Compression neuropathy caused by cancer metastasis to the optic nerve canal
© Tamai et al.; licensee BioMed Central Ltd. 2013
Received: 29 November 2012
Accepted: 18 December 2013
Published: 20 December 2013
Cancerous cells are known to metastasize to different ocular structures. This happens especially to the choroid in males with lung cancer and females with breast cancer. However, we observed two cases of cancerous metastasis to the optic canal region. Both cases showed only a progressive decrease in vision without any other remarkable ophthalmological symptoms or abnormalities in the affected eye.
Two females, a 60-year-old and a 73-year-old, came to our hospital because of progressive loss of vision. These patients showed no remarkable symptoms or signs in their eyes except visual acuity loss. Several ophthalmoscopic examinations, such as slit lamp microscopy and fundoscopy, showed no abnormal changes in their affected eye but magnetic resonance imaging indicated a massive legion around the optic nerve.
It is possible for cancer to metastasize to the optic canal region and the existence of primary tumors should be considered.
KeywordsCancer Metastasis Optic canal
Primary and secondary orbital tumors, including intraorbital and optic nerve tumors, are uncommon observations in daily medical practice. The primary orbital tumors are solitary fibrous tumors, rhabdomyosarcomas, meningiomas, gliomas and others. Secondary orbital tumors include post-transplantation lymphoproliferative disorders and metastatic rhabdomyosarcomas . Primary optic nerve tumors include meningiomas, gliomas and malignant melanomas, and secondary optic nerve tumors include metastases from breast cancer, leukemia, retinoblastoma and gliomatosis cerebri. An earlier study reported that optic nerve tumors make up 8% of all orbital tumors  and metastases to the optic nerve area are rare [2–4].
Both of our cases were secondary tumors as a result of metastases from either a primary breast cancer or lung cancer. We suggest that the growth of the tumor in the optic canal exerted pressure on the optic nerve, which led to the progressive decrease in vision. This was supported by the stationary state and recovery of visual field or visual acuity after surgical removal of the metastatic tumor. Thus, we concluded that the tumor in both patients was secondary and the immunohistochemical staining suggested that the primary cancer was in the breast in Patient 1 and in the lung in Patient 2. PET-CT body scans confirmed the immunohistochemical findings.
We presented our findings on two patients whose only sign and symptom was a progressive decrease in vision. Histopathological examinations of the excised tissues suggested that the retrobulbar tumors were metastases from breast cancer in one patient and lung cancer in the other patient. PET-CT body scans confirmed not only the location of the primary cancer but also the location of the metastatic area. Thus, our examinations of these two patients led not only to stopping the loss of vision but also determining the location of the life-threatening cancer.
Written informed consent was obtained from the patients for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Executive Editor, Editor-in-Chief of this journal.
Magnetic resonance imaging
Positron emission tomography–computed tomography
Thyroid transcription factor 1.
The authors thank Dr. Duco I. Hamasaki for editing the manuscript. This study was supported in part by a Grant-In-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of the Japanese Government (NF; C-22591928), Tokyo, Japan.
- Goldberg SH, Cantore WA: Tumors of the orbit. Curr Opin Ophthalmol. 1997, 8: 51-56. 10.1097/00055735-199710000-00011.PubMedView ArticleGoogle Scholar
- Shields JA, Shields CA, Scartozzi R: Survey of 1264 patients with orbital tumors and simulating lesions. Ophthalmology. 2004, 111: 997-1008. 10.1016/j.ophtha.2003.01.002.PubMedView ArticleGoogle Scholar
- Fox B, Pacheco P, DeMonte F: Carcinoma of the breast metastatic to the optic nerve mimicking an optic nerve sheath meningioma: case report and review of the literature. Skull Base. 2005, 15: 281-289. 10.1055/s-2005-921935.PubMedPubMed CentralView ArticleGoogle Scholar
- Hyun KC, Shin HP, Sun YS: Isolated optic nerve metastasis of breast cancer initially mimicking retrobulbar optic neuritis. Eur J Opthalmology. 2011, 21: 513-515. 10.5301/EJO.2010.6099.View ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.