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Cancer-associated retinopathy secondary to gallbladder carcinoma. 继发于胆囊癌的癌症相关视网膜病变。
Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.3205/oc000243
Karel Goyvaerts, Tanja Coeckelbergh, Pieter-Paul Schauwvlieghe, Michel van Lint

Objective: To present a rare case of cancer-associated retinopathy secondary to gallbladder carcinoma.

Methods: Retrospective case report. Drugs used in case report: methylprednisolone (Medrol), CAS number: 83-43-2, producer: Pfizer; carboplatin, CAS number: 41575-94-4, producer: Accor; etoposide, CAS number: 33419-42-0, producer: Teva; methotrexate (Ledertrexate), CAS number: 59-05-2, producer: Pfizer.

Results: A 57-year-old Moroccan man was referred with bilateral progressive vision loss in the last 4 months. At presentation, best corrected visual acuity (BCVA) was counting fingers for the right eye and 20/500 for the left eye. Examination demonstrated signs of vitritis, an electronegative full-field electroretinography (FF-ERG), ocular coherence tomography (OCT) abnormalities and multiple hyperautofluorescent round lesions on fundus autofluorescence imaging (FAF). The diagnosis of cancer-associated retinopathy (CAR) was considered, thus a positron emission tomography-computed tomography (PET-CT) was performed and revealed the presence of a metastasized gallbladder carcinoma. Additional fluorescence in situ hybridization (FISH) showed seropositivity for anti-retinal autoantibodies. High-dose corticosteroids together with anti-tumoral medication (carboplatin-etoposide) gradually improved the BCVA to 20/66 for the right eye and 20/20 for the left eye.

Conclusions: Consider the diagnosis of CAR in patients with progressive concentric visual field loss, uveitis and fundus abnormalities, especially if bilateral. If CAR is suspected, perform a full work-up: FF-ERG, OCT, and whole-body PET-CT. In the treatment of CAR, immunosuppressives are mostly used, combined with antitumoral therapy. However, in the long-term, progressive visual loss is expected in most cases.

目的:介绍一例罕见的继发于胆囊癌的癌症相关性视网膜病变:介绍一例罕见的继发于胆囊癌的癌症相关性视网膜病变:回顾性病例报告。病例报告中使用的药物:甲基强的松龙(Medrol),CAS 号:83-43-2,生产商:辉瑞公司;卡铂,CAS 号:41575-铂:辉瑞;卡铂,CAS 号:41575-94-4,生产商:Accor;依托泊苷,CAS 号:41575-94-4,生产商:Accor:Accor;依托泊苷,化学文摘社编号:33419-42-0,生产商:Teva;甲氨蝶呤,化学文摘社编号:41575-94-4,生产商:Accor:Teva;甲氨蝶呤(Ledertrexate),CAS 号:59-05-2,生产商:辉瑞:结果:一名 57 岁的摩洛哥男子因近 4 个月来双侧视力进行性下降而转诊。就诊时,右眼最佳矫正视力(BCVA)为数指,左眼为 20/500。检查显示有玻璃体炎、电阴性全场视网膜电图(FF-ERG)、眼相干断层扫描(OCT)异常和眼底自动荧光成像(FAF)多发高自荧光圆形病变。考虑诊断为癌症相关视网膜病变(CAR),因此进行了正电子发射计算机断层扫描(PET-CT),结果显示存在胆囊癌转移。此外,荧光原位杂交(FISH)显示抗视网膜自身抗体血清阳性。大剂量皮质类固醇和抗肿瘤药物(卡铂-依托泊苷)逐渐改善了患者的视力,右眼BCVA为20/66,左眼BCVA为20/20:对于有进行性同心视野缺损、葡萄膜炎和眼底异常的患者,尤其是双侧患者,应考虑 CAR 的诊断。如果怀疑有 CAR,应进行全面检查:FF-ERG、OCT和全身PET-CT。在治疗 CAR 的过程中,主要使用免疫抑制剂,并结合抗肿瘤治疗。然而,从长期来看,大多数病例都会出现进行性视力下降。
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引用次数: 0
Epithelial downgrowth masquerading as granulomatous anterior and intermediate uveitis with histopathologic evidence of 5-FU treatment. 伪装成肉芽肿性前葡萄膜炎和中葡萄膜炎的上皮细胞增生,组织病理学证据显示曾接受过 5-FU 治疗。
Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.3205/oc000245
Colin P Froines, Alexander D Lin, Kaivon Pakzad-Vaezi, Gordana Juric-Sekhar, Caitlin S Latimer, Kathryn P Scherpelz, C Dirk Keene, Eissa M Hanna, Michael R Banitt, Luis F Gonzalez-Cuyar

