title: SOLITARY CIRCUMSCRIBED "PEARL WHITE" RETINAL MASS (SO-CALLED RETINAL ASTROCYTIC PROLIFERATION) RESIDES IN DEEP RETINA OR BENEATH RETINA: FINDINGS ON MULTIMODAL IMAGING IN 4 CASES.
abstract: OBJECTIVE
  To report novel observations of previously described solitary circumscribed retinal astrocytic proliferation using spectral domain optical coherence tomography that suggests this tumor does not arise in the nerve fiber layer as initially believed, but arises within deep retinal or retinal pigment epithelial structures.
  
  
  METHODS
  Retrospective review of four cases.
  
  
  RESULTS
  Patient age ranged from 46 to 75 years. The tumor was pearl white or yellow-white (n = 4, 100%), located in the macula (n = 1, 25%) or macula to equator (n = 3, 75%) regions, and with mean tumor base of 1.2 mm and thickness of 0.8 mm. There were no feeding vessels, intrinsic vessels, subretinal fluid, or vitreoretinal traction. Mild surrounding retinal pigment epithelial hyperplasia and atrophy rimmed each tumor (n = 4, 100%). Fluorescein angiography depicted the mass with early hypofluorescence (n = 3/3, 100%) and late hypofluorescence (n = 2/3, 67%). Spectral domain optical coherence tomography demonstrated the mass with an abruptly elevated "snowball" configuration (n = 4, 100%), with smooth or slightly irregular surface (n = 4, 100%), and originating from deep retina or retinal pigment epithelial (n = 4, 100%), with overlying compression and draping of retinal tissue (n = 4, 100%).
  
  
  CONCLUSIONS
  This previously described small yellow-white retinal tumor appears to arise in the outer retinal layers and not from the inner retinal layers as formerly believed. This tumor may not be astrocytic as initially believed since it arises deep within the retina, but it could represent a deep glial or pigment epithelial fibrous mass. The pathogenesis and pathology of this rare lesion remain unknown.
authors.affiliation: *Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; †Retina-Vitreous Associates Medical Group, Los Angeles, California; and ‡Retina-Vitreous, Macula Associates, New York City, New York.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Richard
authors.initials: R
authors.lastname: Roe
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Yannuzzi
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000368:Aged; D001253:Astrocytes; D001254:Astrocytoma / Q000000981:diagnostic imaging*; D049109:Cell Proliferation; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D019572:Retinal Neoplasms / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity