Ultrastructural changes of mitochondria in human retinoblastoma: correlation with tumor differentiation and invasiveness.

Retinoblastoma still represents a challenge for pediatric tumors. Mitochondria have been implicated in tumor progression, cell differentiation, and apoptotic pathways. Electron microscopy allows the study of mitochondrial morphology and it is still debated in human retinoblastoma. Demographic, clinical, and histopathological parameters were recorded in 17 enucleated retinoblastoma specimens. Hematoxylin and eosin staining was performed to study tumor characteristics and the extent of invasion in ocular structures. The aim of this study was to describe and analyze the mitochondrial morphology in human retinoblastoma by transmission electron microscopy (TEM). There was a male preponderance in our study. Ages ranged from 2 to 78 months. Histopathological analysis revealed that 15 (88.2 %) tumors were poorly differentiated retinoblastomas. Massive choroidal invasion was the most frequent histopathological high-risk factor among the others. Histopathological high-risk factors were found in 7/17 (41.1 %) cases. Tumor samples of all patients were examined by means of TEM. All cases showed tumor cells with high nucleocytoplasmic ratio. Poorly differentiated retinoblastoma cases showed fewer mitochondria, scant cytoplasm, disorganized organelles (mitochondria), and necrosis, whereas well-differentiated retinoblastomas had larger number of mitochondria and more organized organelles. However, there was no significant difference in mitochondrial changes between invasive and noninvasive tumors. Our study observed that cristolysis and swollen mitochondria were more frequent in retinoblastoma tumors. Understanding the structural and functional characteristics of mitochondria in retinoblastoma might be essential for the design of future therapeutic strategies. The authors have no proprietary or commercial interest in any materials discussed in this article.

Assessment of early-stage optic nerve invasion in retinoblastoma using high-resolution 1.5 Tesla MRI with surface coils: a multicentre, prospective accuracy study with histopathological correlation.

OBJECTIVES: To assess the accuracy of high-resolution (HR) magnetic resonance imaging (MRI) in diagnosing early-stage optic nerve (ON) invasion in a retinoblastoma cohort. METHODS: This IRB-approved, prospective multicenter study included 95 patients (55 boys, 40 girls; mean age, 29 months). 1.5-T MRI was performed using surface coils before enucleation, including spin-echo unenhanced and contrast-enhanced (CE) T1-weighted sequences (slice thickness, 2 mm; pixel size <0.3 × 0.3 mm(2)). Images were read by five neuroradiologists blinded to histopathologic findings. ROC curves were constructed with AUC assessment using a bootstrap method. RESULTS: Histopathology identified 41 eyes without ON invasion and 25 with prelaminar, 18 with intralaminar and 12 with postlaminar invasion. All but one were postoperatively classified as stage I by the International Retinoblastoma Staging System. The accuracy of CE-T1 sequences in identifying ON invasion was limited (AUC = 0.64; 95 % CI, 0.55 - 0.72) and not confirmed for postlaminar invasion diagnosis (AUC = 0.64; 95 % CI, 0.47 - 0.82); high specificities (range, 0.64 - 1) and negative predictive values (range, 0.81 - 0.97) were confirmed. CONCLUSION: HR-MRI with surface coils is recommended to appropriately select retinoblastoma patients eligible for primary enucleation without the risk of IRSS stage II but cannot substitute for pathology in differentiating the first degrees of ON invasion. KEY POINTS: • HR-MRI excludes advanced optic nerve invasion with high negative predictive value. • HR-MRI accurately selects patients eligible for primary enucleation. • Diagnosis of early stages of optic nerve invasion still relies on pathology. • Several physiological MR patterns may mimic optic nerve invasion.

Orbital retinoblastoma in an adult.

PURPOSE: Retinoblastoma is usually seen in children before 5 years of age. We report an unusual case of retinoblastoma in an adult who presented to us with an orbital mass. METHODS: A 24 year-old-male presented to our centre with a history of protrusion of the right eye for 6 months, and associated loss of vision. Ultrasonography B-scan revealed an intraocular mass with calcification and MRI of the orbits showed extra-ocular spread. An incisional biopsy was taken from the orbital mass. RESULTS: On biopsy, histopathologic features and immunohistochemical stains were consistent with retinoblastoma. CONCLUSION: To our knowledge, this is the first report of retinoblastoma presenting as an orbital mass in adulthood and highlights the importance of considering this tumour in the differential diagnosis of an intraocular mass with orbital extension in an adult patient.

