视神经转移瘤临床特征分析

Analysis of clinical characteristics of optic nerve metastases

目的观察视神经转移瘤患者临床特征、原发病灶及预后。方法2015年4月至2017年9月在解放军总医院第一医学中心眼科经影像学、实验室及病理检查明确诊断为视神经转移瘤患者7例11只眼纳入研究。均行BCVA、闪光VEP、OCT、眼眶MRI检查,以及血清肿瘤标志物、腰椎穿刺脑脊液检测、PET-CT检查;原发癌灶或接近浅表的转移灶行病理组织活检。随访时间16~44个月,平均随访时间(23.0±10.9)个月。回顾分析发病特点、原发病灶、影像学特征、治疗及预后。结果7例患者中,男性5例,女性2例;平均年龄(53.9±14.99)岁;单侧视神经受累3例,双侧视神经受累4例。首诊眼科5例(71.4%)。11只眼中,误诊为视神经炎5只眼(45.5%);伴视盘水肿6只眼(54.5%);BCVA<0.1、0.1~0.5、>0.5者分别为8(72.7%)、2(18.2%)、1(9.1%)只眼。眼眶增强MRI检查结果显示,视神经眶内段、管内段和颅内段受累分别为1、1、4例,颅内段和视交叉同时受累1例,累及周围组织4例。7例患者中肺癌、肾癌、胃癌分别为4(57.1%)、2(28.6%)、1(14.3%)例。伴全身其他部位转移6例(85.7%);伴颅脑转移2例,其中伴癌性脑膜炎1例。既往因原发癌行手术治疗2例(28.6%)。明确诊断后行化学药物(化疗)、放射治疗(放疗)分别各为1(1只眼)、1(2只眼)例,放弃治疗5例。末次随访时,行化疗的1例1只眼BCVA提高2行,行放疗的1例2只眼BCVA无变化;放弃治疗的5例中,病故、失访分别各为1例,BCVA无变化3例4只眼。结论视神经转移瘤临床表现不典型,易误诊为视神经炎,预后差;原发病灶多见于肺癌。

Objective To explore the clinical features, primary lesions and prognosis of optic nerve metastases. Methods Seven patients (11 eyes) with optic nerve metastatic tumor diagnosed by the examinations of ophthalmology, laboratory and pathology in Chinese PLA General Hospital from April 2015 to September 2017 were included in this study. All patients underwent BCVA, flash VEP, OCT, orbital MRI, serum tumor marker, cerebral spinal fluid detection and PET-CT. Histopathological examination of primary or near superficial metastases was performed. The follow-up period was ranged from 16 to 44 months, with the mean of 23.0±10.9 months. The clinical characteristics, primary tumor, imaging features, treatment and clinical prognosis in the patients were analyzed. Results Among 7 patients, there were 5 males and 2 females, with the mean age of 53.90±14.99 years;3 patients with unilateral optic nerve involvement, 4 patients with bilateral optic nerve involvement;5 patients (71.4%) first diagnosed in ophthalmology. Five patients (45.5%) were misdiagnosed as optic neuritis, optic disc edema in 6 eyes (54.5%). All of them appear loss of visual acuity, including 8 eyes (72.7%) with BCVA<0.1, 2 eyes (18.2%) with BCVA 0.1-0.5, 1 eye (9.1%) with BCVA>0.5. MRI results show that 1 patient with intraorbital segment, 1 patient with internal segment of optic canal, 4 patients with intracranial segment, 1 patient with intracranial segment and optic chiasma involved simultaneously, 4 patients involving surrounding tissue. There were 4 patients (57.1 %) with lung cancer, 2 patients (28.6%) with kidney cancer, 1 patient (14.3%) with gastric cance;6 patients (85.7%) with metastasis from other sites, 2 patients with brain metastasis (1 patient with meningitis carcinomatosa). There were 2 patients(28.6%) with previous primary cancer surgery. After diagnosis, 1 patient received chemotherapy, 1 patient received radiotherapy, 5 patients gave up treatment. At the end of follow-up, 1 patient (1 eye) of chemotherapy with BCVA increased by 2 line;1 patient (2 eyes) of radiotherapy with no change in BCVA;of the 5 patients who gave up treatment, 1 patient died of disease, 1 patient lost follow-up, and 3 patients (4 eyes) had no change in BCVA. Conclusions With atypically clinical manifestations, the optic nerve metastases easily misdiagnosed as optic neuritis, and with poor therapeutic effect. Primary lesions are mostly found in lung cancer.