Progressive enlargement of acquired retinal astrocytoma in 2 cases.
OBJECTIVE
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.


METHODS
Interventional case reports.


METHODS
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.
Shields
Carol L
CL
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. carol.shields@shieldsoncology.com
Shields
Jerry A
JA
Eagle
Ralph C
RC
Cangemi
Francis
F
D000293:Adolescent; D000328:Adult; D001254:Astrocytoma / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D009366:Neoplasm Seeding; D012163:Retinal Detachment / Q000175:diagnosis; D019572:Retinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D014463:Ultrasonography; D014823:Vitreous Hemorrhage / Q000175:diagnosis