Effects of matrine on proliferation and apoptosis of cultured retinoblastoma cells.

BACKGROUND: Extracted from the traditional Chinese medicine of Kushen, matrine is an alkaloid with potential anti-neoplastic and anti-inflammatory effects. Here, we examined the effect of matrine on proliferation and apoptosis of cultured retinoblastoma cells. METHODS: The retinoblastoma cell lines Y79, WERI-RB1 and SO-RB50 were treated with matrine in increasing concentrations from 0.2-1.1 mg/ml for 24 hours, and the cell proliferation rate was measured. The cells were exposed to matrine at 50% inhibition concentration (IC50) for 12, 24 and 48 hours. Cell cycle was analyzed by flow cytometry, concentration of proteins regulating cell cycle and apoptosis was determined by Western blot, apoptosis rate was measured by TUNEL staining, and cell morphology was assessed by electron transmission microscopy. RESULTS: The retinoblastoma cell lines Y79, WERI-RB1 and SO-RB50 showed an increased inhibition of cell proliferation with increasing matrine concentrations. Applying the IC50 concentration of matrine, the alteration of the cell cycle, including a reduced percentage of the S phase, was significantly (P < 0.01) associated with a longer treatment time by matrine. Correspondingly, the cell-cycle-associated proteins P21 and P27 were up-regulated and the protein cyclinD1 was down-regulated. The apoptosis-associated protein Bcl-2 was down-regulated, and Bax was up-regulated. In a similar manner, the apoptosis rate was significantly increased with longer treatment time. CONCLUSIONS: Matrine added to cultures of immortalized retinoblastoma cells led to a reduced tumor cell proliferation, decreased rate of mitosis and an increased tumor cell apoptosis, paralleled by corresponding changes in the proteins regulating the cell cycle or apoptosis.

Sonoporation enhances chemotherapeutic efficacy in retinoblastoma cells in vitro.

PURPOSE: To study the ability of ultrasound (US) and microbubbles (MB) to enhance chemotherapeutic efficacy against retinoblastoma Y79 cells in vitro. METHODS: The experiment was performed in three stages. The authors first compared cell viability of Y79 cells exposed to doxorubicin versus cells exposed to doxorubicin combined with low-intensity, low-frequency US + MB. They then evaluated enhanced cell permeability by studying the intensity of intracellular fluorescence in cells exposed to doxorubicin versus those exposed to doxorubicin with US + MB. Lastly they evaluated the morphologic characteristics of the cells by scanning electron microscopy (SEM) to identify the presence of pores. RESULTS: The Y79 cells exposed to doxorubicin with US + MB showed a significant decrease in cell viability at 72 hours compared with those exposed to doxorubicin alone (P = 0.02). Cells also showed immediate increased permeability to doxorubicin with the addition of US + MB compared with doxorubicin alone, which continued to increase over 60 minutes. SEM did not demonstrate physical pores at the lowest US + MB intensity shown to enhance intracellular doxorubicin fluorescence. CONCLUSIONS: US + MB facilitates the uptake of chemotherapy in retinoblastoma Y79 cells in vitro. This occurs in the absence of visible pores, suggesting a possible secondary mechanism for increased drug delivery. This experiment is the first step toward enhancing chemotherapy with sonoporation in the treatment of intraocular tumors. This technique may lead to more effective chemotherapy treatments with less collateral damage to ocular tissues and may allow reduced systemic dosage and systemic side effects.

Treating retinoblastoma in tissue culture and in a rat model with a novel isoquinoline derivative.

