Pathological TNM classification and staging by the AJCC/UICC for retinoblastoma.
\\n\\n
IntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\\n\\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\\n\\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\\n\\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\\n\\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\\n\\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\\n\\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\\n\\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\\n\\nFeel free to share this news on social media and help us mark this memorable moment!
\\n\\n\\n"}]',published:!0,mainMedia:{caption:"",originalUrl:"/media/original/237"}},components:[{type:"htmlEditorComponent",content:'
After years of being acknowledged as the world's leading publisher of Open Access books, today, we are proud to announce we’ve successfully launched a portfolio of Open Science journals covering rapidly expanding areas of interdisciplinary research.
\n\n\n\nIntechOpen was founded by scientists, for scientists, in order to make book publishing accessible around the globe. Over the last two decades, this has driven Open Access (OA) book publishing whilst levelling the playing field for global academics. Through our innovative publishing model and the support of the research community, we have now published over 5,700 Open Access books and are visited online by over three million academics every month. These researchers are increasingly working in broad technology-based subjects, driving multidisciplinary academic endeavours into human health, environment, and technology.
\n\nBy listening to our community, and in order to serve these rapidly growing areas which lie at the core of IntechOpen's expertise, we are launching a portfolio of Open Science journals:
\n\nAll three journals will publish under an Open Access model and embrace Open Science policies to help support the changing needs of academics in these fast-moving research areas. There will be direct links to preprint servers and data repositories, allowing full reproducibility and rapid dissemination of published papers to help accelerate the pace of research. Each journal has renowned Editors in Chief who will work alongside a global Editorial Board, delivering robust single-blind peer review. Supported by our internal editorial teams, this will ensure our authors will receive a quick, user-friendly, and personalised publishing experience.
\n\n"By launching our journals portfolio we are introducing new, dedicated homes for interdisciplinary technology-focused researchers to publish their work, whilst embracing Open Science and creating a unique global home for academics to disseminate their work. We are taking a leap toward Open Science continuing and expanding our fundamental commitment to openly sharing scientific research across the world, making it available for the benefit of all." Dr. Sara Uhac, IntechOpen CEO
\n\n"Our aim is to promote and create better science for a better world by increasing access to information and the latest scientific developments to all scientists, innovators, entrepreneurs and students and give them the opportunity to learn, observe and contribute to knowledge creation. Open Science promotes a swifter path from research to innovation to produce new products and services." Alex Lazinica, IntechOpen founder
\n\nIn conclusion, Natalia Reinic Babic, Head of Journal Publishing and Open Science at IntechOpen adds:
\n\n“On behalf of the journal team I’d like to thank all our Editors in Chief, Editorial Boards, internal supporting teams, and our scientific community for their continuous support in making this portfolio a reality - we couldn’t have done it without you! With your support in place, we are confident these journals will become as impactful and successful as our book publishing program and bring us closer to a more open (science) future.”
\n\nWe invite you to visit the journals homepage and learn more about the journal’s Editorial Boards, scope and vision as all three journals are now open for submissions.
\n\nFeel free to share this news on social media and help us mark this memorable moment!
\n\n\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"190",leadTitle:null,fullTitle:"Current Trends and Challenges in RFID",title:"Current Trends and Challenges in RFID",subtitle:null,reviewType:"peer-reviewed",abstract:"With the increased adoption of RFID (Radio Frequency Identification) across multiple industries, new research opportunities have arisen among many academic and engineering communities who are currently interested in maximizing the practice potential of this technology and in minimizing all its potential risks. Aiming at providing an outstanding survey of recent advances in RFID technology, this book brings together interesting research results and innovative ideas from scholars and researchers worldwide. Current Trends and Challenges in RFID offers important insights into: RF/RFID Background, RFID Tag/Antennas, RFID Readers, RFID Protocols and Algorithms, RFID Applications and Solutions. Comprehensive enough, the present book is invaluable to engineers, scholars, graduate students, industrial and technology insiders, as well as engineering and technology aficionados.",isbn:null,printIsbn:"978-953-307-356-9",pdfIsbn:"978-953-51-6021-2",doi:"10.5772/718",price:159,priceEur:175,priceUsd:205,slug:"current-trends-and-challenges-in-rfid",numberOfPages:516,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"892bc591e112f141ff4bd9714e7b15aa",bookSignature:"Cornel Turcu",publishedDate:"July 20th 2011",coverURL:"https://cdn.intechopen.com/books/images_new/190.jpg",numberOfDownloads:71942,numberOfWosCitations:22,numberOfCrossrefCitations:25,numberOfCrossrefCitationsByBook:6,numberOfDimensionsCitations:39,numberOfDimensionsCitationsByBook:6,hasAltmetrics:1,numberOfTotalCitations:86,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 13th 2010",dateEndSecondStepPublish:"November 10th 2010",dateEndThirdStepPublish:"March 17th 2011",dateEndFourthStepPublish:"April 16th 2011",dateEndFifthStepPublish:"June 15th 2011",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"52542",title:"Prof.",name:"Cornel",middleName:null,surname:"Turcu",slug:"cornel-turcu",fullName:"Cornel Turcu",profilePictureURL:"https://mts.intechopen.com/storage/users/52542/images/3609_n.jpg",biography:"Prof. Cornel Turcu was born in 1966 in Adjud, Romania. He received the B.Sc. and Ph.D. degrees in automatic systems, from the University of Iasi, Romania, in 1991, and 1999, respectively. He also holds a degree in Informatics (M.Sc.) from the University of Suceava, Romania. Since 1991, he has been with the Faculty of Electrical Engineering and Computer Science, University of Suceava (USV), where he is a full professor of System Theory and Intelligent Systems and also holds a joint appointment as head of Programmes Management Department. At USV he is also a supervisor for Ph.D. and M.S. theses. He has published over 70 research papers and 4 books. His research interests include intelligent systems, RFID systems and automatic control system design.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"1",institution:null}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"762",title:"Wireless Communication System",slug:"electrical-and-electronic-engineering-wireless-communication-system"}],chapters:[{id:"16514",title:"Radio Frequency Background",doi:"10.5772/20648",slug:"radio-frequency-background",totalDownloads:1985,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:null,signatures:"Paulo Crepaldi, Tales Pimenta and Luis 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\r\n\tIn the maintenance and conservation of our planet's biodiversity, knowledge of current biogeographical patterns, speciation or invasion processes, flora, fauna, natural history, and ecology have outstanding importance. Many areas of biodiversity are still completely undiscovered nowadays. The ecological impacts of global climate change, urbanization, overpopulation, environmental pollution, deforestation, land cover and land-use changes also have a significant impact on biodiversity, flora, and fauna, through biogeographical patterns.
\r\n\tThe management tools, methods and processes (as applied ecological aspects) of Protected Areas and National Parks are a very important part of conservation policy. I am sure that this book will be very useful for everybody who would like to get some insight into the recent problems of biodiversity research, ecology and conservation biology also from practical or theoretical viewpoints.
Retinoblastoma was first ever described by Petras Pawius from Amsterdam in 1597, and it wasn’t until 1809 when James Wardrop of Edinburgh established its origination from the retina and recommended enucleation as a primary treatment method for saving lives [1, 2, 3]. Nine years later, the first case of fungus hematodes, old name of retinoblastoma, was reported in the American literature [2, 4]. In the following three decades when the microscope was introduced, Virchow, the well-known pathologist, claimed that this tumor is a glioma as it arises from glial cells [2, 5]. Nevertheless, both the pathologist Simon Flexner (1891) and ophthalmologist Hugo Wintersteiner (1897) believed independently that this tumor is actually a neuroepithelioma due to the presence of cellular rosettes harboring a central lumen histologically. In fact, the Flexner-Wintersteiner rosettes that are diagnostic for retinoblastoma are named after these two physicians [2, 6, 7]. Later in the nineteenth century, the American pathologist Verhoeff confirmed that undifferentiated retinal cells are the original nidus of this tumor; thus, he called it retinoblastoma. This term was first adopted by the American Ophthalmology Society in 1926, and it has been in use since then [2, 8].