Purpose: Highlight an unusual case of epithelial downgrowth (EDG) masquerading as granulomatous anterior and intermediate uveitis with histopathologic evidence of 5-fluorouracil (5-FU) treatment.

Case description: A 33-year-old man presented after multiple corneal surgeries and neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomies with subacute angle closure, pain, light sensitivity, and decreased vision. Exam was notable for granulomatous keratic precipitates, an opacified lens capsule, and vitreous cell/haze. An anterior chamber paracentesis was sent for 16 s (pan-bacterial) and 28 s (pan-fungal) rRNA polymerase chain reaction testing, which returned negative. Diagnostic argon laser photocoagulation was performed on the iris and lens capsule, which blanched upon laser photocoagulation, and subsequent iris biopsy confirmed the presence of epithelial downgrowth (EDG). The patient was treated with multiple injections of 5-FU with repeat biopsy demonstrating both a reduction and apparent resolution in epithelial cell burden after 5-FU.

Conclusion: This case demonstrates an unusual presentation of EDG in a young patient with granulomatous anterior and intermediate uveitis, where simple office-based procedures of Argon laser photocoagulation and anterior chamber paracentesis helped aid in diagnosis and management. Histopathological examination in serial specimens demonstrated the effect of 5-FU on EGD. To our knowledge, this case is the first to describe histopathological reduction in epithelial cell burden with sustained resolution.

目的:重点介绍一例伪装成肉芽肿性前葡萄膜炎和中葡萄膜炎的上皮下生长(EDG)的不寻常病例,病理组织学证据显示该病例接受过5-氟尿嘧啶(5-FU)治疗:一名 33 岁的男子在多次角膜手术和掺钕钇铝石榴石(Nd:YAG)囊切术后出现亚急性角膜闭合、疼痛、光敏感和视力下降。检查结果显示有肉芽肿性角膜沉淀物、晶状体囊不透明和玻璃体细胞/雾状物。前房旁腔穿刺被送去进行16s(泛细菌)和28s(泛真菌)rRNA聚合酶链反应检测,结果均为阴性。对虹膜和晶状体囊进行了诊断性氩激光光凝,激光光凝后虹膜和晶状体囊变白,随后的虹膜活检证实存在上皮下生(EDG)。患者接受了多次注射 5-FU 的治疗,重复活检显示,5-FU 治疗后上皮细胞负担减轻并明显消退:本病例显示,一名患有肉芽肿性前色素膜炎和中间色素膜炎的年轻患者出现了不寻常的 EDG 表现,在诊室进行氩激光光凝和前房旁路穿刺术有助于诊断和治疗。连续标本的组织病理学检查显示了 5-FU 对 EGD 的影响。据我们所知,该病例是第一例描述上皮细胞负担减少并持续缓解的组织病理学病例。
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引用次数: 0
Pseudophakic corneal edema caused by Descemet membrane detachment using high-resolution swept-source OCT imaging. 利用高分辨率扫描源 OCT 成像,观察由 Descemet 膜脱落引起的假性角膜水肿。
Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.3205/oc000244
Maximilian K Köppe, Ramin Khoramnia, Gerd U Auffarth, Victor A Augustin

Background: Small Descemet membrane detachments after cataract surgery are relatively common and most cases do not require any secondary surgical intervention and can be treated conservatively. However, in case of advanced Descemet membrane detachment (DMD), it needs to be recognized and treated appropriately. The advent of anterior segment imaging using optical coherence tomography (OCT) technology has made diagnosing pathologies of the anterior segment accurate and time efficient and has proven as an invaluable tool to guide decision making.