PURPOSE. To investigate the effectiveness of a novel isoquinoline derivative, EDL-155, in killing retinoblastoma in vitro and in vivo. METHODS. Dose-response curves were generated in which Y79 retinoblastoma cells tagged with luciferase (Y79-Luc) were treated with serial concentrations of EDL-155. Electron microscopy was used to evaluate the ultrastructural morphology of EDL-155-treated Y79 cells. To determine whether autophagy was induced in EDL-155-treated Y79-Luc cells, staining with acridine orange and LC-3 immunoblot analysis was performed. To evaluate the efficacy of EDL-155 in vivo, Y79-Luc retinoblastoma cells were injected into the vitreous cavity of newborn rats, followed by periocular injections of EDL-155 (20 mg/kg/day) or an equivalent dosage of saline. RESULTS. EDL-155 appeared to destroy the retinoblastoma cells in vitro with an EC(50) of 9.1 micriM. EDL-155-treated retinoblastoma cells displayed a lack of viable mitochondria and the presence of autophagosomes wrapped in the characteristic double membranes. Acridine orange staining of EDL-155-treated retinoblastoma cells demonstrated the accumulation of vacuoles, and the immunoblots displayed a shift in molecular weight of LC-3, indicative of incorporation into autophagosome vesicles. In the retinoblastoma animal model, four doses of EDL-155 were delivered over 4 days, which was sufficient to see a significant decrease (P = 0.01) in viable intraocular tumors. Seven of the 25 rats treated with EDL-155 had no detectable living tumor. No significant decrease in viable tumor was observed in control animals. CONCLUSIONS. EDL-155 appears to eliminate retinoblastoma cells by disrupting mitochondria and inducing autophagy. Local delivery of EDL-155 may be an effective therapy for some types of ocular cancers.

Neuronal differentiation and synaptogenesis in retinoblastoma.

Retinoblastomas initiate in the developing retina in utero and are diagnosed during the first few years of life. We have recently generated a series of knockout mouse models of retinoblastoma that recapitulate the timing, location, and progression of human retinoblastoma. One of the most important benefits of these preclinical models is that we can study the earliest stages of tumor initiation and expansion. This is not possible in human retinoblastoma because tumors initiate in utero and are not diagnosed until they are at an advanced stage. We found that mouse retinoblastoma cells exhibit a surprising degree of differentiation, which has not been previously reported for any neural tumor. Early-stage mouse retinoblastoma cells express proteins found normally in retinal plexiform layers. They also extend neurites and form synapses. All of these features, which were characterized by immunostaining, Golgi-Cox staining, scanning electron microscopy, and transmission electron microscopy, suggest that mouse retinoblastoma cells resemble amacrine/horizontal cells from the retina. As late-stage retinoblastoma cells expand and invade the surrounding tissue, they lose their differentiated morphology and become indistinguishable from human retinoblastomas. Taken together, our data suggest that neuronal differentiation is a hallmark of early-stage retinoblastoma and is lost as cells become more aggressive and invasive. We also show that rosette formation is not a hallmark of retinoblastoma differentiation, as previously believed. Instead, rosette formation reflects extensive cell-cell contacts between retinoblastoma cells in both early-stage (differentiated) and late-stage (dedifferentiated) tumors.

Novel cell death pathways induced by N-(4-hydroxyphenyl)retinamide: therapeutic implications.

We previously reported that N-(4-hydroxyphenyl)retinamide (4HPR) inhibits retinoblastoma tumor growth in a murine model in vivo and kills Y79 retinoblastoma cells in vitro. In this work, we assayed different cell death-related parameters, including mitochondrial damage and caspase activation, in Y79 cells exposed to 4HPR. 4HPR induced cytochrome c release from mitochondria, caspase-3 activation, and oligonucleosomal DNA fragmentation. However, pharmacologic inactivation of caspases by the pan-caspase inhibitor BOC-D-fmk, or specific caspase-3 inhibition by Z-DEVD-fmk, was not sufficient to prevent cell death, as assessed by loss of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide reduction, lactate dehydrogenase release, disruption of mitochondrial transmembrane potential (Deltapsi(m)), and ATP depletion. We found that 4HPR causes lysosomal membrane permeabilization and cytosolic relocation of cathepsin D. Pepstatin A partially rescued cell viability and reduced DNA fragmentation and cytosolic cytochrome c. The antioxidant N-acetylcysteine attenuated cathepsin D relocation into the cytosol, suggesting that lysosomal destabilization is dependent on elevation of reactive oxygen species and precedes mitochondrial dysfunction. Activation of AKT, which regulates energy level in the cell, by the retinal survival facto]r insulin-like growth factor I was impaired and insulin-like growth factor I was ineffective against ATP and Deltapsi(m) loss in the presence of 4HPR. Lysosomal destabilization, associated with mitochondrial dysfunction, was induced by 4HPR also in other cancer cell lines, including PC3 prostate adenocarcinoma and the vascular tumor Kaposi sarcoma KS-Imm cells. The novel finding of a lysosome-mediated cell death pathway activated by 4HPR could have implications at clinical level for the development of combination chemoprevention and therapy of cancer.