\nThe first step of grossing an enucleated eye in preparation for histopathological microscopic examination is establishing the laterality. Several anatomical landmarks provide useful cues to orient the globe properly, and these include the cornea, oblique muscles, and ciliary arteries. The corneal horizontal diameter is larger than its vertical diameter by around 1 mm, and this produces an oval shape (Figure 1A). The insertion of the superior oblique muscle tendon after originating from the trochlea is in the superior outer (temporal) quadrant just behind the insertion of the superior rectus muscle tendon. The inferior outer (temporal) quadrant receives the insertion of inferior oblique muscle, just lateral to the optic nerve (Figure 1B). Locating the horizontal planes can be done affirmatively by identifying the long posterior ciliary arteries that run horizontally at 3 and 9 o’clock [9].
\nGrossing an enucleated eye with retinoblastoma: (A) vertical corneal measurements; (B) inferior oblique muscle insertion located temporal (lateral) to the optic nerve (asterisk); (C, D) pupil-optic nerve (PO) section; (E) cassettes containing both calottes cut in bread-loaf pattern (red arrows), while the PO section is submitted in a separate cassette.
In the past, the enucleated eye was grossed and processed to produce one pupil-optic nerve (PO) section, which is then studied histopathologically. This practice was abandoned following the consensus of the International Retinoblastoma Staging Working Group (IRSWG) in 2009 where the efforts of 85 members from 24 different countries were joined to establish guidelines for tissue processing and handlining as well as staging. They concluded that the entire enucleated globe should be examined microscopically. This can be achieved by dividing the eye into four blocks. The optic nerve, tumor, and anterior chamber structures are included in the central pupil-optic nerve (PO) section composing one block as demonstrated in (Figure 1C,D). Two mirrored blocks composed of the calottes, representing the remaining eye tissue after harvesting the PO section, are usually cut consecutively in a bread-loaf fashion and embedded on edge to increase the examined surface area of the choroid, and this will subsequently improve the chances of detection of choroidal involvement (Figure 1E). The last block comprises the optic nerve margin cross section, and this is usually taken initially before cutting the eye. The optic nerve head, lamina cribrosa, and optic nerve posterior to the lamina cribrosa in a single section plane are usually displayed in the PO section as shown in (Figure 1D) [9].
\nEnucleation of the eye not only enables histopathological diagnosis, but it also yields fresh ocular tissue on which molecular and genetic testing can be carried out. Such tests are of paramount importance as their results are needed for family counseling and prognosis prediction. To facilitate this, guidelines and protocols were proposed to ensure preservation of the harvested ocular tissue for examination to obtain the best histopathological and molecular testing results. This guideline states that the enucleated globe should be processed and opened soon after surgery in order to prevent proteins and nucleic acid denaturation. Then, the optic nerve length is measured and documented in mm, and this is followed by preparing the block of the optic nerve margin cut section before proceeding with opening the eye. The next step involves opening the globe with the aid of transillumination, which is helpful in localizing the margins of the intraocular mass in addition to planning the collection of the PO section. Opening the eye can be accomplished using one of two techniques. The first proposed technique involves creating a window opening in the sclera adjacent to the edge of the bulk of the tumor. This scleral window is ideally created using a trephine. The second method is done utilizing a large bore 22-gauge needle that is used under sterile conditions to aspirate fresh tumor cells/tissue. The needle is inserted obliquely under direct visualization via the sclera into the posterior chamber behind the lens, and aspiration takes place once it is inside the tumor mass. Finally, the globe is fixed in an adequate amount of formalin for a minimum of 48 hours [10].
\nMacroscopically, the tumor has an encephaloid appearance, and this is not surprising given that it arises from the retina which resembles the neurological tissue (Figure 2A). The tumor is typically white in color, and it encompasses lightly colored flecks. In fact, these flecks are analogous to the dystrophic calcification within the necrotic tissue microscopically (Figure 2A) [10].
\n(A) Gross photo showing the encephaloid appearance of the tumor. (B) White flecks representing the calcification.
Embryologically, retinoblastoma tumors initiate from the inner layer of the optic cup that is derived from the neuroectoderm which is a neurological tissue. At the cellular level, the retinoblastoma constituent cells appear as small, roundish blue cells. Retinal differentiation in RB is categorized as the following: differentiated, undifferentiated, or necrotic. Differentiated tumors are furtherly subdivided into (1) “fleurettes” exhibiting advanced photoreceptor differentiation, (2) the classic Flexner-Wintersteiner rosettes representing early retinal differentiation, (3) Homer Wright rosettes with primitive neuroblastic differentiation, or (4) poorly differentiated [11]. These rosettes in an ascending order of differentiation include Homer Wright, Flexner-Wintersteiner rosettes, and fleurettes providing examples of these histologic structures (Figure 3) [2, 10, 12, 13, 14]. The Flexner-Wintersteiner rosettes when examined by high magnification microscopy demonstrate a ring of nuclei surrounding a central clear lumen corresponding to the subretinal space (Figure 3A). In comparison, the Homer Wright rosettes surround a central tangle of neural filaments with no clear distinct lumen (Figure 3A) [10, 11]. The different types of rosettes and/or fleurettes (Figure 3B) observed in RB tumors represent varying degrees of differentiation, and these are recognized based on the histologic architectural pattern.
\n(A) Different types of rosettes noted by low power. High-power slide showing two types of rosettes: Flexner-Wintersteiner rosettes (arrow) and Homer Wright rosettes (asterisk). (B) Bland-looking pinkish tumor cells with fleurettes (arrow) (original magnification ×1000 stained with hematoxylin and eosin).
On microscopic examination, the neuroblastic tumor cells are mitotically active with scanty cytoplasm and irregular basophilic nuclei. Apoptosis leading to necrosis is also frequently seen in these tumors. Necrotic areas may develop dystrophic calcification which is the source of the red purple color seen on sections stained with the hematoxylin and eosin (H&E) stain (Figure 4) [2, 10, 15]. These calcifications are of great clinical value, and they are usually detected by B-scan ultrasonography.
\nLow-power histopathological appearance of the tumor demonstrating pseudorosettes. Note the extensive necrosis (N) and calcification (arrow) (original magnification ×40 hematoxylin and eosin).
The level of differentiation of these cells varies, and there is a negative correlation between advancing age and the level of differentiation (less differentiation in older children). Notably, an inverse relationship was detected between retinal differentiation and age, where older infants present with poorer retinal differentiation than young infants in whom microscopic examination of their enucleated eyes revealed good differentiation with the presence of Flexner-Wintersteiner rosettes [11, 16].
\nHistopathological examination of removed tumors showed that one-fifth of the cases have foci of differentiated photoreceptors. This condition is attributed to a lesser degree of apoptosis and cellular turnover in highly differentiated tumors as photoreceptor differentiation, which persist regardless of the age, unlike Flexner-Wintersteiner rosettes, which were noted to decrease with older age [10, 11]. It was hypothesized that retinoblastomas originate from retinomas or retinocytomas, which are benign tumors entirely formed of differentiated photoreceptors and what proves this theory is the presence of well-differentiated photoreceptor foci at the base of endophytic retinoblastomas. Moreover, Dimaras demonstrated the presence of both RB1 gene mutation in these benignly behaving precursor tumors mentioned above [10, 17].
\nDetecting the presence of high-risk features on histopathological examination is of utmost significance. This is because of the implications these factors have on the risk of systemic metastasis and overall survival. Moreover, the presence of these factors dictates the institution of post-enucleation systemic chemotherapy to improve survival rates and limit the risk of metastasis [9, 11, 18, 19, 20, 21, 22].
\nSeveral studies from different parts of the world attempted to identify and evaluate these high-risk factors that include the following: retrolaminar optic nerve invasion (Figure 5), massive choroidal invasion (Figures 6 and 7), anterior segment tumor invasion, and extraocular/extra-scleral tumor extension (Figure 8) [9, 11, 18, 19, 20, 23].
\nHistopathological photos of several retinoblastoma tumors showing various degrees of optic nerve invasion: (A) prelaminar, (B) intralaminar, and (C) postlaminar, measuring the depth from Bruch’s membrane (hematoxylin and eosin ×40).
(A) Microscopic photos showing focal choroidal invasion <3 mm, (hematoxylin and eosin ×100). (B) Massive choroidal invasion>3 mm, (hematoxylin and eosin ×12.5). Note the postlaminar optic nerve invasion (arrow).