Case presentation: A 71-year-old patient presented after complicated cataract surgery with decreased visual acuity and cloudy vision. On examination, best corrected visual acuity was 1.5 logMAR. A high-resolution swept-source OCT (Anterion, Heidelberg Engineering, Heidelberg, Germany) was used to better evaluate and visualize the extent of DMD. An anterior chamber gas bubble was injected to reattach the Descemet membrane (DM) to the corneal stroma. The success of the surgery was visualized using the high-resolution swept-source OCT. This revealed a completely attached Descemet membrane.

Conclusions: Clinically, it can be difficult to distinguish the etiology of epithelial and stromal edema post cataract surgery. This case demonstrated the clinical usefulness using high resolution swept source imaging to guide clinical decision making in evaluating timing and treatment success of pneumodescemetopexy after complicated cataract surgery.

背景:白内障手术后出现小的去角膜脱离比较常见,大多数病例不需要二次手术干预,可以采取保守治疗。但是,如果是晚期的去角膜脱离(DMD),则需要识别并进行适当的治疗。利用光学相干断层扫描(OCT)技术进行眼前节成像的出现,使眼前节病变的诊断变得准确、省时,并被证明是指导决策的宝贵工具:一位 71 岁的患者在复杂的白内障手术后出现视力下降和视物混浊。经检查,最佳矫正视力为 1.5 logMAR。为了更好地评估和观察 DMD 的范围,我们使用了高分辨率扫源 OCT(Anterion,海德堡工程公司,德国海德堡)。手术中注入了前房气泡,以使德斯梅尔膜(DM)与角膜基质重新连接。手术成功与否可通过高分辨率扫描源 OCT 观察。结论:在临床上,白内障手术后上皮和基质水肿的病因很难区分。该病例表明,使用高分辨率扫源成像技术指导临床决策,对复杂白内障手术后的积气囊成形术的时机和治疗成功与否进行评估是非常有用的。
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引用次数: 0
Diffuse preretinal infiltrates in a patient with orbital atypical T-cell lymphoproliferative infiltration masquerading posterior uveitis. 一名伪装成后葡萄膜炎的眼眶非典型 T 细胞淋巴增生性浸润患者的弥漫性视网膜前浸润。
Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI: 10.3205/oc000242
Bilge Batu Oto, Oğuzhan Kılıçarslan, Didar Uçar, Samira Hagverdiyeva, Ahmet Murat Sarıcı

Purpose: To report an aggressive and rapidly progressive case of atypical T-cell lymphoproliferative infiltration both with intraocular and orbital involvement and preretinal infiltrates.

Methods: Medical records and imaging of the patient were retrospectively reviewed.

Case presentation: A 25-year-old woman presented first with preretinal infiltrates resembling uveitis and developed orbital and intracranial signs eventually during her evaluation. Clinical presentation worsened gradually. The patient developed bilateral proptosis, pupillary dilation and uvula deviation. Diagnostic orbital incision biopsy revealed T-cell lymphoproliferative disease.

Conclusion: This case gives evidence that intraocular involvement due to T-cell lymphoproliferative disease may present as a masquerade syndrome and should be kept in mind in patients with extraordinary presentation.

目的:报告一例侵袭性和快速进展的非典型T细胞淋巴细胞增生性浸润病例,该病例同时伴有眼内和眼眶受累以及视网膜前浸润:方法:回顾性分析患者的病历和影像学资料:一名 25 岁女性患者首先出现类似葡萄膜炎的视网膜前浸润,在评估期间最终出现眼眶和颅内症状。临床表现逐渐恶化。患者出现双侧眼球突出、瞳孔散大和悬雍垂。诊断性眼眶切口活检显示患者患有 T 细胞淋巴增生性疾病:本病例证明,T 细胞淋巴细胞增生性疾病导致的眼内受累可能表现为一种假性综合征,对于有特殊表现的患者应加以注意。
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引用次数: 0
Combined use of intravitreal bevacizumab and oral steroid treatment in three diabetic papillopathy patients: a diagnostic and treatment challenge. 在三名糖尿病乳头状瘤病患者中联合使用玻璃体内贝伐单抗和口服类固醇治疗:诊断和治疗难题。
Pub Date : 2024-06-25 eCollection Date: 2024-01-01 DOI: 10.3205/oc000238
Burcu Taşkıran Kandeğer, Mehmet Argun, Levent Tök, Özlem Tök