Destruction of human retinoblastoma after treatment by the E variant of encephalomyocarditis virus.

The oncolytic effects of encephalomyocarditis (EMC) virus were examined in human retinoblastoma cell (Y79) cultures which were infected with 10(4 )tissue culture infectious doses (TCIDs) of the E variant of EMC (EMC-E) virus. The TCIDs were used to titer the maximum effect of EMC virus on L-929 cells. In-vitro studies showed 90% cytopathic effect (CPE) at 24 h and 100% CPE at 52 h. The CPE was used to observe pathologic effects of the cells. In-vivo studies employing human retinoblastoma grown as a tumor in nude mice, revealed degeneration of 80% of the tumor cells at 3 days and total destruction at 4 days following inoculation with the EMC-E virus. The virus is highly neurotropic in mice, but is usually not pathogenic in man. These studies suggest a possible new direction in the treatment of retinoblastoma and other malignant tumors using the viral technology.

Cell death in retinoblastoma: electron microscopic, immunohistochemical, and DNA fragmentation studies.

Apparent cell loss by apoptosis occurs in carcinomatous tissue. To investigate cell death in retinoblastoma (Rb), ultrastructural examination, ApopTag staining, electrophoresis to detect apoptotic DNA fragmentation, and flow cytometric studies were performed. Immunostaining for the oncogenic products bcl-2 and p53 was also carried out. Relationships between the proliferation fraction (PF), apoptotic index (AI), and the distribution of bcl-2 and p53 were investigated according to the degree of histologic differentiation of Rb. Ultrastructurally, two patterns of cell death were seen. Necrotic cells exhibited vacuolation of cytoplasmic organelles with a marked lytic change in the karyoplasm and cytoplasm. In contrast, apoptotic cells were characterized by crescentic margination of chromatin, condensation of karyoplasm and cytoplasm, and fragmentation of the nucleus. Differentiated Rb had a low AI value (< 1%), whereas undifferentiated Rb had a high AI value (> 8%). The PF of undifferentiated RB (31%) was significantly higher than that of differentiated RB (14%). Analysis of DNA fragmentation using 3'-end labeling with terminal transferase indicated that undifferentiated Rb has increased DNA cleavage. The distribution of apoptotic bodies within Rb was inversely correlated with the expression of bcl-2. A majority of tumor cells of differentiated Rb were negative for p53, whereas 20-40% of tumor cells of undifferentiated Rb showed a positive reaction for p53. These findings suggest that the degree of susceptibility to apoptosis is closely related to PF, is inversely related to the degree of differentiation of Rb, and is protected by oncogene bcl-2.

Establishment and characterization of a second primary osteosarcoma cell line (OSrb/N-M) from a patient cured of bilateral retinoblastoma.

A cell line, designated OSrb/N-M, was established from the second primary osteosarcoma that developed in a 17-year-old Japanese female patient who had suffered from bilateral retinoblastoma at infancy. The OSrb/N-M cells grew as an adherent monolayer and retained some osteogenic biochemical phenotypes. In cytogenetic analyses, this cell line revealed many structural and numerical abnormalities, however, the bands q14 of both chromosomes 13 appeared to be normal, whereas the constitutional cells displayed normal female karyotypes. Immunoblot studies using monoclonal antibodies specific to RB protein demonstrated that the tumor cells did not express RB protein, suggesting that the OSrb/N-M cells might suffer from a loss-of-function mutation at this gene locus. Thus, this cell line is useful to study the molecular mechanism for the tumorigenesis of osteosarcoma with regard to an association with retinoblastoma.

Diffuse anterior retinoblastoma.

PURPOSE: The authors describe the clinicopathologic features of an anterior variant of diffuse retinoblastoma. METHODS: The clinical history of a child with an anterior chamber infiltrate and cells in the anterior vitreous was reviewed. An anterior chamber aspirate was processed by a Millipore filter technique. The eye was enucleated and routinely processed for light and transmission electron microscopic examination. RESULTS: An 8-year-old girl was treated for anterior uveitis in her right eye that failed to resolve. Examination of an anterior chamber aspirate showed cells suggestive of retinoblastoma. The eye was enucleated, and the enucleation specimen showed retinoblastoma confined to the iris, ciliary body, and anterior vitreous with one microscopic focus of tumor in the peripheral retina. CONCLUSION: This variant of diffuse retinoblastoma involved only anterior ocular structures with minimal involvement of the retina.

