A Case of Orbital Pilocytic Astrocytoma in the Philippines
Author: Zyrene Mary Chantal Urgel
Base Hospital / Institution: Rizal Medical Center
ePoster presentation
Abstract ID: 24-111
Purpose
This report aims to discuss the clinical, radiologic and histopathologic features of an optic nerve glioma and its management. To our knowledge, this is the first locally reported case of optic nerve pilocytic astrocytoma.
Methods
A nine-year-old female had a five-year history of gradual proptosis of the left eye and subsequent loss of vision. Ocular examination was done which showed no light perception with a 10 x 6 x 9.5 cm axial, downward and lateral displacement of left eye. Birth history, developmental history and past medical history were all unremarkable with no signs and symptoms of neurofibromatosis.
Diagnostic tests such as computed tomography scan of the orbits and incision biopsy were done. Orbital exenteration was also performed to remove the painful and cosmetically disfiguring left orbital mass.
Results
Orbital CT Scan revealed a complex hypodense mass which extends minimally to the left aspect of suprasellar cistern and is not associated with any orbital bone defect, erosion or hyperostosis.
Incision biopsy at the superomedial part of the upper eyelid revealed reactive lymphoid aggregates indicating a chronic inflammatory process rather than malignancy. Immunohistochemical markers for lymphoproliferative malignancies (CD3, CD20) were also negative.
Orbital exenteration was then performed with histopathology findings of the retrobulbar tissue a Low-Grade Glioma. Immunohistochemical staining of Glial Fibrillary Acidic Protein favors Pilocytic Astrocytoma.
Conclusion
Optic nerve glioma is a rare orbital tumor that poses as a diagnostic challenge to ophthalmologists. It presents as a chronically inflamed anteriorly displace eye due to the enlarging optic nerve tumor. A high level of suspicion is essential when initial biopsies do not match the clinical findings. Radiologic imaging studies render reliable basis for surgical planning. Histopathologic evaluation provides definitive diagnosis. Exenteration may be justified in painful cosmetically disfiguring cases. Adjunctive chemotherapy and radiotherapy were not warranted in the absence of optic chiasm and brainstem involvement.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Elaine Marie | Yatco-Omaña | Rizal Medical Center |
| Eric Constantine | Valera | Rizal Medical Center |
| Andrei | Martin | Rizal Medical Center |