Diabetic papillopathy (DP), a form of optic disc edema, is characterized by decreased visual acuity and mild to severe visual field defects. While there is no consensus about treatment, some publications report that intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection may be beneficial. To our knowledge, however, no research reports on the effects of combining anti-VEGF injection and oral steroids in DP treatment. In this case report we present three DP cases that showed rapid improvement following therapy with intravitreal bevacizumab and oral steroids. Optic disc edemas were significantly decreased, and visual acuities were markedly increased in the first week of treatment. This report suggests that combined use of these therapies may be safely used in patients diagnosed with DP.

糖尿病乳头状病变(DP)是视盘水肿的一种形式,其特征是视力下降和轻度至重度视野缺损。虽然对治疗方法还没有达成共识,但一些出版物报道说,玻璃体内注射抗血管内皮生长因子(anti-VEGF)可能有益。然而,据我们所知,目前还没有研究报告称,抗血管内皮生长因子注射和口服类固醇联合应用于DP的治疗效果如何。在本病例报告中,我们介绍了三例在接受玻璃体内贝伐单抗和口服类固醇治疗后病情迅速好转的 DP 病例。在治疗的第一周,视盘水肿明显减轻,视力明显提高。该报告表明,联合使用这些疗法可安全地用于确诊的 DP 患者。
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引用次数: 0
Unilateral alacrimia as a presenting symptom of Meckel's cave tumour. 作为梅克尔洞穴瘤首发症状的单侧白细胞增多症。
Pub Date : 2024-06-25 eCollection Date: 2024-01-01 DOI: 10.3205/oc000241
Ignacio Manuel López Miñarro, Laura Prieto Domínguez, Víctor Manuel Asensio-Sánchez

Meckel's cave tumour, a rare benign tumour originating from the Schwann cells surrounding the trigeminal nerve within the Meckel's cave region, can present with a variety of clinical manifestations. We report a case of a 44-year-old male patient who presented with symptoms of tear deficiency, including dryness, ocular discomfort, and blurred vision. Diagnostic evaluation revealed the presence of a Meckel's cave tumour harming the trigeminal nerve, leading to alacrimia. This case highlights the association between Meckel's cave tumour and tear deficiency disorders.

梅克尔穴肿瘤是一种罕见的良性肿瘤,起源于梅克尔穴区域内三叉神经周围的许旺细胞,临床表现多种多样。我们报告了一例 44 岁男性患者的病例,该患者出现泪液缺乏症状,包括眼干、眼部不适和视力模糊。诊断评估显示,患者的三叉神经受到梅克尔氏洞穴瘤的损害,从而导致白内障。本病例强调了梅克尔穴肿瘤与泪液缺乏症之间的关联。
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引用次数: 0
A case of endogenous endophthalmitis caused by Escherichia coli septicemia. 一例由大肠杆菌败血症引起的内源性眼底病。
Pub Date : 2024-06-25 eCollection Date: 2024-01-01 DOI: 10.3205/oc000239
Tejinder Talwar, Prateek Chandra, Sugandha Goel, Kuntal Patel

Endogenous endophthalmitis is a severe sight-threatening condition that requires urgent intervention. It is a rare complication of Escherichia coli septicemia. We herein report a case of left eye endogenous endophthalmitis with uncontrolled type 2 diabetes mellitus with pyelonephritis associated with Escherichia coli septicemia. Vitrectomy was done along with intravitreal antibiotics and steroids. There was significant improvement in vision after vitrectomy.

内源性眼内炎是一种严重威胁视力的疾病,需要紧急干预。它是大肠杆菌败血症的一种罕见并发症。我们在此报告了一例左眼内源性眼内炎病例,患者患有未得到控制的 2 型糖尿病,并伴有大肠杆菌败血症引起的肾盂肾炎。在进行玻璃体切割的同时,还在玻璃体内注射了抗生素和类固醇。玻璃体切除术后视力明显改善。
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引用次数: 0
Bilateral reversible optic neuropathy as the first sign of Waldenström macroglobulinema. 双侧可逆性视神经病变是瓦尔登斯特伦巨球蛋白症的首发症状。
Pub Date : 2024-06-25 eCollection Date: 2024-01-01 DOI: 10.3205/oc000240
Yoshiaki Shimada, Yoshiki Akatsuka, Kazuya Nokura

Objective: To report a case of bilateral reversible optic neuropathy as the first sign of Waldenström macroglobulinemia (WM).

