A 3-year-old boy presented with white reflex in the pupillary area along with mild divergent squint in right eye for 4 months which was noticed by the family members. On examination, leukocoria of right eye with dilated pupil which was non-reactive to light, secondary glaucoma, corneal edema, pseudohypopyon and proptosis were noted. USG B-scan of the eye was done. Eye exam under anesthesia was done. MRI of the region was also done. Which of the following is the most common histopathological finding seen in the above condition: –

**Core Concept**
The patient's presentation is consistent with retinoblastoma, a malignant tumor of the retina that is the most common intraocular malignancy in children. Retinoblastoma can cause leukocoria (white reflex), strabismus, and vision loss due to secondary effects such as glaucoma and retinal detachment.

**Why the Correct Answer is Right**
The correct answer is due to the presence of a malignant tumor of the retina, which is characterized by the rapid proliferation of primitive neuroectodermal cells. The histopathological hallmark of retinoblastoma is the presence of Flexner-Wintersteiner rosettes, which are a type of neuroblastic rosette composed of a central lumen surrounded by a ring of pale-staining cells. This feature is diagnostic of retinoblastoma and is often seen in conjunction with other histological features such as Homer Wright rosettes and pseudorosettes.

**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect because it does not describe a histopathological feature of retinoblastoma. While retinoblastoma can cause secondary effects such as glaucoma and retinal detachment, these are not histopathological findings.
* **Option B:** This option is incorrect because it describes a histopathological feature of a different condition, such as medulloepithelioma. Medulloepithelioma is a rare malignant tumor of the ciliary body that can cause secondary glaucoma, but it is not characterized by Flexner-Wintersteiner rosettes.
* **Option C:** This option is incorrect because it does not describe a histopathological feature of retinoblastoma. While retinoblastoma can cause secondary effects such as corneal edema and proptosis, these are not histopathological findings.

**Clinical Pearl / High-Yield Fact**
Retinoblastoma is a highly malignant tumor that requires prompt treatment to prevent metastasis and preserve vision. The presence of leukocoria, strabismus, and secondary effects such as glaucoma and retinal detachment should raise suspicion for retinoblastoma, and prompt referral to an ophthalmologist is essential for diagnosis and treatment.

**Correct Answer:** D. Flexner-Wintersteiner rosettes.

✓ Correct Answer: A. <img style="max-width: 100%" src=" />