Orbital Fungating Mass as a Rare Manifestation of Retinoblastoma: A Case Study in Palliative Care.
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BACKGROUND Retinoblastoma is the most common childhood eye cancer, and palliative care is crucial when curative care is no longer feasible, particularly in patients lost to follow-up, who frequently present with advanced stages. The patient in this report presented bilateral extensive orbital involvement with dural metastasis. CASE REPORT A 4-year-old girl with moderate malnutrition, short stature, and unvaccinated status first presented at 1 year and 10 months of age with leukocoria in the right eye, a mass larger than 10 mm involving all quadrants with diffuse vitreous seeding. Bilateral intraocular retinoblastoma was identified on computed tomography (CT) imaging, and chemotherapy was initiated after parental refusal of enucleation; however, she was lost to follow-up. At 3 years of age, she returned with cauliflower-like masses in both eyes and invading the left cheek. The CT scan confirmed orbital retinoblastoma with dural metastasis, and treatment was shifted to palliative care. After 6 cycles of vincristine, etoposide, and carboplatin (VEC) chemotherapy, eye protrusion and nutritional status were improving. Magnetic resonance imaging (MRI) revealed reduced masses. After oral etoposide, she developed leg pain and a left temporal lump. She is currently receiving alternating VEC and vincristine, doxorubicin, and cyclophosphamide (VDC) chemotherapy, with palliative radiotherapy, resulting in a prolonged palliative response. CONCLUSIONS Strategies for the treatment of advanced-stage retinoblastoma include multiple treatment approaches. Delivered within a long-term palliative framework, underscoring the importance of individualized therapeutic sequencing and adapted to social constraints, this approach can prolong survival, preserve comfort, and enhance quality of life. The national screening programs enabling early retinoblastoma detection through a multidisciplinary approach are needed to prevent loss to follow-up.