Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 7103
  • Home
  • Print this page
  • Email this page

   Table of Contents      
PHOTO ESSAY
Year : 2016  |  Volume : 64  |  Issue : 3  |  Page : 225-226

Central retinal vein occlusion as the initial presentation in leptomeningeal carcinomatosis


1 Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Radiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Submission17-Jul-2015
Date of Acceptance16-Jan-2016
Date of Web Publication4-May-2016

Correspondence Address:
Dr. Bijnya Birajita Panda
Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.181745

Rights and Permissions

How to cite this article:
Venkataraman A, Panda BB, Nagarajan K. Central retinal vein occlusion as the initial presentation in leptomeningeal carcinomatosis. Indian J Ophthalmol 2016;64:225-6

How to cite this URL:
Venkataraman A, Panda BB, Nagarajan K. Central retinal vein occlusion as the initial presentation in leptomeningeal carcinomatosis. Indian J Ophthalmol [serial online] 2016 [cited 2020 Apr 7];64:225-6. Available from: http://www.ijo.in/text.asp?2016/64/3/225/181745

A 72-year-old male presented with complaints of sudden diminution of vision in his left eye associated with a severe headache, nausea and vomiting of 15 days duration. He gave a history of noncompliance to chemotherapy for gastric adenocarcinoma (after partial radical gastrectomy) 7 months back. Best-corrected visual acuity in the right eye was 20/40 and no light perception in the left eye. An afferent pupillary defect was detected in the left eye. Fundoscopy revealed papilledema in both eyes with a central retinal vein occlusion (CRVO) in the left eye [Figure 1]. There was no involvement of cranial nerves other than both optic nerves. Visual fields tested by confrontation field testing were within normal limits for the right eye. Magnetic resonance imaging (MRI) brain and orbit showed irregular dilatation of ventricles with periventricular hyperintensities suggestive of extraventricular obstruction. Thickening and enhancement of bilateral optic nerve sheath complex [Figure 2] were also noted raising the possibility of leptomeningeal carcinomatosis (LC). Cerebrospinal fluid (CSF) cytology revealed signet ring cells [Figure 3] as seen in adenocarcinoma. He was referred to the oncology for intrathecal chemotherapy and palliative radiotherapy but due to his deteriorating general condition he died within 2 months.
Figure 1: Colour fundus montage photographs showing papilledema in both eyes and central retinal vein occlusion in left eye

Click here to view
Figure 2: Magnetic resonance imaging of brain and orbits showing bilateral optic nerve sheath thickening with lumpy infiltration along the sheath margins

Click here to view
Figure 3: Cerebrospinal fluid specimen with May–Grunwald–Giemsa stain under ×40 showing few signet ring cells (cell nucleus pushed to the periphery) in a background of lymphocytes and arachnoid cap cells

Click here to view



  Discussion Top


The incidence of retinal vein occlusion varies from 2/1000–8/1000 people, seen typically above 65 years of age with conditions such as diabetes mellitus, hypertension, collagen vascular diseases, and hyperviscosity syndromes.[1],[2],[3] A neoplastic cause is, however, rare. LC, an infiltration of the pia mater and the arachnoid membrane by malignant cells is less commonly associated with solid tumors; lung, breast and melanoma being the ones most often reported. Gastric cancer complicated by LC as observed in our patient is very rare. It is estimated to occur in 0.16% of all cases of gastric cancer,[4] of which 87% have disseminated disease.[5] The most common ocular manifestations in LC include visual loss due to optic atrophy or optic neuritis, followed by diplopia due to cranial nerve palsies, ptosis, papilledema, anisocoria, exophthalmos, orbital pain, scotomas, hemianopsia, and nystagmus.[6] CRVO as an initial presentation in LC as seen in our patient with an inadequately treated gastric adenocarcinoma is not reported in literature until date except for a single case report of combined central retinal artery and CRVO in a patient with breast carcinoma.[7] Hence, an elderly patient presenting with CRVO and a no PL eye in the context of malignancy warrants high suspicion and detailed evaluation including MRI and CSF cytology to diagnose this rare association.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Klein R, Klein BE, Moss SE, Meuer SM. The epidemiology of retinal vein occlusion: The Beaver Dam Eye Study. Trans Am Ophthalmol Soc 2000;98:133-41.  Back to cited text no. 1
    
2.
David R, Zangwill L, Badarna M, Yassur Y. Epidemiology of retinal vein occlusion and its association with glaucoma and increased intraocular pressure. Ophthalmologica 1988;197:69-74.  Back to cited text no. 2
    
3.
Clarkson JG. Central retinal vein occlusion. In: Schachat AP, editor. Retina. 3rd ed. St. Louis, MO: Mosby; 2001. p. 1368.  Back to cited text no. 3
    
4.
Kim M. Intracranial involvement by metastatic advanced gastric carcinoma. J Neurooncol 1999;43:59-62.  Back to cited text no. 4
    
5.
Oh SY, Lee SJ, Lee J, Lee S, Kim SH, Kwon HC, et al. Gastric leptomeningeal carcinomatosis: Multi-center retrospective analysis of 54 cases. World J Gastroenterol 2009;15:5086-90.  Back to cited text no. 5
    
6.
Lanfranconi S, Basilico P, Trezzi I, Borellini L, Franco G, Civelli V, et al. Optic neuritis as isolated manifestation of leptomeningeal carcinomatosis: A case report and systematic review of ocular manifestations of neoplastic meningitis. Neurol Res Int 2013;2013:892523.  Back to cited text no. 6
    
7.
Schaible ER, Golnik KC. Combined obstruction of the central retinal artery and vein associated with meningeal carcinomatosis. Arch Ophthalmol 1993;111:1467-8.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Discussion
Discussion
References
Article Figures

 Article Access Statistics
    Viewed1115    
    Printed3    
    Emailed0    
    PDF Downloaded143    
    Comments [Add]    

Recommend this journal