PMC3363316_01
Color fundus photograph, fluorescein angiographic image, and spectral-domain optical coherence tomographic image at the initial visit for a 24-year-old man with aggressive retinal astrocytoma. The best-corrected visual acuity was 0.09. (A) Fundus photograph demonstrates an elevated lesion in the superior aspect of the optic disc accompanied with marked neovascular vessels located on the surface, retinal hemorrhage, and exudative change. Hard exudates are seen in the macula. (B) Late-phase fluorescein angiography reveals marked leakage from the neovascular vessels. (C) Horizontal optical coherence tomographic image through the fovea shows serous retinal detachment.
opth-6-715f1.jpg
PMC3363316_01_opth-6-715f1.jpg
f1-opth-6-715
In the right eye, fundus examination demonstrated an elevated lesion in the superior aspect of the optic disc accompanied with marked neovascular vessels on the surface, retinal hemorrhage, and macular edema (Figure 1A). Fluorescein angiography revealed marked leakage from the neovascular vessels (Figure 1B). Spectral-domain optical coherence tomographic (OCT) imaging through the fovea showed a serous retinal detachment (Figure 1C).
Color fundus photograph, fluorescein angiographic image, and spectral-domain optical coherence tomographic (OCT) images after six intravitreal injections of bevacizumab. The best-corrected visual acuity improved to 0.3. (A) Fundus photograph demonstrates marked regression of neovascular vessels, retinal hemorrhage, and exudative change. The direction of the OCT scan is indicated by a white arrow (C) or a black arrow (D). (B) Late-phase fluorescein angiography reveals decreased leakage from neovascular vessels. (C) Horizontal OCT image through the fovea shows disappearance of the serous retinal detachment. (D) Vertical OCT image through the elevated lesion shows a retinal tumor located on the retinal surface (black arrowhead) and epiretinal membrane (white arrowhead).
opth-6-715f2.jpg
PMC3363316_01_opth-6-715f2.jpg
f2-opth-6-715
Fundus examination demonstrated marked regression of neovascular vessels, retinal hemorrhage, and exudative change (Figure 2A). Fluorescein angiography revealed decreased leakage from neovascular vessels (Figure 2B). OCT imaging through the fovea showed disappearance of the serous retinal detachment (Figure 2C). OCT imaging through the elevated lesion showed an epiretinal membrane and retinal tumor located on the retinal surface (Figure 2D).
Histopathologic analysis of a biopsy sample of the retinal tumor which was obtained during pars plana vitrectomy.. Notes: Plump spindle-shaped cells with round or slightly elongated nuclei are observed. Mitotic activity is not evident. Hematoxylin-eosin staining was used. Yellow bar represents 100 mum.
opth-6-715f3.jpg
PMC3363316_01_opth-6-715f3.jpg
f3-opth-6-715
Histopathologic analysis of the retinal tumor revealed plump spindle-shaped cells with round or slightly elongated nuclei (Figure 3).
Immunoreactivity of biopsy sample of retinal tumor for vimentin (A), glial fibrillary acidic protein (B), neuron-specific enolase, (C), and vascular endothelial growth factor (D).. Notes: The biopsy sample is intensely immunoreactive for vimentin, glial fibrillary acidic protein, and neuron-specific enolase, being consistent with the diagnosis of astrocytoma. The sample also shows moderate immunoreactivity for vascular endothelial growth factor. Yellow bar represents 100 mum.
opth-6-715f4.jpg
PMC3363316_01_opth-6-715f4.jpg
f4-opth-6-715
The retinal tumor was intensely immunoreactive for vimentin, glial fibrillary acidic protein (GFAP), and neuron-specific enolase, being consistent with a diagnosis of astrocytoma (Figure 4A-C). Despite the preceding intravitreal bevacizumab injections, the tumor also showed immunoreactivity for VEGF (Figure 4D).
Immunoreactivity of surgically removed epiretinal membrane for vascular endothelial growth factor (A) and von Willebrand factor (B). (C) Nuclear staining of the same section. (D) Triple labeling.. Notes: Despite intravitreal bevacizumab injections, triple labeling demonstrates coexpression of vascular endothelial growth factor and von Willebrand factor, indicating the presence of vascular endothelial growth factor in vascular endothelial cells. Yellow bar represents 100 mum.
opth-6-715f5.jpg
PMC3363316_01_opth-6-715f5.jpg
f5-opth-6-715
Immunohistochemical analysis of the surgically removed epiretinal membrane demonstrated coexpression of VEGF and von Willebrand factor, indicating the presence of VEGF in the vascular endothelial cells (Figure 5).
Color fundus photograph and spectral-domain optical coherence tomographic image after pars plana vitrectomy. The best-corrected visual acuity was 0.2. (A) Fundus photograph demonstrates retinal photocoagulation scars corresponding to retinal astrocytoma. Small residual retinal astrocytoma is seen in the center of the photocoagulation scars. (B) Horizontal optical coherence tomographic image through the fovea shows no serous retinal detachment.
opth-6-715f6.jpg
PMC3363316_01_opth-6-715f6.jpg
f6-opth-6-715
Fundus examination revealed photocoagulation scars corresponding to retinal astrocytoma, and OCT imaging showed no serous macular detachment (Figure 6).