Unilateral paraneoplastic optic disc edema and retinal periphlebitis in pineal germinoma

Abstract

PurposeTo describe a unilateral ocular paraneoplastic syndrome in pineal germinoma.ObservationsA 24-year-old male presented with diplopia, excessive thirst, and frequent urination. Cranial MRI showed a mass in pineal gland. Dorsal midbrain syndrome signs were present. Examination showed optic disc edema and segmental retinal periphlebitis in right and normal fundus in left eye. Rheumatologic work-up was negative. Brain biopsy confirmed pineal germinoma. Retinal findings were attributed to paraneoplastic syndrome. Resolution of optic disc edema and retinal periphlebitis occurred following chemotherapy and focal irradiation.Conclusionsand importance: To date there are two published case reports on bilateral optic disc edema and retinal periphlebitis occurring as a paraneoplastic syndrome in pineal germinoma. This is the first report on a patient with pineal germinoma who had unilateral paraneoplastic involvement characterized by optic disc edema and retinal periphlebitis and who showed complete resolution of ocular disease after treatment of underlying tumor.

A case of bilateral uveitis associated with seminoma/germinoma in thymus and pineal glands, two primary lesions

“…We report a case with seminoma/germinoma in thymus and pineal glands, two primary lesions who presented with bilateral periphlebitis and optic disc swelling. Although a paraneoplastic ocular involvement was reported previously in four separate case reports, 2 , 3 , 4 , 5 the present case differs from those because of having seminoma/germinoma in thymus and pineal glands, two primary lesions.…”

“…Forooghian and Uludag previously showed intracranial pressure was within normal range in cases of ocular paraneoplastic syndrome by pineal gland germinoma. 3 , 4 It suggests that the optic nerve swelling was inflammatory and not secondary to raised intracranial pressure. In our case, since the obstruction of the aqueduct was confirmed, endoscopic thirdventriculostomy was performed.…”

Diagnosis and Management of Pineal Germinoma: From Eye to Brain

“… 39 A paraneoplastic syndrome can occur from collapsin response- mediating protein antibodies from pineal germinoma and cause autoimmune optic neuropathy and associated subacute vision loss with bilateral disc edema, visual field defects, vitreous cells, and vascular leakage. 40 Retinal phlebitis can accompany paraneoplastic syndrome, presenting with loss of visual acuity, 41 diplopia, 42 and red, painful eye. 37 While the classic symptom of retinal phlebitis is a painless decrease in vision, other symptoms include blind spots, metamorphopsia (changes in shape of object), or changes in color vision.…”