(A) Massive choroidal invasion noted grossly (G). (B) Corresponding histopathology massive choroidal invasion (H). Note the postlaminar optic nerve invasion (arrow) (hematoxylin and eosin, scanned slide).
Extraocular extension identified during surgery (A), grossing (B), and by microscopy (C). Note tumor cells on the outer surface of the sclera (EOE, hematoxylin and eosin ×40).
Optic nerve invasion is usually classified as prelaminar (anterior the lamina cribrosa), laminar (involving the lamina cribrosa but not extending beyond it), retrolaminar (extending beyond the lamina cribrosa), and tumor at the surgical cut margin (Figure 5A–C). In addition to the length of invasion, the focus of tumor invasion must be determined by measuring the maximum depth of invasion into the optic nerve. This is achieved by measuring from the internal limiting membrane (ILM) of the optic disc or Bruch’s membrane if ILM was destroyed by the tumor to the deepest area of invasion as demonstrated in (Figure 5C) [24, 25]. On the other hand, experts defined massive as more than 3 mm foci of choroidal invasion whether in thickness or width, whereas focal choroidal invasion was defined as less than 3 mm foci of choroidal invasion whether in thickness or width (Figures 6 and 7). Another helpful anatomical definition is whether the tumor cells are reaching the inner scleral layers in massive invasion or not reaching the sclera in focal invasion [9, 11, 18, 19, 26]. It is important not to misinterpret artificial tumor seeding of the choroid or other ocular structures as invasion. This will prevent over-reporting of high-risk features (such as choroidal invasion) and will consequently avoid additional unnecessary treatments in these vulnerable children. Artificial seeding classically consists of tumor cells clustered in small groups along with many necrotic cells in natural or potential ocular spaces (e.g., suprachoroidal space, anterior chamber, or subarachnoid space of the optic nerve), sectioning artifacts created during tissue preparation and/or ocular surfaces (e.g., episclera, optic nerve meningeal sheath). On the other hand, truly existent invasion consists of solid nests of infiltrative tumor cells that anatomically destroy and substitute the area of invasion; however, necrosis is rarely seen except if the tumor is massive [9, 10].
\nIn the literature, there are several key studies that looked at these high-risk factors. A large study conducted by Eagle et al. from the USA looked at the overall occurrence of high-risk features in children with unilateral retinoblastoma (n = 387), whether treated preoperatively or not, and found an incidence of 20.4%. Further evaluation of the untreated group (n = 297) revealed that high-risk features were present in 18.5% of the enucleated eyes. Among these, retrolaminar optic nerve invasion was the commonest feature occurring in 10.4% followed by massive choroidal invasion in 8.1%, and lastly a combination of both features was observed in 3.4% [11]. In fact, these percentages were similar to those (11.6 and 9.3% for retrolaminar optic nerve invasion and massive uveal invasion, respectively) reported previously by large specialized American treatment centers [11, 27]. The incidence of high-risk features is to the lower side in developed countries (e.g., 20% in the USA); yet, higher rates were observed in developing countries ranging between 29 and 48% [28, 29]. Gupta studied retrospectively 142 cases of retinoblastoma eye enucleated over a 5-year period and found that the high-risk histopathologic features were present in 54.2% of these eyes. Choroidal invasion was the most frequent where it was detected in 40% followed by retrolaminar optic nerve invasion 17% and less commonly other ocular structures such as the iris and sclera. This study further linked the identified high-risk features to the clinical presentation and reported a positive correlation between age > 24 months and choroidal invasion, whereas iris neovascularization correlated with both retrolaminar optic nerve invasion and choroidal invasion [11, 18]. Furthermore, Kaliki evaluated patients with an International Classification of Retinoblastoma (ICRB) classes D and E for high-risk features and reported their presence in 17% of class D eyes (15/87) and 24% of class E eyes (102/432). The fact that high-risk features were more likely to be present in advanced disease is evidently supported by the fact that 10% of patients demonstrating high-risk features on histopathology in the previous study developed metastasis which was fatal in two children. To compare, none of the children in group D with high-risk features developed metastasis nor died [19].
\nOverall, choroidal and optic nerve invasion reported incidences in the literature are variable and were noticed to be higher in previous publication than more recent ones [23, 28, 30, 31, 32, 33, 34]. To add, a trend of higher occurrence was observed in developing countries and specific geographic locations such as Asia and India, and this is explained by the later presentation and unique biological behavior of tumors in these areas. This variability in incidence was looked at by Eagle where he attributed it to multiple factors including diagnosis to enucleation time, reporting institute location and ununified assessing techniques of enucleating specimens [11].
\nThe survival rates in the presence of these high-risk features are usually decreased. In general, patients with massive choroidal invasion had a 70% survival rate, while patients with tumor extending up to the optic nerve cut margin had an obviously lower survival rate of approximately 35%. On the contrary, those with prelaminar optic nerve invasion had excellent survival rates reaching more than 90% [2, 24, 35].
\nAnother characteristic feature seen in RB cases is tumor or ocular tissue necrosis. This condition occurs secondary to mitotically active tumor cells that grow 90–110 micron from the tumor-feeding vessels resulting in ischemia and necrosis. Papillary appearance may be seen in necrotic tissue termed as pseudorosettes (wrong nomenclature) consisting of basophilic viable tissue resembling sleeves and cuffs measuring 100um from the central blood vessels separated by eosinophilic necrotic sheets (Figure 9) [10, 15, 20].
\nPseudorosettes with viable blue cell tumor survived for about 100 um from the central blood vessels, surrounded by pink necrotic tissue.
Chong studied the association between extensive tumor and ocular tissue necrosis in RB enucleated eyes with high-risk histopathological features. Extensive tissue necrosis was defined as more than 95% of ocular tissue or tumor to be necrotic in enucleated samples. The total number of eyes showing extensive necrosis is 11 (25.6%) out of 43 enucleated eyes. Histopathological high-risk features were more prevalent and statistically significant in enucleated eyes with extensive necrosis. On review of histopathological slides, 11 (100%) had optic nerve invasion with 8 (72.2%) showing retrolaminar invasion and 9 (81.8%) with choroidal invasion. This study concluded that the presence of extensive necrosis of tumor or ocular tissue in RB should alert the ocular pathologist to extensively review the slides for high-risk histopathological features to improve the survival rate and lower the risk of metastasis [20].
\nRB originates and destroys the neurosensory retina. The tumor is subdivided into two types based on the growth pattern. Endophytic tumors, which are known to be the most common type, arise from the inner layers of the retina which maintains its attachment and normally invades into the vitreous chamber (Figure 10C, D) [10]. They are clinically visible by ophthalmoscopy as white mass lesions surrounded by fine feeding vessels, which may be mistaken for an astrocytic hamartoma [36]. These tumors may also occasionally seed the anterior chamber. On the other hand, exophytic tumors arise from the outer retinal layers in between the sensory retina and the retinal pigment epithelium and grow outward typically causing high bullous retinal detachments which may progress to total retinal detachment (Figure 10A, B) [10, 36]. They are usually invisible by ophthalmoscopy but may initially be identified with difficulty as small gray masses [36]. They may also cause anterior displacement of the lens-iris diaphragm and secondary angle closure [10]. When presenting with a total retinal detachment, exophytic tumors may be mistaken as Coats disease, persistent hyperplastic primary vitreous, retinopathy of prematurity, or retinal dysplasia [36]. The two previously mentioned growth patterns may overlap manifesting as a mixed endophytic-exophytic retinoblastoma [10]. Rarely, a diffuse infiltrating RB may be found which grows diffusely within the retina without forming a discrete mass. These usually present with signs suggestive of inflammation and are misdiagnosed as uveitis [36].
\n(A) Gross photo of an exophytic growth pattern (posterior to the retina). (B) Low magnification sample demonstrating exophytic growth pattern (hematoxylin and eosin). (C) Gross photo of an endophytic growth pattern (anterior to the retina) with subretinal fluid. (D) Low magnification sample demonstrating endophytic growth pattern with subretinal fluid (hematoxylin and eosin).
