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Optic nerve metastasis caused by lung adenocarcinoma
Metástasis de nervio óptico secundaria a adenocarcinoma de pulmón
F. Hernández Pardines
, J.C. Molina Martín, L. Fernández Montalvo, A. Juárez Marroquí
Corresponding author
Hospital Universitario San Juan de Alicante, San Juan, Alicante, Spain
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A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "555" "paginaFinal" => "558" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome del microftalmos posterior-drusas papilares-retinosis pigmentaria asociado a puntos blancos. 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Hernández Pardines, J.C. Molina Martín, L. Fernández Montalvo, A. Juárez Marroquí" "autores" => array:4 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Hernández Pardines" "email" => array:1 [ 0 => "oftalmofer@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.C." "apellidos" => "Molina Martín" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Fernández Montalvo" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Juárez Marroquí" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitario San Juan de Alicante, San Juan, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metástasis de nervio óptico secundaria a adenocarcinoma de pulmón" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 649 "Ancho" => 1500 "Tamanyo" => 95973 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">RE papillary edema in inferior sector with marked vascular tortuosity. LE exhibits small navicular hemorrhage with a white central spot (Roth spot) in the superotemporal vascular arcade, and a 0.5<span class="elsevierStyleHsp" style=""></span>mm diameter solitary whitish infiltrates in the inferior temporal arcade with well defined edges.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Optic nerve metastases are very infrequent.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> When the optic nerve is affected by a metastatic lesion, it is usually an extension from the choroid, orbit or CNS.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> The primary tumors that most frequently compromise ocular structures are carcinoma of the breast, lung and stomach in adults and acute leukemia in children.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,4,5</span></a> The case of an optic nerve metastasis in a patient with lung adenocarcinoma in stage IIIa is reported.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Clinic case</span><p id="par0010" class="elsevierStylePara elsevierViewall">Female, 57, diagnosed in 2014 with lung adenocarcinoma in stage IIIa, for which reason surgical treatment was performed in association with chemotherapy and adjuvant radiotherapy. Six months after diagnostic the patient experienced a relapse, exhibiting pleuro-pulmonary metastasis confirmed with biopsy, which was treated with first-line chemotherapy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Four months later, the patient visited the emergency section referring sudden visual acuity loss in the right eye (RE). Ophthalmological examination revealed best corrected visual acuity of no perception of light in the RE and of 1 in the left eye (LE) as per the Snellen chart, with relative afferent pupil defect in the RE. Intraocular pressure was 14<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in the RE and 16 in the OI, with normal extrinsic ocular motility examination. Anterior pole did not exhibit alterations. Ocular fundus showed papilla edema in the inferior sixth with marked vascular tortuosity in the RE. The LE showed a small navicular hemorrhage with a white central spot (Roth spot) in the superotemporal vascular arc, while the inferior temporal arc showed a single whitish infiltrate having a diameter of approximately 0.5<span class="elsevierStyleHsp" style=""></span>mm with well-defined edges (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Nuclear magnetic resonance (NMR) was requested, which showed enhanced contrast near the right orbital apex. This was interpreted as nerve metastasis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Orbit echography did not reveal obvious alterations.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Considering personal pathological history, physical examination findings and NMR results with and without contrast, optic nerve metastasis diagnostic was established.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was referred to the Oncology Section for treating a second metastatic relapse with chemotherapy, consisting in intravenous nivolumab and palliative holocranial radiotherapy. Despite said treatment, the patient died 2 months later due to significant overall deterioration. Consent for autopsy was not given.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">Metastases constitute the first cause of intraocular malignity and affect approximately 2–7% of patients with cancer.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> In most cases, metastases express in the choroid, probably due to abundant vascularization through the posterior short ciliary arteries.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Optic nerve compromise is much less frequent, with isolated presentation being extremely rare. The series by Ferry and Font<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> and Shields et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> reported metastatic optic nerve compromise in only 1.3% and 4.5% respectively of patients with cancer. In what concerns the origin of said optic nerve metastases, in 47% of cases the primary tumors are located in the breast, 25% in the lung, 3% in the kidneys and gastrointestinal tract, 2% in the testicles, 1% in the prostate, pancreas, thyroids and skin melanoma.