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Optic nerve pilocytic astrocytoma with retinal involvement.Arch
Soc Esp Oftalmol. 2005 Dec;80(12):733-6
INTRODUCTION:
This is an atypical case of a pilocytic astrocytoma that involved
the optic nerve (ON) and the retina. CLINICAL CASE: The patient was
a 30-year-old male, who had attended ONCE since his early childhood
because of the suspicion of an intraocular tumor. The ophthalmology
exploration showed an ON and retinal coloboma in the right eye and
microphthalmy, shutting of the pupil, retinal detachment and proof
of an intraocular tumor in the left eye. The MR revealed an ON tumor
that involved the retina. The histopathological study after
enucleation was pilocytic astrocytoma. DISCUSSION: Long standing
congenital pathology in a blind patient does not exclude the
possibility of the patient suffering from other pathology as well.
Intraocular
astrocytoma without phacomatosis.
Eur J Ophthalmol. 2004 Jul-Aug;14(4):350-4.
PURPOSE:
Astrocytic tumors occur in the retina or in the optic disc usually
as a part of tuberous sclerosis complex or other phacomatosis and
their isolated occurrence is rare. The authors present two adult
patients in whom the diagnosis of intraocular astrocytoma was
established but no signs of phacomatosis were revealed.
Progressive
enlargement of acquired retinal astrocytoma in 2 cases.Ophthalmology.
2004 Feb;111(2):363-8
PURPOSE: To
document 2 cases of progressively enlarging retinal astrocytoma that
caused exudative retinal detachment, vitreous hemorrhage, and tumor
seeding, simulating retinoblastoma in 1 case and choroidal melanoma
in the other. DESIGN: Interventional case reports. PARTICIPANTS: Two
patients. METHODS: Two patients with visual loss from an atypical,
enlarging amelanotic retinal mass were evaluated. The first patient,
a 14 year-old otherwise healthy girl, had a noncalcified gelatinous
retinal mass with prepapillary involvement and surrounding retinal
traction, as well as overlying vitreous hemorrhage and vitreous
seeds. Over 37 months, the tumor grew in basal dimension from 4 mm
to 10 mm. Retinal astrocytoma was suspected, but the presence of
tumor enlargement and vitreous seeding raised concern for possible
retinoblastoma. Fine-needle aspiration biopsy was performed. The
second patient, a 33-year-old woman, had an amelanotic mass develop
in the macula of her amblyopic left eye. Over 2 years, the mass
enlarged to 9.5 mm in basal dimension and 6.3 mm in thickness, and
total serous retinal detachment developed. Choroidal melanoma with
retinal invasion was clinically suspected. Enucleation was
performed. RESULTS: In patient 1, cytologic examination revealed
bland spindle cells with fibrillar cytoplasm consistent with an
astrocytic tumor of the retina. Enucleation was subsequently
performed because of continued tumor growth, progressive retinal
detachment, and visual loss. Histopathologic examination confirmed
astrocytoma of the retina and optic disc. In patient 2, enucleation
revealed astrocytoma of the retina and optic disc with total retinal
detachment. There was no evidence of systemic tuberous sclerosis in
either patient. CONCLUSIONS: Retinal astrocytoma can show
progressive enlargement, retinal detachment, and vitreous seeding,
findings that can mislead the clinician toward the diagnosis of
retinoblastoma or choroidal melanoma.
Invasive
giant cell astrocytoma of the retina in a patient with tuberous
sclerosis.Ophthalmology.
1999 Mar;106(3):639-42.
OBJECTIVE:
To report an unusual case of giant cell astrocytoma of the retina.
