A Case of Huge Pilocytic Astrocytoma Causing Eyeball Subluxation

Eun Yeong Kim; Su Kyung Jung; Ji Sun Paik; Suk Woo Yang

doi:10.3341/jkos.2014.55.10.1543

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

Case Report

J Korean Ophthalmol Soc 2014;55(10):1543-1548.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.10.1543

A Case of Huge Pilocytic Astrocytoma Causing Eyeball Subluxation

Eun Yeong Kim, MD, Su Kyung Jung, MD, Ji Sun Paik, MD, PhD, Suk Woo Yang, MD, PhD

Department of Ophthalmology and Visual Science, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to Suk Woo Yang, MD, PhD, Department of Ophthalmology, The Catholic University of Korea, Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea, Tel: 82-2-2258-2846, Fax: 82-2-599-7405 E-mail: yswoph@hanmail.net

Received 24 May 2014 Revised 8 July 2014 Accepted 17 September 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Optic chiasm, Optic nerve, Pilocytic astrocytoma

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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).

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.

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).

Figure 4.

Gross specimen of the optic nerve and optic chiasm astrocytoma, measuring 3.3 × 3.0 × 2.3 cm.

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).

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