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> In addition, isolated cases associated to primary tumors in the female genital apparatus have been reported.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Primary tumor location is unknown in 15% of cases.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Signs and symptoms of ocular presentation vary depending on size, location and side effects caused by the tumor. Blurred vision and ocular pain are the most frequent symptoms.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a> In the present case, the dissociation between the large visual acuity deterioration and ocular fundus findings must be noted. In fact, NMR allowed to locate the lesion at the orbital apex, leading to expect retrobulbar optic neuropathy. However, the patient exhibited papillary edema that compromised only the lower half, which gives reason to consider that the metastatic optic neuropathy was complicated by a NOIA secondary to possible compromise of the retrobulbar vascular tree, giving rise to papillary infarct.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the present patient, tumor was suspected due to pathological antecedents, sudden visual acuity loss in the RE and papilla edema. The Roth spot found in the fellow eye could be associated to chronic anemia and platelet disorders exhibited by the patient, although the presence of micro-metastasis mainly related to the whitish retinal infiltrate in the inferior temporal vascular arch was not discarded.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Optic nerve metastases are an infrequent condition which must be suspected in patients with oncological antecedents presenting deteriorated visual acuity, even more so when some type of infiltrative lesion is found at the level of the optic nerve.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">No conflict of interest was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres933128" "titulo" => "Abstract" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Case report" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec907507" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres933129" "titulo" => "Resumen" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec907508" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-11-10" "fechaAceptado" => "2017-01-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec907507" "palabras" => array:3 [ 0 => "Lung cancer" 1 => "Optic nerve metastasis" 2 => "Roth spot" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec907508" "palabras" => array:3 [ 0 => "Cáncer de pulmón" 1 => "Metástasis de nervio óptico" 2 => "Manchas de Roth" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Isolated optic nerve metastases are extremely uncommon. Many cases are associated with involvement from locations such as the choroid, orbit, or central nervous system. Optic nerve metastases often have their origin in primary tumors of the breast, lung, and stomach, in adults.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The case is presented of a 57 year-old woman with a diagnosis of lung adenocarcinoma. Her first complaint was a sudden loss of visual acuity in her right eye. The diagnosis of optic nerve metastases was made based on her history, and the results of the MRI scan.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Isolated optic nerve metastases are an uncommon condition, but should be suspected in any patient with a history of oncology who has deteriorated visual acuity.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Case report" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introducción</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las metástasis del nervio óptico aisladas son extremadamente infrecuentes. Muchos casos se asocian con afectación de otras localizaciones como la coroides, órbita o el sistema nervioso central.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Caso clínico</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Mujer de 57 años de edad con el diagnóstico de adenocarcinoma de pulmón con pérdida brusca de la visión del ojo derecho. Ante los hallazgos encontrados y los resultados de la RMN se realiza el diagnóstico de metástasis del nervio óptico.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discusión</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las metástasis de nervio óptico aisladas son un cuadro infrecuente, pero que tendremos que sospechar en todo paciente con antecedentes oncológicos que presenten un deterioro de la agudeza visual.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Caso clínico" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hernández Pardines F, Molina Martín JC, Fernández Montalvo L, Juárez Marroquí A. Metástasis de nervio óptico secundaria a adenocarcinoma de pulmón. Arch Soc Esp Oftalmol. 2017;92:552–554.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 649 "Ancho" => 1500 "Tamanyo" => 95973 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">RE papillary edema in inferior sector with marked vascular tortuosity. LE exhibits small navicular hemorrhage with a white central spot (Roth spot) in the superotemporal vascular arcade, and a 0.5<span class="elsevierStyleHsp" style=""></span>mm diameter solitary whitish infiltrates in the inferior temporal arcade with well defined edges.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1092 "Ancho" => 900 "Tamanyo" => 104265 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">RMN T1-fast spoiled gradient-echo 3D with enhanced contrast close to the right orbital apex (arrow shows optic nerve metastasis).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Survey of 1,264 patients with orbital tumors and simulating lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. 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