Lions and Tigers and Bears, Oh My! (abstract)

Lung biopsy revealed adenocarcinoma. Metastatic carcinoma to the intracranial optic nerve is very rare and we doubted that the optic nerve mass was a metastasis, especially with the lack of any mediastinal adenopathy. Over the next month, her vision deteriorated to no light perception in the right eye and a new superotemporal visual field defect developed in the left eye. MRI revealed an increase in size of the right optic nerve lesion. Repeat lab work and lumbar puncture were unrevealing. A pterional craniotomy and right optic nerve biopsy were performed revealing a diffusely infiltrating glial neoplasm of high cellularity with atypical, pleomorphic, hyperchromatic nuclei with irregular contours and occasional prominent nucleoli. A subset of cells with abundant eosinophilic cytoplasm and multinucleated bizarre tumor cells were also identified. Findings were consistent with anaplastic astrocytoma (WHO grade III). The patient recovered from surgery without additional neurological deficits. She was treated with partial brain radiation, lung radiation, and adjuvant temozolomide. Malignant optic glioma of adulthood (MOGA) was first described by Hoyt in 1973(1), and is an extremely rare, invasive entity, with only 66 cases reported in the literature. Visual loss with or without pain is usually the initial symptom and often leads to a misdiagnosis of optic neuritis or NAION. Neuroradiologic findings are non-specific, and diagnosis is biopsy dependent. Recommended treatment is radiotherapy and chemotherapy. Prognosis is poor with a lifespan of 1-2 years(2).