Microscopic and ultrastructural aspects in retinoblastoma.

A number of 12 retinoblastoma cases were studied. We had in view a number of histopathological aspects (tumor type, neighbouring structures invasion) which are considered to be decisive in appreciating the vital prognosis. We mention that undifferential retinoblastoma of histopathological type was met in 8 cases and the neighbouring structures invasion was present in 7 of them. We also studied the ultrastructura of the tumor cells belonging to the malignant tumor.

Human retinoblastoma: a morphological study of apoptotic, leukocytic, and vascular elements.

Retinoblastoma (Rb), derived from retinal neuroepithelial progenitor cells, is the most common intraocular malignancy of childhood. This study examined 10 human Rb biopsy specimens with light and electron microscopy for histopathological features not previously described in detail, including cell death, leukocytic infiltration, and the tumor vasculature. Rb is a solid well-vascularized tumor with regions of viable tumor cells surrounding vessels, interspersed with zones of necrosis; apoptotic cells were seen in all specimens. Mononuclear phagocyte series (MPS) cells and lymphocytes often colocalized, adjacent to tumor vessels, and MPS cells frequently invested the perivascular space. Lymphocytes were rarely seen within areas of viable tumor. Tumor vessels at early stages of formation resembled normal developing retinal vessels. While junctions were often seen between endothelial calls, disruption of these junctions and endothelial fenestrae was sometimes evident. Müller cells and astrocytes extended processes around tumor cells and blood vessels, and contributed to the formation of the vascular glia limitans, which in some mature vessels was disrupted and discontinuous. Overall, this study provides further morphological details of cell death within Rb, particularly apoptotic involution, and describes the presence of a vascular-associated leukocytic infiltration in Rb. Evidence of compromise of the normal blood-retinal barrier (BRB) within the Rb tumor vessels is presented.

Malignancy after retinoblastoma: secondary cancer or recurrence?

The risk of second malignancy after retinoblastoma is reported to be as high as 20% at 10 years after initial diagnosis. This incidence may be an overestimate because of difficulties in distinguishing a second malignancy from recurrent tumor. We encountered a patient with bilateral retinoblastoma who developed a temporal mass 3.5 years after initial treatment for what had first been diagnosed as rhabdomyosarcoma; further study suggested that it was recurrent retinoblastoma manifesting as primitive neuroectodermal tumor (PNET) with multilineage differentiation. Chromosome 13 abnormalities were compatible with either rhabdomyosarcoma or recurrent retinoblastoma. To determine how often second malignancies in retinoblastoma patients may be confused with recurrent primary tumor, we reviewed our experience at Children's Hospital of Pittsburgh. Of 43 retinoblastoma patients seen between 1951 and 1992, presumed second malignancies were documented in four, including the current case. Of the three other second tumors, one had both neural and skeletal muscle differentiation; another was diagnosed as rhabdomyosarcoma unclassifiable as embryonal or alveolar; the last was an osteosarcoma. Only the osteosarcoma was clearly a second neoplasm; two and perhaps three of the other cases may be recurrent retinoblastoma. The distinction between second malignancy and recurrent retinoblastoma may be difficult but is worth determining, because treatment may differ, depending on the correct designation.

[Ultramicroscopic studies in retinoblastoma]. / Cercetari ultramicroscopice în retinoblastom.

Were examined three cases with undifferentiated retinoblastoma. Were effected cross sections on the samples, remarking tumoral cells with normal aspect interspersed with tumoral necrosis cells. Tumoral cells of the undifferentiated retinoblastoma has low size and a poor cytoplasmic with a big nucleus that occupies nearly the whole cell; the ratio nucleus/cytoplasmic is increased. The cells are uni- or binucleus and the nucleus is monstrous deep invagination of the cover nucleus. Cytoplasmic has poor organelles and mitochondria are swelling following a high degree of hypoxia. Also tumoral cells on remark nontumoral cells (melanocyte).

Observation of surface structure of retinoblastoma cell line.