Methods: Observational case report.

Results: A 52-year-old man had a sudden loss of vision in the left eye. Examinations revealed the presence of a serum monoclonal immunoglobulin (IgM kappa) in the serum. Even after a session of steroid pulse therapy, optic neuropathy became bilateral and then resolved almost completely after 4 months. The condition progressed to WM with multiorgan lesions years later. There was no evidence of optic neuropathy recurrence. The literature revealed two cases of monoclonal gammopathy (MG): a 64-year-old man with multiple myeloma (MM) with IgA lambda and a 51-year-old man with MM with IgG kappa. These cases have similar conditions: 1) visual reduction as an initial symptom of MG, 2) bilateral involvement, 3) no sign of central nervous system (CNS) infiltration shown by normal brain magnetic resonance images, and 4) recovery to a visual acuity of ≥1.0 bilaterally with no reoccurrence. The excessive Igs or B-cell hyperactivity may activate an autoimmune mechanism that reversibly interferes with the bilateral optic nerves.

Conclusion: Bilateral optic neuropathy was the initial symptom of WM. There was no evidence of CNS infiltration; it recovered and then did not reoccur. The pathogenesis remained unknown, but two cases of MG were reported in the literature with remarkably similar conditions.

摘要报告一例以双侧可逆性视神经病变作为瓦尔登斯特伦巨球蛋白血症(WM)首发症状的病例:方法:观察性病例报告:结果:一名 52 岁的男性左眼突然失明。检查发现血清中存在单克隆免疫球蛋白(IgM kappa)。即使在接受了一个疗程的类固醇脉冲治疗后,视神经病变仍变成了双侧,4 个月后几乎完全缓解。几年后,病情发展为伴有多器官病变的 WM。没有证据表明视神经病变复发。文献中发现了两例单克隆丙种球蛋白病(MG)病例:一名是 64 岁的多发性骨髓瘤(MM)患者,患有 IgA lambda;另一名是 51 岁的多发性骨髓瘤(MM)患者,患有 IgG kappa。这些病例的情况相似:1)视力下降是多发性骨髓瘤的最初症状;2)双侧受累;3)正常脑磁共振图像未显示中枢神经系统(CNS)浸润的迹象;4)双侧视力恢复至≥1.0,且未再发病。过量的 Igs 或 B 细胞过度活跃可能会激活一种自身免疫机制,从而可逆地干扰双侧视神经:结论:双侧视神经病变是 WM 的首发症状。结论:双侧视神经病变是 WM 的最初症状,没有中枢神经系统浸润的证据;病变恢复后不再复发。发病机制仍然不明,但文献中报道了两例情况极为相似的 MG。
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引用次数: 0
A rare case report of bilateral Purtscher-like retinopathy in juvenile dermatomyositis. 一例罕见的幼年皮肌炎双侧珀切尔样视网膜病变报告。
Pub Date : 2024-05-07 eCollection Date: 2024-01-01 DOI: 10.3205/oc000237
Nidhi Paharia, Shruti Agrawal, Nikhil Agrawal, Jayesh Shah

Purpose: To report a rare case of bilateral Purtscher-like retinopathy (PLR) in a young adult diagnosed with dermatomyositis.

Method: A case report with multi-modal imaging.

Result: A 17-year-old male presented with subacute marked diminution of vision along with arthralgia, weakness of all four limbs and development of multiple rashes around body. Fundus examination revealed bilateral multiple Purtscher flecken, pseudo-cherry red spot, and intra-retinal haemorrhages with cotton wool spots. Systemic and laboratory examinations, magnetic resonance imaging (MRI) and biopsy of tissue confirmed the diagnosis of juvenile dermatomyositis with PLR.

Conclusion: Dermatomyositis, being a rare cause of PLR, should essentially be considered as one of the differentials as timely intervention can alter the course of disease and prove life-saving for the patient.

