Progressive vision loss as the initial symptom of prostate cancer

Orbital metastasis may be the initial manifestation of a malignancy of unknown origin. The primary locations of orbital metastasis are usually the lung, prostate, gastrointestinal tract, skin, kidney, eye, or thyroid gland. Metastasis of gastric carcinoma to an extraocular eye muscle is extremely rare. A solitary thickening in an extraocular eye muscle with no inflammatory features is suspect for a tumor. Symptoms such as diplopia, proptosis, ptosis, vision loss, or pain may be associated with an orbital malignancy. Our patient, a 67-year-old man known with radically resected prostate cancer, presented with complaints of vertigo with a tendency to fall, headache, and diplopia when looking to the right. As a coincidental finding, swelling of the rectus lateralis muscle of the left eye was observed on imaging. Extensive additional investigations showed that a gastric carcinoma with intraorbital and leptomeningeal metastasis was the cause. In conclusion, a solitary thickened extraocular eye muscle should be recognized in time and examined further.

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Pituitary Metastatic Composite Tumors: A Case Report with Next-Generation Sequencing and Review of the Literature

Case Reports in Oncological Medicine ◽

10.1155/2020/5073236 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Matthew Helton ◽

Muhammad Abu-Rmaileh ◽

Kevin Thomas ◽

Murat Gokden ◽

Alissa Kanaan ◽

...

Keyword(s):

Next Generation Sequencing ◽

Vision Loss ◽

Clear Cell ◽

Metastatic Cancer ◽

Postoperative Mortality ◽

Initial Symptom ◽

Next Generation ◽

Endoscopic Endonasal ◽

Primary Tumors ◽

Generation Sequencing

Background. While pituitary tumors are well understood, little research has been done on metastasis from primary tumors into pituitary adenomas, also known as composite tumors. Because only 34 cases of composite tumors have been reported to date, we hope to better characterize these tumors by reviewing cases reported in the literature and reviewed our own documented case, which includes next-generation sequencing. Case Presentation. A 74-year-old man presented to the emergency department with left vision loss for 3 months. He had a history of colon cancer treated with colectomy and clear cell renal carcinoma treated with left nephrectomy. A preoperative MRI demonstrated growth of a peripherally enhancing, centrally necrotic mass with sellar expansion measuring 5.7×3.1×3.0 cm. Given these findings, an endoscopic endonasal transsphenoidal resection was performed. Histological assessment revealed a composite tumor: one neoplasm was a nonfunctioning pituitary adenoma, and another neoplasm was a clear cell carcinoma. Next-generation sequencing demonstrated that the tumors shared mutations in VHL and Notch2. The patient died 2 months later from systemic metastatic cancer. Conclusion. From our literature review, most metastatic lesions in these composite tumors originated from neoplasms of the lung and kidney. Approximately 63% patients presented with ophthalmoplegia as the initial symptom while 23% displayed hormonal abnormalities. Postoperative mortality had a median of 3.5 months. In our patient, the presence of VHL and Notch2 mutations in both tumors highlights the possibility of using next-generation sequencing to help identify therapeutic targets even in complex composite neoplasms.

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Neck swelling and airway narrowing as an initial manifestation of giant cell arteritis

BMJ Case Reports ◽

10.1136/bcr-2020-237743 ◽

2021 ◽

Vol 14 (3) ◽

pp. e237743

Author(s):

Zhen Sheng Lim ◽

Colin Sharp

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Vision Loss ◽

External Carotid Artery ◽

External Carotid ◽

Initial Symptom ◽

Neck Swelling ◽

Initial Manifestation ◽

Airway Narrowing ◽

Wide Range

Giant cell arteritis can result in a wide range of symptoms due to the extensive distribution of the external carotid artery. Face and neck swelling and trismus are under-recognised features of giant cell arteritis and can present as the initial symptom prior to the development of classical temporal tenderness and jaw claudication. The lack of awareness of the less common symptoms may result in a late diagnosis of giant cell arteritis, leading to irreversible vision loss. In this paper, we present a case of neck swelling and airway narrowing as the initial manifestation of giant cell arteritis.

