title: Signet ring cell adenocarcinoma and bilateral leptomeningeal involvement of optic nerve sheaths.
abstract: Signet ring cell adenocarcinoma has a propensity for leptomeningeal carcinomatosis, and although bilateral optic nerve involvement is rare, this may occur with or without obvious signs of diffuse leptomeningeal involvement. We describe a 41-year-old woman who presented with a brief history of simultaneous bilateral visual deterioration and a distended abdomen. Examination revealed bilateral no light perception vision and bilateral optic disc edema. Radiologic work-up showed large multiple pelvic masses involving the ovaries, multifocal boney deposits, and widespread central nervous system carcinomatosis, involving the optic nerves and the first, fifth, and eighth cranial nerves. Biopsy of an ovarian mass demonstrated islands of signet ring cells. Signet cell adenocarcinomatous infiltration of the leptomeningeal space should be considered in cases of bilateral simultaneous vision loss with signs suggestive of leptomeningeal infiltration of the optic nerve sheath.
authors.affiliation: Department of Ophthalmology (JNM), North Bronx Health Network; Department of Ophthalmology & Visual Sciences (JNM), Albert Einstein College of Medicine of Yeshiva University, Bronx, New York; Departments of Ophthalmology (MQH, SAAH), Pathology (AMT), Gynecologic Oncology (SHH), and Neuro-radiology (MAD), King Faisal Specialist Hospital, Riyadh, Saudi Arabia; and the Al Faisal University College of Medicine (SAAH), Riyadh, Saudi Arabia.
authors.forename: Joyce N
authors.initials: JN
authors.lastname: Mbekeani
authors.forename: Mohammed Q
authors.initials: MQ
authors.lastname: Haseeb
authors.forename: Asma M
authors.initials: AM
authors.lastname: Tulbah
authors.forename: Salem H
authors.initials: SH
authors.lastname: Hamed
authors.forename: Selwa A
authors.initials: SA
authors.lastname: Al Hazzaa
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Dogar
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008577:Meningeal Neoplasms / Q000473:pathology*; D009186:Myelin Sheath / Q000473:pathology*; D009900:Optic Nerve / Q000473:pathology*; D014057:Tomography, X-Ray Computed