Journal List > J Korean Ophthalmol Soc > v.55(10) > 1009818

Kim, Jung, Paik, and Yang: A Case of Huge Pilocytic Astrocytoma Causing Eyeball Subluxation

Abstract

Purpose

To report a relatively rare case of huge pilocytic astrocytoma of the optic nerve and optic chiasm causing eyeball subluxation.

Case summary

An eight-year-old male presented with proptosis and visual loss in the left eye for one year. The radiological findings showed a 2.9 × 2.7 × 4.2-cm tumor on the left optic nerve and optic chiasm. For diagnosis and treatment, the patient underwent tumor resection and enucleation. Pathohistological analysis of the tumor specimen revealed pilocytic astrocytoma, which is classified by the World Health Organization as a grade I astrocytic tumor.

Conclusions

Astrocytoma is a tumor of the brain that affects children more often than adults. In general, gross-total resection of pilocytic astrocytoma is expected to be curative due to the non-invasive feature of the tumor. Considering pilocytic astrocytoma as differential diagnosis of orbital tumor in children with symptoms of rapidly progressive proptosis and decreased visual acuity is important because occurrence in the optic nerve and optic chiasm is possible.

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Figure 1.
(A) Photograph of the patient taken at the first visit to the hospital shows severe proptosis and subluxation of the left eye. (B) Left eyeball is infero-laterally deviated (40-PD LXT, LHT by Hirschberg test).
jkos-55-1543f1.tif
Figure 2.
Photographs show limitation of the left eyeball movement for adduction and upward gaze. (A) Right side gaze, (B) left side gaze, (C) downward gaze, (D) upward gaze.
jkos-55-1543f2.tif
Figure 3.
(A) 2.9 × 2.7 × 4.2-cm-sized enhancing mass involving the left optic nerve and optic chiasm (Orbit MRI (T1-weighted fat-suppressed gadolinium-enhanced image): A: axial view; B: coronal view; C: sagittal view).
jkos-55-1543f3.tif
Figure 4.
Gross specimen of the optic nerve and optic chiasm astrocytoma, measuring 3.3 × 3.0 × 2.3 cm.
jkos-55-1543f4.tif
Figure 5.
(A) Round and piloid cells constitute this tumor; Rosenthal fibers (arrow) is seen (H&E stain, ×100). (B) Immunohistochemical stains (×100), positive for (B-1) CD34, (B-2) Glial Fibrillary Acidic Protein (GFAP), (B-3) Synapto- physin, (B-4) Oligodendrocyte transcription factor (OLIG-2).
jkos-55-1543f5.tif
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