In 1990, Palazzi classified 297 cases of RB into two types of growth pattern. Their study showed that 61% of the cases were endophytic, while 39% of the cases were exophytic [37]. Similarly, in a more recent study published in 2014, Nawaiseh reported 42 cases of RB where 45% of cases were endophytic, 33% were exophytic, and 21% were mixed endophytic-exophytic. The study did not report any cases of the diffuse infiltrating type [36]. However, Taktikos reported the diffuse infiltrating type in 1% of the cases in his published article in 1966 [38].
\nThe growth patterns have different impacts on the pathological features of the tumor in the eyes with retinoblastoma and no treatment prior to enucleation. Endophytic tumors, which have a direct contact with the vitreous, are more likely to be associated with vitreous seeds than exophytic tumors. On the other hand, exophytic tumors characteristically grow toward the choroid with a higher risk of choroidal invasion than endophytic tumors. This theory was supported by Palazzi’s findings where 71% of tumors with choroidal invasion had an exophytic growth pattern [37]. Nawaiseh also found that all cases with massive choroidal invasion occurred with tumors of exophytic growth patterns [36].
\nWilson and Kaliki found that group Vb eyes according to the Reese-Ellsworth (RE) classification (eyes with vitreous seeds) have higher incidence of high-risk features than group Va (eyes without vitreous seeds) [19, 39, 40]. The risk of optic nerve invasion (laminar or postlaminar) was found to be 58% in that group, while the risk of massive choroid invasion was as low as 29% [39]. Nawaiseh correlated the above conclusions by Wilson to his own findings and anticipated that endophytic tumors are more likely to be associated with optic nerve invasion rather than choroidal invasion based on the fact that vitreous seeding was more likely to be associated with an endophytic growth pattern [36].
\nA mixed tumor growth pattern indicated a more advanced tumor stage and a more damaging tumor. Nawaiseh found that the mixed tumor growth pattern was more likely to be associated with neovascular glaucoma and with more advanced IIRC groups (67% were associated with IIRC group E, the most advanced stage of intraocular RB) [36]. On the other hand, Palazzi found that neovascular glaucoma was more likely to be associated with the exophytic tumor which may be due to the long-standing retinal detachment leading to ischemia. However, in that study, only the exophytic and endophytic growth patterns were studied without the mixed growth pattern [37].
\nThe well-differentiated part of the RB is relatively radioresistant and chemoresistant; therefore, photoreceptor differentiation is more common in the enucleated eyes after radiotherapy or chemotherapy [11].
\nThe histopathological examination of the enucleated eyes with RB after chemoreduction therapy may show Type 1, cottage cheese; Type 2, fish flesh; Type 3, combination of types 1 and 2; and Type 4, complete regression or presumably viable histologically intact tumor cells [3, 41, 42]. Type 2 regression pattern may have the same histological features as a retinocytoma and result in a retinocytoma-like clinical appearance, which may be because well-differentiated tumors are relatively resistant to chemotherapy and therefore the cells are not cycling [42]. Similar regression patterns are also seen in tumors treated by intra-arterial chemotherapy (IAC) [43].
\nThe American Joint Committee on Cancer and the International Union Against Cancer (AJCC/UICC) created a TNM staging scheme system for RB [26, 44, 45, 46]. It has multiple updated editions where the 8th edition is the latest updated one [45]. It is considered one of the extraocular classification systems besides the International Retinoblastoma Staging System (IRSS) [47]. Unlike other staging systems, TNM and IRSS were developed by multiple specialists and medical centers worldwide [48, 49]. The TNM8 system is subclassified into clinical, pathological, and hereditary classifications which stand for cTNM, pTNM, and H, respectively [45]. Furthermore, pathological staging necessitates enucleation of the eye to classify primary tumor plus examining local extension or distant metastasis by biopsies or total resection if present. The pTNM categories are divided to pT, the histological staging of the primary tumor after biopsy or enucleation, pN stands for microscopic examination of lymph node biopsy, and clinical plus microscopic examination of distant metastatic lesions implies as M [45, 49]. However, on initial evaluation application of clinical or cTNM, subclassification is wildly used by ophthalmologist which subclassify the tumor burden to intraretinal, intraocular, advanced intraocular, or extraocular [47]. The clinical “cTNM” and hereditary “H” classification are beyond the scope of this chapter. Further details of pTNM classification and staging are demonstrated in Table 1 [45].
\nPathological TNM classification and staging by the AJCC/UICC for retinoblastoma.
Retinoblastoma is a subclassification composed of three aspects: pT, pN, and M. Pathological definition of primary tumor (pT): stands for histopathological staging of the primary tumor after biopsy or enucleation. Pathological definition of lymph node (pN): stands for microscopic examination of lymph node biopsy. Definition of distant metastasis (M): stands for grading distant metastatic lesions including both clinical and pathological definitions.
The abovementioned aspects of pTNM are categorized to 4 stages demonstrated in the last part of Table 1.
The updated pathological TNM8 version emphasized the importance to define focal, massive choroidal invasion and scleral invasion in compression to previously published TNM7 and TNM6 staging system in 2009 and 2002, respectively [45, 46, 49]. Furthermore, newly updated TNM8 staging system officially released formal staging group for prognosis. It is subdivided into four stages assigned for both clinical and pathological classifications as seen in Table 1 [45]. Guillermo reported poor disease-free survival in patients staged by the pTNM7 staging system due to omission of scleral invasion. The major event of disease-free survival was extraocular relapse [49].
\nHistopathological examination of RB cases is highly valuable in diagnosing, staging, and predicting prognostic factors and risk of metastasis. Further attention should be given while evaluating the four submitted block sections to detect high-risk features that indicate adjuvant chemotherapy administration that lowers metastatic rate and improves the survival rate. The high-risk features include retrolaminar optic nerve invasion, choroidal invasion, anterior chamber involvement, extraocular or extra-scleral spread. Moreover, incidences of previously mentioned high-risk features were studied in various articles. TNM staging created by AJCC/UICC provided pathological staging scheme for retinoblastoma. The recently released 8th edition in 2017 embedded choroidal and scleral invasion definition in tumor pathological staging section. In addition, formal prognostic stages were added.
\nThe authors would like to thank the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, and King Khaled Eye Specialist Hospital for their academic support and for providing us with images.
\nThere is no financial interest to disclose.
One of the most striking characteristics of human beings is the diversities. Different ways of being, thinking and existing, different needs, world views, ethical positions mark the relationships between people. In this sense, interpersonal conflicts are understood as tension that involves different interests or positions, are inherent to human relationships, and are present in various social organizations, among them, the school.
The school as microcosms of society brings together different views of the world, different ways of being, thinking, and living, thus becoming a space for representing social differences and being a place where different conflicts occur daily. Dealing with this situation type requires learning and that is why teachers need training in conflict management so that they can correctly manage the classroom conflicts and educate also your students for conflict management.
Recognizing that the school is an organization that brings together social diversity and adopting as an assumption that interpersonal conflicts are inherent to human relationships, we define the school conflicts as this chapter theme. In this sense, this chapter addresses school conflicts with a focus on classroom conflicts in the teacher-student relationship. In the first part, a brief reference is made to the conflict. This is followed by a review of the bibliography on school/classroom conflict causes.
Due to its intrinsic characteristics, school is a favorable medium for conflict situations development. So, the conflict in the education system can be seen from the dialectic between the macrostructure of the education system, the general policies oriented towards it, and the management processes that prevail in each school [1].
The conflict presents formative possibilities, since the perception of the differences existing between people/or groups and their needs, values, ideas, and different ways of living are essential to a democratic society [2]. In this sense, it is important to enhance positive conflict characteristics and reduce the negative ones. So, the difficulty in resolving conflicts is largely due to the difficulties existing between those involved in the conflict to be able to communicate effectively. Therefore, the constructive and educational potential of conflicts depends largely on the skills of those involved. Thus, knowing how to communicate, and respecting the rights of others and existing differences are essential for conflicts to revert to social and human development benefits.
The concern with improving coexistence in schools, centred on the conflict variable, is addressed in different studies, whose objectives mark both understanding the school conflict [3, 4, 5, 6], as well as preventing its occurrence [7]. Since it is impossible to eliminate school conflicts, it is essential and urgent to reduce their intensity, duration, and severity, so that the teaching and learning process is not harmed. In this sense, this chapter addresses also the strategies used to manage classroom conflict, and some examples of programs that work these skills on teachers and students.
