Optic nerve and chiasmal germinoma.
A 15-year-old boy presented with visual acuity of 20/200 OD and no light perception OS. The anterior segment of the left eye showed a relative afferent pupillary defect. A large (4.5 x 4.5 x 2.0 mm) infiltrative optic nerve head lesion with dilated vessels was seen OS with disc pallor OD. MRI of the brain and orbit revealed lobulated optic nerve thickening and chiasm. A biopsy revealed features consistent with germinoma and was positive for marker placental alkaline phosphatase. Systemic examination, chest x-ray, abdominal ultrasound, cerebrospinal fluid, and serology were normal. He received 27 Gy to the craniospinal region followed by a boost of 27 Gy to the left optic nerve. Eight months postirradiation, vision stabilization was achieved with 20/200 OD and light perception with inaccurate projection of rays OS.
Rath
Suryasnata
S
Ocular Oncology Service, L.V. Prasad Eye Institute, Bhubaneswar, India. suryasnata@lvpei.org
Vemuganti
Geeta K
GK
Biswas
Ghanashyam
G
Mod
Hemendra
H
D000293:Adolescent; D000469:Alkaline Phosphatase / Q000032:analysis; D005260:Female; D005654:Fundus Oculi; D018237:Germinoma / Q000150:complications / Q000175:diagnosis* / Q000201:enzymology / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009897:Optic Chiasm / Q000473:pathology; D009900:Optic Nerve / Q000473:pathology; D019574:Optic Nerve Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000201:enzymology / Q000532:radiotherapy*; D010920:Placenta / Q000201:enzymology; D013997:Time Factors; D014786:Vision Disorders / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity / Q000528:radiation effects
D000469:Alkaline Phosphatase