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Prostate cancer metastatic to the planum sphenoidale presenting as sequential bilateral vision loss

Case Reports in Internal Medicine ◽

10.5430/crim.v5n4p5 ◽

2018 ◽

Vol 5 (4) ◽

pp. 5

Author(s):

Binoy Yohannan ◽

Mark Feldman

Keyword(s):

Prostate Cancer ◽

Vision Loss ◽

Early Recognition ◽

Locally Advanced ◽

Surgical Excision ◽

Neurological Impairment ◽

High Dose ◽

Tissue Mass ◽

Metastatic Involvement ◽

Planum Sphenoidale

Metastasis to the anterior cranial fossa from solid tumors is very unusual. We describe a 72-year-old male with history of locally advanced prostate cancer who presented with sequential bilateral vision loss, initially misdiagnosed and mistreated as giant cell arteritis. Neuroimaging eventually revealed an extra-axial soft tissue mass in the planum sphenoidale exerting a pressure effect on the cisternal segments of the optic nerves. He underwent surgical excision of the mass to try to improve his vision. Biopsy results confirmed high grade metastatic adenocarcinoma of the prostate. He was started on high dose glucocorticoids and radiation therapy and his visual symptoms improved. Patients with metastatic prostate cancer can develop cranial nerve deficits secondary to metastatic involvement of the skull base. Early recognition and appropriate therapy is essential to prevent permanent neurological impairment.

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Complete unilateral vision loss and optic nerve cupping from metastatic prostate cancer to the optic canal

BMJ Case Reports ◽

10.1136/bcr-2020-236685 ◽

2021 ◽

Vol 14 (1) ◽

pp. e236685

Author(s):

Aaron T Chan ◽

Jonathan A Micieli

Keyword(s):

Prostate Cancer ◽

Optic Nerve ◽

Optic Disc ◽

Vision Loss ◽

The Body ◽

Optic Canal ◽

Neuroretinal Rim ◽

Bone Expansion ◽

Castrate Resistant ◽

Optic Disc Cupping

A 71-year-old man, living with metastatic castrate-resistant prostate cancer to the lymph nodes, spine and skull, presented with acute on chronic left eye vision loss. Examination revealed no-light-perception vision, a relative afferent pupillary defect and optic disc cupping. MRI brain revealed optic canal narrowing from metastatic sphenoid bone expansion and extraosseous tumour compressing the intracanalicular optic nerve. The optic disc cupping and excavation without significant pallor of the remaining neuroretinal rim was likely secondary to chronic compression of the optic nerve. The patient was treated with radiation therapy, but did not regain vision and was referred to palliative care as his condition continued to worsen. As patients live longer with advanced cancer, there is a greater risk of metastasis to atypical areas of the body including the optic nerve. This case demonstrates the unique combination of optic disc cupping from optic canal metastasis due to prostate cancer.

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Acute presentation of idiopathic intracranial hypertension with severe vision deficits

SAGE Open Medical Case Reports ◽

10.1177/2050313x20945573 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2094557

Author(s):

Jacqueline K Shaia ◽

Carrie Elzie

Keyword(s):

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Vision Loss ◽

Initial Symptom ◽

Symptom Presentation ◽

Rare Presentation ◽

Acute Presentation ◽

Severe Vision Loss ◽

Vision Deficits ◽

Visual Disturbances

Fulminant idiopathic intracranial hypertension is a rare presentation of idiopathic intracranial hypertension in which visual decline occurs within 4 weeks of initial symptom presentation. Idiopathic intracranial hypertension usually presents with headaches, visual disturbances, and in women who are overweight. We present a case of idiopathic intracranial hypertension in which a female patient presented with rapid, severe vision loss within 8 days of symptom presentation and no other idiopathic intracranial hypertension symptoms. This case highlights a rare presentation of Fulminant idiopathic intracranial hypertension and the need for a quick diagnosis and treatment to preserve vision.

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