OBJECTIVE: We study the adhesion molecules on the surface of SO-Rb50 retinoblastoma cell line. METHODS: The distribution of proteoglycans in the retinoblastoma SO-Rb50 cell line was analyzed by histochem-electron microscopy, using Colloidal Iron in combination with a series of enzyme digestions. In addition, immunohistochemistry was performed using a panel of specific antibodies including neuron specific enolase (NSE), glial fibrillary acidic protein (GFAP), S-100 protein, fibronectin, laminin, and collagen IV. RESULTS: Immunohistochemical stains showed the most marked cytoplasmic reactivity of SO-Rb50 cells with anti-NSE and anti-S100. The cells member and surface was postive with anti-NSE. No reactivity was noted with antibodies against laminin, GFAP, and collagen IV. After incubated with colloidal iron solution, three types of colloidal iron-positive stained material could be distinguished based on differences in shape, size, electron density: (1) electron dense particles, (2) the larger colloidal iron-positive filaments, (3) the smaller colloidal iron-positive filaments, which were observed present on the tumor cells surface and in the extracellular matrix. CONCLUSION: We think that the cell surface proteoglycans is the main component of adhesion molecules of retinoblastoma, which may play a central role in mediating tumor cell adhesion to extracellular matrix and adjacent host cell.

Clinical and electron microscopic features of retinoblastoma.

A male child of 1-year, 6-month-old had a history of leukocoria of the left eye for approximately three months prior to admission into our facility. No abnormality was found in the right eye. There was negative family history of retinoblastoma. Ophthalmoscopy revealed a white mass extending from the supero-posterior part of the left globe to the posterior surface of the lens. Orbital tomograms showed no intraocular tissue densities in the mass but a B-scan ultrasound showed an echo dense area of the mass. Histopathologically areas of photoreceptor differentiation and Flexner-Wintersteiner rosettes were observed in the tumor mass by light microscope. Transmission electron microscopy disclosed the presence of prominent mitochondria on the luminal side of the cells forming rosettes and these were believed to be the component parts of the inner-segments of the photoreceptor cells. The results of this study indicate a predominant neuronal nature of the neoplastic cells with photoreceptor-like differentiation.

Characteristics of an established retinoblastoma cell line HXO-Rb44.

PURPOSE: To study the retinoblastoma cell culture and to establish a new retinoblastoma cell line. METHODS: 22 retinoblastomas were cultured by using the method of single cell suspension. Characteristics of the cultured cells were studied in the following programs: tumor cell morphology in vitro, electron microscopic, growth curve, cloning in soft agar, immunohistochemistry, karyotype and tumorigenicity. RESULTS: 22 retinoblastomas were cultured successfully in vitro, only a continued cell line HXO-Rb44 was established (more than 3 years). The characteristics of this cell line are that it grew as a suspension of round cell in graps like clusters in vitro, its population doubling time was 44 hours, and it could be cloned in soft agar. Histopathologic and ultrastructured pictures showed the characteristics of Rb. HXO-Rb44 cell was positive to NSE and negative to GFAP in immunohistochemical staining. A subcutaneous injection of HXO-Rb44 cells produced a retinoblastoma in BALB/C athumic nude mice. CONCLUSIONS: HXO-Rb44 has the characteristics of retinoblastoma and is a new retinoblastoma cell line. It is a useful material for study this tumor both in basic and clinical fields.

A study of immunoactivity of retinal S-antigen in retinoblastoma.

PURPOSES: To study retinal S-antigen expression in human retinoblastoma and assess if there is a correlation between S-antigen immunoactivity and degree of retinoblastoma cell differentiations. METHODS: Ten cases of Chinese retinoblastoma parafin-embedded tissues were applied for this study. A strain of monoclonal antibody,MabA9C6, which defines an epitope in S-antigen retained in fixed-tissue sections, was used to study S-antigen expression in 10 cases of retinoblastomas. S-antigen was localized by the biotinavidin indirect immunoperoxidase technique and purified MabA9C6 ascites fluid was used with 1:100 dilution. The whole procedure could be finished within a few hours. RESULTS: The S-antigen immunoactivity was observed in different patterns: the "normal" photoreceptor elements incorporated in 3 cases of growing tumors; 3 of 4 Fleurettes and E-W rosettes; and scattered tumor cells in 50% of the cases. CONCLUSIONS: The result suggests that the expression of S-antigen in retinoblastoma may be used to assess the degree of tumor differentiation as another tumor marker in retinoblastoma.