PMC7234965_01
Color fundus photographs at the initial presentation. Papillary swelling in the right eye (A) and the left eye (B) and optic disc hemorrhage in the left eye are observed.
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There was no abnormality in the anterior segment; however, papillary swelling in both eyes and optic disc hemorrhage in the left eye were observed on the fundus examination (Figure 1).
Fluorescein angiography at the initial presentation. Fluorescein angiography revealed dye leakage from the papillae of the right eye (A) and the left eye (B). (C) Multiple nodular staining along the retinal veins was also observed (indicated by white arrows).
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Fluorescein angiography (FA) revealed dye leakage from the papillae of both eyes (Figure 2A and B) and multiple nodular staining along the veins (Figure 2C).
Brain CT findings. (A) No cerebral ventricular enlargement (white arrows), but (B) dilation of the bilateral nerve (white arrows), (C) 8 mm and 10 mm nodules on the left frontal skull (white arrows), and (D) subcutaneous nodules in the right parietal region (white arrow) are detected.
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Brain CT showed no cerebral ventricular enlargement (Figure 3A), but dilation of the bilateral nerve (Figure 3B), 8 mm and 10 mm nodules on the left frontal skull (Figure 3C), and subcutaneous nodules in the right parietal region (Figure 3D) were observed.
Brain/myelography MRI findings. (A) Enhancement of contrast effect around both optic nerves (white arrows), (B) high signal of fatty tissue around the optic nerve (white arrows), (C) high signal of cerebral sulcus of frontal parietal lobe (white arrows), (D) enlargement of lateral ventricular angle (white arrows), and (E) high signal of cervical meninges (white arrows) are recognized.
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In brain/myelography MRI, enhancement of contrast effect around both optic nerves, high signal of fatty tissue around the optic nerve, high signal of cerebral sulcus of the frontal parietal lobe, enlargement of the lateral ventricular angle, and high signal of cervical meninges were recognized (Figure 4).
Histopathological examination. (A) Papanicolaou staining and (B) Giemsa staining reveal highly atypical metastatic adenocarcinoma cells (Class IIIb) containing mucus-like substances.
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Cytodiagnosis suggested highly atypical metastatic adenocarcinoma cells (Class IIIb) containing mucus-like substances in the cytoplasm (Figure 5), and biopsy found that poorly differentiated adenocarcinoma with signet-ring cells originating in the gastroduodenum had metastasized to the brain, resulting in meningeal carcinoma, which caused bilateral optic disc invasion.
Color fundus photographs at the last presentation. Optic disc swelling had improved in (A) the right eye and (B) the left eye.
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BCVA at the final visit to our hospital (after 10 months after the first visit) after completing five courses of chemotherapy was 4/200 in both eyes, and central flicker could not be measured in either eye, although bilateral optic disc swelling had improved (Figure 6).