The conflict is defined and classified from different perspectives, and its definition can differ, in context, process, intervention, and study areas [1, 8]. Conflict is a phenomenon of incompatibility between individuals or groups with irreconcilable ends and/or values between them, considering it a social process [1]. For this author, four elements are present and must be addressed in all conflicts: the causes that give rise to it; the conflict protagonists; the process and the way the protagonists face the conflict; and the context in which it occurs. In turn, Chrispino [9] understands conflict as to any divergent opinion or a different way of seeing or interpreting an event, that is, the conflict originates in the difference of interests, desires, aspirations, or positions between individuals. He adds that conflicts can arise from difficulties in communication and assertiveness.
In this way, we can say that there is a conflict when two or more people interact with each other and perceive incompatible differences, or threats to their resources, needs, or values and when they respond according to what was perceived, then the ideal conditions for conflict are created. The conflict intensity, duration, or severity can then increase or decrease depending on the strategies used to resolve it. Regardless of the different conflict definitions, there is no conflict if the individuals involved are not aware of its existence. This conclusion is consensual to the majority of the definition proposals and to the attempts to conceptualize the conflict found in the specialized literature.
In addition to different conflict definitions, there are also different proposals for classifying it. Concerning the different conflict classification [8, 10, 11] the emphasis is placed on the theoretical proposals of [8, 11]. Conflicts can be classified into five different types: structural, value, relationship, interest, and data [11]. In structural conflicts, causes are associated with unequal control situations, possession or resource distribution, unequal power, and authority, geographical, physical, or environmental factors that prevent cooperation and time pressures. In value conflicts, it highlights situations of opposing ideas or behaviors, different ways of life, ideology, or religion. Relationship conflicts are caused by strong emotions, misperceptions or stereotypes, inadequate or deficient communication, and negative and/or repetitive behaviors. The causes of interest conflicts are perceived or real competition over fundamental interests (content), procedural interests, and psychological interests. Finally, about data conflicts, [11] highlights the lack of information or wrong information, different points of view on what is important, different data interpretations, and different assessment procedures.
In turn, Torrego [8] presents a typology that seems to reflect the type of school conflicts: relationship-communication conflicts; interest/needs conflicts; and preferences, values, and beliefs conflicts. As for the relationship-communication conflicts, it cannot be said that there is a concrete cause that justifies their appearance, however, it appears as a result of the relationship deterioration itself. As such, aggressions, struggles, offenses, defamations, rumors, humiliations, misunderstandings are part of this type of conflict, but also perception conflicts, because, despite the conflict reality being only one, this fact does not invalidate that those involved have their view of it. Interest or needs conflicts usually occur when one party considers that it will only be able to satisfy its needs/interests if the other gives in to theirs. This conflict type can include those that stem from disagreement about how to perform jobs or tasks and those that result from the need felt by one of the parties to own or be coerced into giving in: objects, time, space, or any type of appeal. Finally, preferences, values, and beliefs conflicts result when these systems are discordant or viewed as such by those involved in the conflict. However, this conflict type can be resolved if the parties identify higher values common to both.
It is important to say that the conflict constructive paradigm indicates that the conflict has positive and negative aspects, advantages, and disadvantages. This new model is opposed to the classic model and indicates that moderate levels of conflict are perceived as positive [12]. The conflict effects are positive, when they are well managed, to establish more cooperative relations and seek to reach an integrated solution, for the benefit of those involved in the conflict [10]. In any organization, the existence of low levels of conflict leaves the organization vulnerable to stagnation, to making impoverished decisions, even to the lack of effectiveness; on the other hand, having too much conflict leads the organization directly into chaos.
Given the above, we can say that conflicts are inherent to human relationships since human beings are characterized by diversity. The school, by bringing together people from different social groups with different values and worldviews, becomes a locus for conflicts.
The school is a society microsystem, in which are reflected constant changes. Thus, one of the most important school functions is to prepare students, teachers, and parents to live and overcome the difficulties of a world full of rapid changes and interpersonal conflicts, contributing to the development process of each individual. For being a society microsystem and bringing together different ways of life, thinking, feeling, relationship, constitutes a space conducive to interpersonal conflicts.
School conflict is defined as the disagreement between individuals or groups regarding ideas, interests, principles, and values within the school community, perceiving the parties their interests as excluded, although they may not be [13], being that the most frequent school conflicts occur in the relations between student–student and between student-teacher [14].
Conflicts in the school can be classified according to their causes and those involved. For Martinez [15], the conflicts between teachers are mainly caused by lack of communication, personal interests, previous conflicts, issues of power, or political and ideological differences. This author indicates that conflicts between students and teachers, as they happen due to the lack of understanding of the teacher’s explanation, due to arbitrary grades and divergence in the evaluation criteria, lack of didactic material, discrimination, disinterest in the study material, and because the students are ears. In turn, conflicts between students can arise due to misunderstandings, fights, the rivalry between groups, discrimination, bullying, use of spaces and assets, dating, sexual harassment, loss or damage of school assets, diverse elections, travel, and parties. Conflicts between parents, teachers, and administrators can arise due to aggressions that occurred between students and between teachers, due to the loss of work material, problems in the school canteen or similar, lack of teachers, lack of pedagogical assistance by teachers, evaluation, approval and disapproval criteria, failure to meet bureaucratic and administrative requirements of management [15].
From the literature review, it is possible to infer and highlight the different causes pointed to the school conflict. Participating teachers in the Göksoy and Argon [16] study indicate as causes for school conflict: the communication failures, personal, political/ideological, and organizational causes.
With a very similar rating, Jares [1] indicates four main causes: ideological-scientific, related to different pedagogical, ideological, and organizational options, and the type of school culture or cultures that coexist; power causes, related to organization control, professional promotion, access to resources and decision making; causes of structure, related to the ambiguity of objectives and functions, organizational fragility, organizational and variable contexts; and personal and interpersonal causes, related to self-esteem, security, professional dissatisfaction, and communication. Also, Burguet [17] points out as possible causes for the school conflict in the school’s organizational structure.
In this sequence, and given the increase in school conflicts, Ibarra [18] recognizes as school conflict causes: the increase in compulsory schooling, the increase in the number of students per class, teachers perceive a progressive decline in their authority about students, and students are less likely to comply with certain rules and limits, which results in conflict situations. Regarding the increase in compulsory education, this leads to a greater number of unmotivated and undisciplined students, which implies an increase in school conflict. Likewise, the increase in the number of students per class, without increasing the facilities or associated conditions, increases the conflict occurrence, because of their negative changes in the physical and psychological environment, in overcrowded classrooms, with a lack of space for practical and collaborative activities.
In addressing interpersonal relationships in schools cannot neglect family background. When dealing with interpersonal relationships in the school context, it is necessary to take into account the family reality of each student, since the family interpersonal relationships have a strong connection with the school conflict [19]. Distinguished authors indicate that school conflict situations often have their genesis at the family level [17, 20] since they are the most deprived families, where alcoholism, domestic violence, and unemployment problems occur, being that all these violence and incivilities manifestations that arise in the students’ lives are transported to school. Burguet [17] points the dismissal of families as educational agents. This author highlights the overprotection with a sense of guilt for not dedicating more time to children, the experience of fatherhood as a “burden” of those who educate in aggressiveness, and the criticisms of parents, and society itself, to teachers, instigates conflicts. In other words, the role of the family often does not seem to offer a good foundation in the education of young people, which is reflected in their behavior in the processes of interaction at school. As Berkowitz [20] indicates, many of the interaction problems originate in the family, and the student reproduces the behaviors he learns with his parents.
It should be noted that the context experienced by the Covid-19 pandemic has a greater impact on students from poorer families. The situation of these most vulnerable students was a problem whose dimension grew with online classes, as they encountered immense barriers and lack of support for quality education during confinement. Thus, students who before the pandemic were unmotivated and presented conflicting behaviors at school should be the target of more support during this pandemic phase, to minimize the conflicting behaviors. It should also be noted that although family-school relationships are extremely important for students’ learning and development, family participation in school is not always satisfactory.
