继发于胆囊癌的癌症相关视网膜病变。

GMS ophthalmology cases Pub Date : 2024-09-23 eCollection Date: 2024-01-01 DOI:10.3205/oc000243
Karel Goyvaerts, Tanja Coeckelbergh, Pieter-Paul Schauwvlieghe, Michel van Lint
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引用次数: 0

摘要

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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Cancer-associated retinopathy secondary to gallbladder carcinoma.

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.

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Cancer-associated retinopathy secondary to gallbladder carcinoma. Diffuse preretinal infiltrates in a patient with orbital atypical T-cell lymphoproliferative infiltration masquerading posterior uveitis. Epithelial downgrowth masquerading as granulomatous anterior and intermediate uveitis with histopathologic evidence of 5-FU treatment. Pseudophakic corneal edema caused by Descemet membrane detachment using high-resolution swept-source OCT imaging. Bilateral reversible optic neuropathy as the first sign of Waldenström macroglobulinema.
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