DESIGN: Case report. INTERVENTION: A 10-month-old girl with tuberous
sclerosis was found to have bilateral astrocytic hamartomas, the
right eye being prominently involved by elevated and pedunculated
lesions. At 7 years of age, she had posterior subcapsular cataract,
retinal detachment, and subretinal exudation develop in the right
eye. At 12 years of age, her blind, painful right eye had to be
enucleated because of neovascular glaucoma and a spontaneous scleral
perforation. RESULTS: Histopathologic examination showed that the
entire vitreous cavity was filled with a mixture of tumor,
granulation tissue, and necrotic debris. Part of the tumor was
composed of spindle-shaped glial cells. The remainder was composed
of large gemistocytic cells that contained large atypical nuclei and
copious amounts of cytoplasm, which was intensely eosinophilic in
some areas. The tumor contained foci of necrosis and rare mitotic
figures. It had infiltrated the parenchyma of the retrolaminar nerve
and extended to the surgical margin. Areas of unequivocal choroidal
invasion were also identified. The tumor cells were intensely
immunoreactive for neuron-specific enolase and S-100 protein. In
contrast, glial fibrillary acidic protein was only minimally
positive. CONCLUSIONS: The histologic and immunohistochemical
features of this retinal tumor resemble those of subependymal giant
cell astrocytoma, a characteristic lesion in tuberous sclerosis.
Although this unusual giant cell astrocytoma of the retina had
atypical histopathologic features and local aggressive behavior, the
systemic prognosis was excellent.
Solitary
retinal astrocytoma with "acoustic shadowing".Klin
Monatsbl Augenheilkd. 1995
Mar;206(3):188-9.
PATIENT: A
polycyclic lesion slightly prominent and yellowish in colour with a
mulberry-like surface was incidentally detected in the left eye of a
69-year-old white female. It was located in the nasal horizontal
sector of the fundus in a distance of about 5.5 mm from the optic
disk. It was surrounded by a bright halo. Retinal arterioles
penetrated the lesion superficially and more deeply. The vitreous
body was unremarkable. Visual acuity was 0.8 to 1.0 p with a
hyperopia of 3.5 dpt. Intraocular pressure was 116 mm Hg. In both
eyes partially confluent drusen of the retinal pigment epithelium
were present without a serous detachment of the retina. Ultrasound
examination revealed an ovally shaped, 1.3-mm prominent solid tumor
consisting of highly reflective granular internal echoes with
acoustic shadowing behind. X-ray of the skull showed punctate
calcifications in the medial orbit. The brain was unremarkable
(incl. MRI). In fluorescein angiography the whole tumor was
diffusely stained without signs of leakage or subretinal
neovascularization. On red-free wide-angle photographs of the
retinal nerve fiber layer no localized defects were detected.
Neurological and dermatological examination were unremarkable
without any hints for tuberous sclerosis or neurofibromatosis. All
these findings led to the diagnosis of a solitary retinal
astrocytoma. With no therapy performed, the functional and
morphological status of the eye remained unchanged one year later.
CONCLUSION: A retinal astrocytoma is a hamartoma that usually shows
no tendency to grow and there is no need for treatment. It can
rarely be the reason of a serous retinal detachment or vitreous
hemorrhage. Especially solitary astrocytomas have sometimes been
reported to show a tendency towards severe intraocular damage.
Additional calcifications showing acoustic shadowing in ultrasound
examination are important for the differential diagnosis of
retinoblastoma.
Astrocytic
tumors of the retina. Differentiation of sporadic tumors from
phakomatosis-associated tumors.
Arch Pathol Lab Med.
1984 Feb;108(2):160-3.
A single,
1.3-cm, intraocular tumor, composed of interlacing, spindle-shaped
astrocytes, involved the retina and optic disc of a 13-month-old
girl. Neither the patient nor her family had stigmas of a
phakomatosis. We found 42 previous cases of histologically
documented astrocytic tumors of the retina. Twenty-four patients
(57%) had tuberous sclerosis, six patients (14%) had
neurofibromatosis, and 12 patients (29%) were otherwise normal.