So, the family and the school must go together to contribute to the conflict becoming part of a process of growth, acceptance of the other, and accountability. Learning to deal with school conflicts positively is essential for the development of healthy relationships.
Another cause of school conflicts is pointed to society and the values it conveys, Burguet [17] points to the example of social communication, which encourages violence through violent programs, broadcasting news with prejudiced and conflicting messages. All of these situations enhance the conflicting attitudes of children and young people, which are reflected in school behaviors.
The school builds a social interface favorable to involvement, where conflicts proliferate in the educational process complexity, being common and daily in classes. Thus, in the classroom different types of conflict occur, being a challenge for most teachers to know how to face, manage, and resolve these conflicts [7].
Teachers often perceive conflicts as indiscipline, violence, disrespect, and like all situations threatening his authority, and inexperienced and experienced teachers emphasize the teacher-student conflict as a frequent situation in difficult classes [21]. In this context, Silva and Flores [19] refer to the negative effect that these situations have on attainment and student motivation, so it is urgent to find solutions to avoid or mitigate such effects.
The classroom coexistence problems are mainly related to social and pedagogical changes [22]. In this sequence, there are several conflict situations that teachers can face during classes. Some of those indicated by the teachers are, namely: the student’s presence that did not focus on activities; students with serious learning and communication difficulties; students groups who do classroom not work and maintain an aggressive and provocative attitude; students with destructive attitudes towards school material, theirs and/or colleagues, as well as aggressive and violent attitudes towards colleagues and teachers; apathetic students, who do not show classes enthusiasm; and in extreme situations, students who take and display instruments in the class that can be used as weapons, in an attitude of defiance to the teacher [23].
Given the increase in the classroom conflicts, multiple causes, which include a combination of external and internal factors in the school environment, are indicated, such as the increase in compulsory education, the increase in students per class, the progressive decline in the teacher’s authority about students, and students are less likely to comply with rules and limits, which results in conflict [18]. The increase in the year of schooling also leads to greater difficulties in living and learning in the classroom, and older age student’s groups consider themselves inserted in an educational system that sometimes does not respond to their needs and some of them consider not be essential to your life. So, the increase in compulsory education leads to a greater number of dissatisfied, unmotivated, and undisciplined students. Likewise, the increase in students per class, without increasing the facilities or associated conditions, negatively affects the psychological environment in overcrowded classrooms, with a lack of space for practical and collaborative activities. In turn, the progressive decline in teacher authority in relation to students and students are less likely to comply with certain rules and limits, results in conflicts in the classroom.
Conflicts in the teacher-student relationship are recurrent in the classroom, and [17] indicates as causes generating conflict, not only concerning the expectations of the teacher-student but also the student towards the teacher. In this sequence, the authors highlight the following problems that cause conflict: discipline problems, adaptation to individual differences problems, and evaluation problems.
As for discipline problems, these are the result of provocation and contempt of the student towards the teacher, or the teacher towards the student, to exercise their authority. In turn, problems of adaptation to individual differences are related to heterogeneous behaviors and diminished personal relationships. As for the problems related to the evaluation, result mainly from the personal rhythms of each student and teacher.
Students’ undisciplined classroom behavior can lead to conflicts that divert the teacher’s attention to issues that blur him from his teaching function [19]. In this context, Pérez-de-Guzmán et al. [7] indicate disinterest, mainly academic, as the main source of classroom conflict, also mentioning that one of the conflicts that persist and continues to be common is the lack of study habits and the carrying out work, leading to a negative attitude during class. Also, the mandatory stay in the classroom, away from the interests and expectations of some students, is recurrent as a conflict cause.
There are many and diverse classroom conflict situations that disturb the class dynamics. And in situations where the conflict remains latent, the result of the diversity of class interests, if the teacher does not create a good environment, acting positively about communication, the use of legitimate authority, and the conflict management, he will see conflicts increase exponentially within the classes [24]. Thus, regardless of the classroom conflicts type, if they are not managed, they accumulate, which makes them more cohesive and complicated, triggering negative feelings in those involved, and negatively affecting the educational quality [24].
The causes of the aforementioned conflicts are linked to personal issues and interpersonal relationships. And, most of these conflicts reveal an undisciplined character and increase daily in the class context. In this way, the teacher in the absence of solid guidelines can develop discontent, insecurity, and dissatisfaction that are reflected in his conflict face performance. Another aspect to be highlighted is that related to the power or lack of it that, increasingly, the teacher presents, and that reveals itself in discontent. In short, there is a gap in society, between the values it promotes and demands the school and the lack of credibility that is given to the teacher, questioned before the disapproval of parents and society itself, which instigates an even greater student’s conflict, in classes.
Conflict can inspire innovations and creative strategies in addressing challenging issues, as well as improving work, results, and encouraging organizations to achieve higher levels of quality and achievement. In this context, Göksoy and Argon [16] argue that school conflicts have positive and negative impacts on psychological, social, and organizational results.
Negative psychological impacts include discomfort, insecurity, insignificance feelings, sadness, resentment, frustration, and stress. In turn, at the social level, results of hostility, intolerance, and violence are present [16]. As for the negative results within the institutions, the author highlights the existence of a tense environment, weakened cooperation, communication failures, poor performance, and an undisciplined environment. Inevitably, in this way, there is a decrease in education quality.
The conflicts traditional and negative view has implications for the training of students, as the current discourse in many schools is about how to avoid conflicts since their educational potential is sometimes not perceived by the school community. This discourse conceives the conflict by the violent consequences that result from its non-management.
Conflict is recognized as an engine of social development and its effects are positive when the conflict is managed well. Thus, about the positive impacts arising from the school conflict, these have various levels of benefits [16]. At a personal level, the conflict allows learning to be related to the perception of errors, and to develop new ideas. On the other hand, at the social level, it enables the reinforcement of communication, respect for others, and enhances commitment. Regarding the benefits at the organizational level, it makes it possible to understand problems, seek and develop new solutions, and develop a democratic and enriching environment in the school. Thus, conflicts can contribute to the construction of broader visions of certain situations and, at the same time, guarantee rights and opportunities for all, regardless of interpersonal differences.
Teachers’ perceptions of conflict indicate that they focus mainly on the conflicts’ negative aspects [6, 25]. It is noteworthy that the methods most used at school, face of students conflicting behaviors, include warning, disapproval, summoning guardians, and in some cases, student suspension. Methodologies that provoke negative feelings and, later, originate new undesirable behaviors, being applied without taking into account the needs, personal conflicts, problems, and students expectations [26]. As indicated by Torrecilla et al. [22] if the teacher is not an effective conflict manager, he will project this lack of skill, resulting in negative learning for students.
As noted earlier, classroom conflict is an unavoidable reality. Thus, being inevitable, adequate strategies are needed to resolve it so that the conflict potential advantages are taken advantage of and its harmful effects are minimized or canceled out. Conflict management strategies are understood as the behavior types that are adopted in the conflict context, that is, they are basic strategies to manage a situation in which the parties consider their interests to be incompatible.
It is important to note that the choice between different conflict management strategies depends on the conflict level and the various situations that must be managed effectively [27], that is, to manage conflict functionally, it is important to recognize that one strategy may be more appropriate than another, depending on the conflict situation, being considered appropriate if its use leads to the effective formulation or resolution of the conflict [27]. So, strategies refer to specific patterns of behavior that are adopted in conflict situations. Following this approach, Rahim and Bonoma [28] established five conflict management strategies using two dimensions “self-concern” and “others concern”. They are different strategies for conflict management and correspond to the attitudes to confront and conflict resolutions.
