RESUMO
We herein report the case of a 74-year-old woman with a lung tumor. She presented with complaints of blurred and rapid, progressively impaired vision. A visual field examination revealed bilateral concentric contraction of the visual field and a ring scotoma in the right eye. She was diagnosed with cancer-associated retinopathy (CAR) combined with large-cell neuroendocrine carcinoma (LCNEC) of the lung via a visual field examination and underwent thoracoscopic surgery. CAR has been mostly associated with small-cell lung cancer (SCLC). Combined LCNEC is relatively rare and accounts for 10.6% of all LCNECs. This is the first case report of CAR-combined LCNEC.
Assuntos
Carcinoma de Células Grandes/patologia , Neoplasias Pulmonares/patologia , Síndromes Paraneoplásicas Oculares/patologia , Idoso , Carcinoma de Células Grandes/diagnóstico , Feminino , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico , Síndromes Paraneoplásicas Oculares/cirurgiaAssuntos
Autoanticorpos/sangue , Neoplasias Encefálicas/patologia , Germinoma/patologia , Proteínas do Tecido Nervoso/imunologia , Doenças do Nervo Óptico/patologia , Síndromes Paraneoplásicas Oculares/patologia , Pinealoma/patologia , Adolescente , Biomarcadores Tumorais/metabolismo , Western Blotting , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/imunologia , Neoplasias Encefálicas/cirurgia , Germinoma/diagnóstico por imagem , Germinoma/imunologia , Germinoma/cirurgia , Humanos , Hidrolases , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Proteínas Associadas aos Microtúbulos , Doenças do Nervo Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/imunologia , Doenças do Nervo Óptico/cirurgia , Síndromes Paraneoplásicas Oculares/diagnóstico por imagem , Síndromes Paraneoplásicas Oculares/imunologia , Síndromes Paraneoplásicas Oculares/cirurgia , Glândula Pineal/patologia , Pinealoma/diagnóstico por imagem , Pinealoma/imunologia , Pinealoma/cirurgiaRESUMO
BACKGROUND: To present a case of melanoma-associated retinopathy (MAR) which manifested 26 months prior to a formal diagnosis of melanoma. METHODS: Case report. RESULTS: A 72-year-old female presented with bilateral continuous photopsia consistent with MAR of 7-months duration. At this point, visual function appeared normal with the exception of mildly impaired colour vision (10/17 Ishihara plates). The flash electroretinographic (ERG) revealed extinguished rod responses, a normal a-wave and reduced b-wave (electronegative ERG) on the maximal combined response, absent oscillatory potentials and broadened a-wave trough on the cone response. Multifocal ERG (mfERG) responses were delayed and demonstrated atypical morphology. Nineteen months after the initial presentation, her visual symptoms had progressed significantly with constant debilitating photopsia in combination with 13 kg weight loss. Biopsy of a now evident left axillary mass demonstrated a metastatic high-grade malignant melanoma. No primary was detected, and an axillary lymph node clearance was undertaken. Subsequently, visual symptoms resolved with corresponding improvement in the ERG over the next 18 months. Rod responses recovered such that the amplitude was at the lower limit of normal and the mfERG response delay lessened. Unfortunately, the melanoma recurred and the patient passed away 6 months later. Visual symptoms did not recur. CONCLUSION: We present a case which demonstrates MAR may precede the formal diagnosis of melanoma by up to 26 months. The potential for improvement in the rod visual function persists over a period of years with normalisation of an electronegative waveform. In this case, cytoreductive surgery resulted in complete resolution of the MAR, which did not return even with a recurrence of the tumour.