目的:报告一例罕见的双侧皮肌炎样视网膜病变(PLR)病例:方法:通过多模态成像进行病例报告:结果:一名17岁的男性患者出现亚急性视力明显减退、关节痛、四肢无力和全身多处皮疹。眼底检查发现双侧多发性普氏斑、假性樱桃红斑、视网膜内出血并伴有棉絮斑。全身检查、实验室检查、磁共振成像(MRI)和组织活检证实了幼年皮肌炎伴PLR的诊断:结论:皮肌炎是 PLR 的罕见病因,应将其作为鉴别诊断之一,因为及时干预可改变病程并挽救患者的生命。
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引用次数: 0
Rare metastasis in a patient with BRAF-mutated rectal cancer: choroidal metastasis - case report and literature review. BRAF突变直肠癌患者的罕见转移:脉络膜转移--病例报告和文献综述。
Pub Date : 2024-04-19 eCollection Date: 2024-01-01 DOI: 10.3205/oc000235
Hacer Demir, Mustafa Muhterem Ekim, Esra Özgül, Sena Ece Davarci, Meltem Baykara

Purpose: Colorectal cancers are common and have high mortality, and metastasis is common in follow up. Choroidal metastasis is encountered rarely in rectum cancers, and there is no previous case reported from Turkey. We present our patient who developed choroidal metastasis in his cancer follow-up.

Case report: A 74-year-old male patient had undergone operation due to the diagnosis of rectum cancer two years ago, and lung (L) metastasis developed in the 4th month after the adjuvant therapy, but he refused to receive treatment and remained out of follow-up. The patient presented with complaints of decreased vision and light flashes in his eye 21 months after the diagnosis.

Management and outcome: Ocular examination revealed a choroidal mass and radiologically choroidal and multiple brain metastases were detected. In our case, whole-brain radiotherapy was administered in the treatment since there were also multiple brain metastases. However, as the ECOG (Eastern Cooperative Oncology Group) performance status of the patient was 3-4 after radiotherapy, systemic treatment was not considered appropriate, and the best supportive care was given. The patient died 2 months after the diagnosis of choroidal metastasis.

Conclusion: Currently, there are few suggestions in case reports regarding appropriate treatment approaches for the treatment of rectal cancerchoroidal metastases. Multidisciplinary approaches may be effective for local and systemic treatment. Our case highlights a pathological entity with poor prognosis, which is rarely encountered during the course of rectal adenocarcinomas, and it is the first case of choroidal metastasis reported from our country. However, we believe that it will be important to draw attention to the fact that it is the first reported case of choroid metastasis in a rectal cancer patient with a BRAF V600 E mutation, and patients with BRAF V600 E mutation may develop metastasis to atypical areas due to their aggressive biology.

目的:结肠直肠癌很常见,死亡率很高,在随访过程中常见转移。直肠癌很少发生脉络膜转移,土耳其也没有相关病例报道。病例报告:一名 74 岁的男性患者两年前因直肠癌接受了手术,在辅助治疗后的第 4 个月出现肺(L)转移,但他拒绝接受治疗,一直未接受随访。确诊 21 个月后,患者主诉视力下降,眼睛有闪光:眼部检查发现脉络膜肿块,放射学检查发现脉络膜转移和多发性脑转移。在我们的病例中,由于也有多发脑转移灶,因此在治疗中采用了全脑放疗。然而,由于放疗后患者的 ECOG(东部合作肿瘤学组)表现状态为 3-4,因此不适合进行全身治疗,而是给予了最佳支持治疗。患者在确诊脉络膜转移后 2 个月死亡:目前,病例报告中关于治疗直肠癌脉络膜转移的适当方法的建议很少。多学科方法可能对局部和全身治疗有效。我们的病例突出了一种预后不良的病理实体,在直肠腺癌的病程中很少遇到,这也是我国报告的首例脉络膜转移瘤。然而,我们认为有必要提请注意的是,这是首例报道的BRAF V600 E基因突变的直肠癌患者脉络膜转移病例,而BRAF V600 E基因突变的患者由于其侵袭性生物学特性,可能会发生非典型区域的转移。
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引用次数: 0
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GMS ophthalmology cases
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