessed this patient as retinoblastoma of the left eye and decided to perform enucleation with dermato fat graft. A week after enucleation, result from pathological anatomic examination was coats disease.

Conclusion : Retinoblastoma and coats' disease is hard to be distinguished in this patient. There are no presentation of subretinal masses with secondary calcifications are more common in retinoblastoma. The frequency of clinical misdiagnosis of retinoblastoma is high, at point average 16,3% so that it must be considered in every case of leukokoria.