Glioblastoma of the Optic Nerve
Xiaoyin "Sara" Jiang, Thomas J Cummings. Duke University, Durham, NC
Background: Gliomas of the optic nerve are uncommon neoplasms, comprising approximately 3% of all gliomas, and 2% of all orbital tumors. Most optic nerve gliomas are pilocytic astrocytoma (WHO Grade I). Glioblastomas (GBM) (WHO grade IV) of the optic nerve and chiasm are rare, aggressive tumors that typically present with visual symptoms.
Design: We reviewed two cases of GBM arising in the optic nerve. Both patients were adult females who presented with visual complaints.
Results: Patient A was a 67-year-old female who presented with headaches, total vision loss in her left eye, and partial vision loss in her right eye. She had no previous ophthalmologic history, and no significant medical history. Magnetic resonance images (MRI) showed enlargement of the optic nerves and chiasm. Biopsy of optic nerve and chiasm demonstrated GBM. Follow-up MRI showed tumor extension to the visual cortex in the occipital pole. She expired 5 months following the biopsy. Patient B was a 61-year-old female who presented with blurred vision in her right eye, without any associated pain, nausea, vomiting, or other symptomatology. She had no previous ophthalmologic history, and had medical history only of hypertension and dyslipidemia. MRI showed evidence of an enhancing lesion of the right optic nerve and optic pathway (Fig. 1). A biopsy of the right optic nerve was performed, demonstrating GBM (Fig. 2). Microscopic examination of biopsies from both patients showed a hypercellular population of malignant astrocytes, characterized by cytological pleomorphism, mitoses, microvascular changes, and pseudopalisading necrosis.
Conclusions: Optic nerve GBMs are rare tumors. We present two cases with involvement of the optic nerves and chiasm, both of which presented with visual symptoms. GBM should be considered in the differential diagnosis of optic nerve lesions in adults with visual complaints.
Tuesday, March 5, 2013 9:30 AM
Poster Session III # 222, Tuesday Morning