These five strategies for conflict management are [27]: (a) Avoiding: when conflicted parties show low levels of concern for others’ interests and a low level of concern for oneself. Strategy characterized by a low degree of assertiveness and a low degree of cooperation, where neither its interests nor those of its opponents are satisfied; (b) Dominating: reflecting the attempt to satisfy one’s interests without consideration of the interests of the other. Characterized by a high assertiveness and lack of cooperation, in which the acquisition of objectives is viewed with supremacy over the interests of the other party. Furthermore, it is often considered an aggressive strategy; (c) Obliging: tends to be adopted by those individuals who attempt to play down the differences and emphasizes commonalities to satisfy the concerns of the other party. Represents a conflict management strategy where the cooperation is high, and assertiveness is low; (d) Integrating: individuals who use this strategy manage conflicts directly and cooperatively, seeking to solve in collaboration with the other, is a strategy connected with problem-solving. The use of this involves openness, exchanging information, looking for alternatives, and examination of differences to reach an effective solution for everyone involved in the conflict. Is a strategy useful for effectively dealing with complex problems; and (e) Compromising: represents the attempt to satisfy, moderately and partially, the interests of all those involved in the conflict, and shares commonalities with all of the other four strategies. Is a strategy that requires compromise and assignment. Compromising is an intermediate strategy on assertiveness and cooperation, which implies a compromise in the search for an acceptable intermediate position for everyone involved in the conflict.
Among the variables that influence the choice of different conflict management strategies, the teachers’ emotional intelligence stands out. Valente and Lourenço [24] conclude that teachers who tend to have higher levels of emotional intelligence use more integration and commitment strategies, for conflict management in the classroom, and fewer strategies of consent, avoidance, and domination. Too, the findings of Aliasgari and Farzadnia [29] indicate that teachers prefer the integrating strategy over the other conflict management strategy. So, in the presence of classroom conflict, the teacher proposes alternatives, applies open lines of communication, makes concessions, accepts responsibility, maximizes similarities, and minimizes existing differences between self and student [24]. Therefore, the integrating strategy is connected with classroom problem-solving, the use of this strategy involves openness and exchanging information, being the ideal strategy in dealing with complex classroom problems [24]. When applying a commitment strategy, the teacher’s objective is an intermediate solution for conflict management, for this, he knows how to reduce differences with the student suggests an exchange of proposals with the student, and provides a quick solution to conflicts in the classroom [24]. This is an intermediate strategy on assertiveness and cooperation, which implies a compromise in the search for an acceptable intermediate position for everyone involved in the conflict [27]. In this way, teachers’ emotional intelligence allows for better conflict management, which supports the development of interpersonal relationships in the classroom and enables a favorable environment for teaching and learning.
So, conflicts involve, in addition to interpersonal skills such as availability for dialog, emotional intelligence skills, which require the perception and recognition of the affective dimension, and the feelings of those involved. In this sense, we can say that the evolution of interpersonal relationships has not kept pace with scientific and technological developments. We were not educated to know how to interpret the language of emotions, just as we did not learn to solve conflict situations. We do not learn to perceive and manage emotions. Thus, the emotions that emerge from conflicts must be the target of attention and discussion, so that teachers and students are aware of their emotions and know how to deal with them.
The concern with improving coexistence in schools, namely about conflict, is mentioned in several studies, whose objectives refer to the understanding of school conflicts, as well as preventing their occurrence through programs aimed at teachers and students [4, 5]. Thus, the school community must develop effective skills for conflict management, increasing self-awareness, and understanding of conflict through formal education sessions.
The manage conflict ability is not innate, so it must be learned through educational interventions. There are different programs that work these skills in the educational context, of which they stand: Recognizing, Understanding, Labeling, Expressing, Regulating (RULER), Social and Emotional Learning (SEL), and the Collaborative for Academic, Social and Emotional Learning (CASEL).
RULER program was created based on the emotional intelligence Mayer-Salovey’s model [30]. This training program focuses on emotional intelligence development and involving the students, parents, teachers, and the entire educational community [31]. RULER focuses on learning skills that deal with issues of interpersonal conflict and teach strategies for emotional regulation. Empirical evidence regarding the effectiveness of RULER programs indicates that they enhance students’ academic performance, improve the quality of learning environments, improve teacher-student relationships and reduce student behavior problems, being a success in reducing violence and abusive classroom behavior [32].
The SEL was developed with the aim of preventing school violence and includes five areas of interconnected skills (self-knowledge, social awareness, self-management and organization, responsible problem solving, and relationship management). Teaching these skills is vital to deal with behavioral, academic, disciplinary, and safety problems, promoting self-awareness, managing emotions, and acquiring skills such as empathy, the ability to perceive different perspectives and points of view, respect for diversity, and the ability to make the right decisions [33]. SEL programs refer to processes of developing socio-emotional competencies, which depend on the individual’s ability to recognize, understand, and manage emotions. These skills are the main building blocks for other outcomes that SEL programs include, such as the ability to persist in the face of challenges, stress management, the ability to develop healthy relationships, build trust in others, and to thrive both in the academic context, as in personal and social life. In a study carried out on more than 213 SEL programs, it was concluded that a school that successfully applies a quality curriculum of the SEL program can achieve behavioral improvements and a positive increase in the results of assessments [34].
CASEL program was created with the aim of establishing social and emotional education in a school context and making it a reality in today’s education. Its purpose is to apply high-quality, evidence-based SEL programs, from pre-school to secondary education [35]. The results of this program reveal significant changes in the socio-emotional capacities, social interactions, and academic results of the students who attended these programs. Among the results, it should be noted that students show greater communication skills, are more collaborative in teamwork, and more resistant to challenges and difficulties [36].
The school is a space for socialization par excellence and, precisely, due to the variety of styles, cultures, and values, it becomes an environment rich in conflicts. Conflict, commonly seen as something negative, destructive, and generating violence, is, in fact, extremely necessary for individual evolution. It should be noted that the conflict itself does not generate violence; this comes when there is a lack of peaceful solutions to conflict resolution, when there is no conflict constructive management.
Among the conflict management methodologies used in the school, the following stand out: arbitration, conciliation, negotiation, and mediation. School arbitration is a dialog process that takes place between the involved in the conflict with the presence of a third party that determines the conflict resolution based on the benefits of the parties with their authority and knowledge [37]. The school conciliation is a dialog process carried out between the involved in the conflict, with the support of a conciliator, who helps them decide, based on their interests and needs. This may present proposals for solutions that the parties can accept or not. The decision-making power belongs to the parties, even if the solution comes from the conciliator [37]. In turn, the school negotiation is a dialog process focused on conflict resolution between the involved in the conflict, which either meet face to face to work together unassisted to conflict resolution. Negotiation is one of the most used conflict management mechanisms in the classroom. The school mediation, this is a dialog process carried out between the parties in conflict, assisted by a third party, the mediator, who should not influence the conflict resolution, acting as a communication facilitator. Inserted in a socio-constructivist paradigm, it is considered not only as of the most current and flexible instrument for peaceful conflict resolution at the educational level, and promote a new culture for conflict management. Arising not only to solve school problems, but equally as a feasible way for creative conflict modification [38].
A more detailed approach to school negotiation is presented as it is considered the most appropriate method for resolving classroom conflicts, in teacher-student relationships. Negotiation includes a set of behavioral skills that teachers must master. It is essentially a well-structured process and based on some tacit behavior, being understood as a process of communicative interaction in which two parties seek to resolve a conflict of interest, use dialog, and progress gradually through mutual concessions. The negotiation process implies several skills, which stand out, effective communication, considered the main tool of the negotiation process.
Effective communication is essential to the school conflicts negotiation, as it enhances: the fear decrease of being rejected, the anxiety reduction produced in the struggle for acceptance and recognition, a greater predisposition to listen to the other and recognize their positive aspects, a strengthening of self-esteem, an increase in the degree of security, and a decrease in defensive-offensive behavior [39].
Concerning the negotiation phases, although there is no consensus on the definition of the negotiation stages, there are at least three that are classically identified [40]: definition of the content and limits of the negotiation (exploratory stage), with the manifestation of antagonism, facing individuals the “dilemma of trust” and the “dilemma of honesty”; negotiation dynamics (dynamic and tactical stage), with manifestations of concession flexibility, systematically assisting proposals and counter-proposals, constituting the central moment of the negotiation process; and, the resolution and agreements stage, this more integrative, brief, and intense phase, almost always implies tension and uncertainty.
These phases testify to the transformation that the negotiations must undergo and must respond to the three negotiation objectives, namely: identification of differences between the parties, making joint decisions, and building a commitment to resolve the conflict.
