Intraocularly, retinoblastoma exhibits a variety of growth patterns, which have been described below -
a)
Endophytic growth Endophytic growth occurs when the cancer growth breaks through the internal limiting membrane and a whitish mass, either showing an absence of tumor vessels or showing minute but irregular vessels, becomes visible. This growth pattern is characteristic of vitreous seeding in which tissue fragments become separated from the main tumor. In some aggressive cases tumor cells, resembling spheroid masses, may be seen floating in the vitreous and anterior chamber. These floating masses may obscure the view of the primary mass.
b)
Exophytic growth This growth pattern occurs in the subretinal space (behind the retinal layer) and is associated with the accumulation of subretinal fluid and retinal detachment. The tumor cells may enter the choroid layer of the eye and then infiltrate blood vessels or ciliary nerves.
c)
Diffuse infiltrating growth This rare subtype makes up for 1.5% of all the cases of retinoblastoma. Here, a distinct tumor mass is absent although tumor cells infiltrate the retina. The whitish mass seen in the pupils rarely occurs, or it may be slow growing.
Cross section of both the eyes showing dense white area of tumor