Patients with tuberous sclerosis usually had multiple, peripheral,
retinal tumors containing giant "astrocytes." Patients with
neurofibromatosis and otherwise normal patients more frequently had
disc-based tumors. However, three patients (50%) with
neurofibromatosis had multiple tumors, whereas multiplicity occurred
in only one of the patients in the sporadic group. We conclude that
if the tumor is single, is disc based, and lacks giant cells, the
patient is not at great risk of tuberous sclerosis.
Giant cell
astrocytoma of the retina. A tumor of possible Mueller cell origin.Ophthalmology.
1983 Dec;90(12):1565-76.
A
5-month-old boy presented with a right retrolental mass and
glaucoma. Both B-scan ultrasonography and CAT scanning failed to
disclose any evidence of intralesional calcification, the absence of
which is unusual for retinoblastoma. An aqueous lactic dehydrogenase
(LDH) determination disclosed elevated levels of this enzyme, which
were six times that detected in the blood. Pathologic examination of
the enucleated globe revealed rubeotic glaucoma, and a massively
necrotic retinal tumor that had filled the vitreous cavity. A small
focus of viable tumor in the posterior pole of the lesion displayed
a population of rounded astrocytic giant cells, with abundant
eosinophilic cytoplasm and eccentrically placed vesicular nuclei
possessing prominent nucleoli. The cytoplasm of these tumors cells
contained a moderate number of PTAH-positive fibrils, and these were
identified positively as glial in nature by immunoperoxidase
reaction for the presence of glial fibrillary acidic protein (GFAP).
Mueller cells in a portion of surviving retina also stained
positively for GFAP. Electron microscopic studies performed on a rim
of surviving tumor cells abutting the subretinal space demonstrated
features consistent with a Mueller cell origin, namely, abundant
profiles of smooth and rough-surfaced endoplasmic reticulum and
elaborate villous processes, the latter being typically produced by
Mueller cells as they project beyond the external limiting membrane
of the retina.
Retinal
phacomas. Apropos of 10 cases of astrocytoma.J
Fr Ophtalmol. 1983;6(3):275-90.
Clinical and
angiographic findings in 10 cases of retinal astrocytomas seen at
the Clinique Ophtalmologique de Creteil are described. Classical
features concerning onset of the disease, clinical aspects, and
evolution of these tumors are confirmed. Some atypical findings are
reported, including the marked proportion of isolated astrocytomas
unrelated to phacomatosis, and the high frequency of complications
of these lesions, usually considered to be stable.
Localization
of glial fibrillary acidic protein in retinal astrocytoma: an
immunohistochemical study.Curr
Eye Res. 1982-1983;2(8):523-7.
Glial
fibrillary acidic protein (GFA) is found in glial filaments, and is
specific for reactive or neoplastic astrocytes and ependyma. Using a
commercially available antibody to GFA protein, a retinal neoplasm
from a patient with neurofibromatosis is intensely stained with the
brown immunoperoxidase reaction product. Rather than the less
specific phosphotungstic acid hematoxylin (PTAH) or Holzer's stain,
antibody to GFAP protein is a relatively rapid, simple, and reliable
immunohistochemical technique for formalin-fixed and
paraffin-embedded tissue.
Retinal
astrocytoma.Am
J Ophthalmol. 1979 Jul;88(1):32-6.
A
41-year-old man had a 6 x 6 x 5-disk diameter amelanotic tumor in
the posterior fundus. The clinical and fluorescein angiographic
appearance suggested a benign retinal vascular tumor, although
amelanotic choroidal melanoma and retinoblastoma were diagnostic
possibilities. An incisional 48-hour radioactive phosphorus (32P)
uptake test was performed and the result showed an increased uptake
over the tumor mass of 100% as compared to the control quadrants.
The globe was enucleated and the pathologic diagnosis was isolated
astrocytic glioma of the retina with minimal, if any, malignant
potential. The highly developed vascular system of the tumor
probably contributed to the false-positive test result.
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