It should be noted that during a conflict negotiation, it is also important to highlight the importance of [39]:
Empathy: the pillar of good communication and the connection between teacher and student, which allows one to understand each other’s feelings and motivations;
Assertiveness: being able to expose your point of view, emotions, or opinions without provoking a defensive attitude, through a self-affirmative phrase that tells students what to think without blaming you, not putting you as an opponent. Being assertive requires understanding limitations to do another. The teacher when negotiating a conflict must establish his position and build self-confidence thus limiting abuse situations without attacking students;
Active listening: a tool is useful to obtain more information, corroborating data so that the student knows that he was heard. When we listen actively, we are asking, paraphrasing, asking for clarification, defining, and contextualizing. Some ways of they appear can be by echo, repetition of what the other said, reformulation, expressing in words what was understood, resolving points or questions, summarizing and ordering information or reflection of the feeling, an expression of what we perceive of the other; and
Feedback: the teacher must support and encourage positive behavior, correcting the inappropriate ones. To put feedback into practice, it is necessary to let the student know what the teacher feels and what he thinks.
That way, thinking of the joint construction of solutions to the conflict, through the correct use of empathy, assertiveness, active listening, and feedback can make those involved in the conflict evaluate their actions and rethink their attitudes, discovering ways to solve the problems, trying to maintain respect and balance. Knowing how to listen, evaluate, rethink with everyone involved in the conflict, creating the habit of dialog. Because when those involved in the conflict participate in the construction of possible actions for solutions, relationships can be restored, and the conflict constructively resolved. Therefore, classroom conflicts when managed constructively contribute to the preservation of interpersonal bonds and promote the socio-emotional skills of involved, since it makes possible to develop skills to know how to see reality from the perspective of the other, knowing how to cooperate, and also learn that conflict is an opportunity for growth and maturation.
As seen, although conflicts have negative impacts in general, the constructive and destructive consequences of conflict depend on the management skills of the individuals who experience it [25]. Effective conflict management strategies minimize the conflict negative impacts and enhance the positive ones, helping to improve interpersonal relationships and job satisfaction at school.
In general, teachers and the school ignore the importance of conflicts in the integral development of the student and training as autonomous citizens. In this way, most schools do not conceive of conflict resolution as an integral part of the curriculum, emphasizing only the contents of the curricular subjects. They leave aside interpersonal relationships, homogenizing the training of students without promoting the development of problem and conflict management skills. Thus, for the educational potential of the conflict to be truly used in the school context, it is necessary that the community, and especially teachers and management bodies, recognize the conflict possibilities. Constructive management of school conflicts is important and necessary for new generations to learn to live with social differences.
In this sequence, educational action is required, intentionally aimed at conflict management as an element inherent to the human condition and indispensable to democratic societies. Therefore, the formative potential of the conflict depends on the strategies used to resolve the conflict and the management that takes place. The way to conflict management, in turn, depends on how those involved experience the conflict. Therefore, the negative view of the conflict and the lack of perception of its educational potential can prevent those involved from developing essential skills such as respect for diversity, respect for the rights of others, and availability for dialog.
Pérez-de-Guzmán et al. [7] indicate that training in conflict management, generates very positive results in all members of the educational community, verifying a reduction in the interpersonal conflict between teacher-student. Also, Massabni [41] defends the urgency to prepare teachers to face professional conflicts; otherwise, we will have a generation of teachers able to succumb to the pressure that the profession is going through, to accept the reduction of their action, their status, and to share their commitments with other professionals, who take away the property of regulating their work. It is necessary to support teachers and provide them with tools to develop their ways of managing conflicts.
By making conflicts the subject of reflection and explaining the professional context in which teachers work is, in the opinion of [41], the commitment of the different higher education institutions that form them. It is important to work not only on the training of future teachers but also on training in the active teachers in conflict management, small or large, which inevitably emerge in the teacher-student relationship, throughout their professional life. Also, the Freire et al. [42] results support the importance of professional development opportunities with a focus on facilitating the relationship of teachers with students with perceived challenging behavior.
The school is an institution that reproduces a microcosm of society, bringing together diverse identities. This context with diverse personalities, rules, and values is full of conflicts, problems, and differences between the different actors that make up the school (students, teachers, staff, and parents). Thus, the school system, in addition to involving a range of people, with different characteristics, includes a significant number of continuous and complex interactions, depending on the stages of development of each one. So, school is a place where individuals with different characteristics, backgrounds, experiences, and personalities live together daily. Among so many differences, naturally, divergences of the most diverse species arise. It is essential, then, the proper management of conflicts that may arise so that harmony and respect are present in the school of the main causes presented for the school conflict, we highlight family problems. Being the family the main student emotional support, it becomes the life model of this. In this way, unstable and weakened family relationships directly affect the behavior of your children, behaviors that these after reproduced in the school social relationships. The families of the most deprived students are considered less functional. They do not contribute to the growth of positive feelings, they do not carry out good communication between family members, nor do they assist in healthily making decisions that are, based on the exchange of ideas together instead of imposition. In this sequence, students from more dysfunctional families need school increased support to learn and develop interpersonal skills. Thus, family and school must go together to contribute to the conflict becoming part of a process of growth, acceptance of the other, and accountability. Learning to deal with conflicts positively is essential for the development of healthy relationships.
The school, by bringing together people from different social groups with different values and worldviews, becomes a locus for conflicts. Thus, the conflict must be understood as a reality inherent to the educational context, and the school, as responsible for the education of values and skills for living together must be differently prepared to deal with the conflicts that occur in it.
Conflicts of various types have always been present in the classroom, and the causes that originate them are of great importance, as they allow a better conflict understanding and, consequently, a more correct intervention to its management. It should be noted that personal harmony and the development of attitudes that promote understanding, dialog, and tolerance are indispensable for negotiating conflicts in the teacher-student relationship. The way to intervene in classroom conflicts is essential in education, not only in terms of content, but also as a series of vital procedures in interpersonal relationships. As Lapponi [39] points out, for conflicts correct negotiation with the student, it is necessary to communicate effectively, cooperate, decide responsibly, and so teach to resolve conflicts.
Ending school conflict is impossible, since they are intrinsic to the human being, being an integral part of their development and the interpersonal relationships they experience daily. Learning to live with school conflict requires creating attitudes of openness, interest in differences, and respect for diversity, teaching how to recognize injustice, taking measures to overcome it, resolving differences constructively, and moving from conflict situations to reconciliations. So, it is essential that the initial and continuous training of teachers encompasses conflict management, providing them with tools so that they can resolve the conflicts they experience in the classroom.
In summary, it is important to conflict face and resolve it with skills to manage it properly and constructively, establishing cooperative relationships, and producing integrative solutions. Harmony and appreciation should coexist in a classroom environment and conflict should not interfere, negatively, in the teaching and learning process.
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Aalborg University has Two Satellite Campuses, one in Copenhagen (Aalborg University Copenhagen) and the other in Esbjerg (Aalborg University Esbjerg).\n· He is a member of prestigious IEEE (Institute of Electrical and Electronics Engineers), and IAENG (International Association of Engineers) organizations. \n· He is the chief Editor of the Journal of Software Engineering.\n· He is the member of the Editorial Board of International Journal of Computer Science and Software Technology (IJCSST) and International Journal of Computer Engineering and Information Technology. \n· He is also the Editor of Communication in Computer and Information Science CCIS-20 by Springer.\n· Reviewer For Many Conferences\nHe is the lead person in making collaboration agreements between Aalborg University and many universities of Pakistan, for which the MOU’s (Memorandum of Understanding) have been signed.\nProfessor Akbar is working in Academia since 1990, he started his career as a Lab demonstrator/TA at the University of Sussex. After finishing his P. hD degree in 1992, he served in the Industry as a Scientific Officer and continued his academic career as a visiting scholar for a number of educational institutions. In 1996 he joined National University of Science & Technology Pakistan (NUST) as an Associate Professor; NUST is one of the top few universities in Pakistan. In 1999 he joined an International Company Lineo Inc, Canada as Manager Compiler Group, where he headed the group for developing Compiler Tool Chain and Porting of Operating Systems for the BLACKfin processor. The processor development was a joint venture by Intel and Analog Devices. In 2002 Lineo Inc., was taken over by another company, so he joined Aalborg University Denmark as an Assistant Professor.\nProfessor Akbar has truly a multi-disciplined career and he continued his legacy and making progress in many areas of his interests both in teaching and research. 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