Tuberous sclerosis in infancy

Intraocular Astrocytoma without Phacomatosis

PURPOSE

Astrocytic tumors occur in the retina or in the optic disc usually as a part of tuberous sclerosis complex or other phacomatosis and their isolated occurrence is rare. The authors present two adult patients in whom the diagnosis of intraocular astrocytoma was established but no signs of phacomatosis were revealed.

Tuberous sclerosis complex: genotype/phenotype correlation of retinal findings

OBJECTIVE

To evaluate genotype/phenotype correlations in individuals with astrocytic hamartoma (AH) and retinal achromic patch (AP) in the setting of tuberous sclerosis complex (TSC).

DESIGN

Retrospective consecutive case series.

PARTICIPANTS

A total of 132 patients enrolled in the Cleveland Clinic Foundation Tuberous Sclerosis Program (CCF-TSCP) and 907 patients from the Tuberous Sclerosis Alliance (TSC-A).

METHODS

Patient gender, age at TSC diagnosis, presence of TSC1 or TSC2 mutations, detailed ophthalmic examination findings, systemic manifestations, and whether or not the patient had a diagnosis of epilepsy or cognitive impairment were analyzed.

MAIN OUTCOME MEASURES

Genotype/phenotype correlation of retinal findings and systemic disease manifestations.

RESULTS

No significant difference was found in the prevalence of AH or AP in the CCF-TSCP (36.1%) and TSC-A (34.1%) groups (P = 0.743). Astrocytic hamartomas were bilateral in 43.3% and 18.1% (P=0.009) and multiple in 40.0% and 15.3% (P = 0.008) in the CCF-TSCP and TSC-A groups, respectively. In the CCF-TSCP group, the average number of AH was 4 (range, 2-7). Average tumor size was 1.0 disc diameter (range, 0.5-2.5 disc diameters). The most common location was along the arcades (41.5%), adjacent to the optic nerve (29.2%), and in the retinal periphery (27.7%). In the CCF-TSCP group, AP was observed in 12.0% of patients (40.0% bilateral, 50.0% multiple). The presence of retinal features was associated with giant cell astrocytoma (37.1% vs. 14.6%; P = 0.018), renal angiomyolipoma (60.0% vs. 27.1%; P = 0.003), cognitive impairment (77.1% vs. 43.8%; P = 0.002), and epilepsy (91.4% vs. 70.8% (P = 0.022) in those with and without retinal findings, respectively. In patients with retinal findings in both the CCF-TSCP and TSC-A groups, mutations in TSC2 were more frequent than in TSC1, 3.3 times and 5.8 times, respectively; in those without retinal findings, the relative rates were 0.67 times and 2.3 times, respectively.

CONCLUSIONS

Individuals with retinal findings are more likely to have concomitant subependymal giant cell astrocytomas, renal angiomyolipomas, cognitive impairment, and epilepsy. TSC2 mutations are more frequent in patients with retinal findings than in those without retinal findings.

Glial tumors of the retina. The 2009 King Khaled Memorial Lecture

Retinal glial tumors and pseudotumors can be classified into astrocytic hamartoma, acquired retinal astrocytoma, massive gliosis, and focal nodular gliosis. Each has different clinical manifestations. Astrocytic hamartoma is usually seen patients who have some manifestations of tuberous sclerosis complex (TSC). It can occur as a noncalcified or calcified variety, and often a combination of the two, and has fairly typical features with fluorescein angiography, ultrasonography, and optical coherence tomography. Although it is generally a stationary lesion, an aggressive variant seen in very young children with TSC can lead to exudative retinopathy, retinal detachment, and neovascular glaucoma. Acquired astrocytoma general occurs in somewhat older individuals who do not have TSC. Like the aggressive form of astrocytic hamartoma it can lead to exudative retinopathy and exudative retinal detachment. Pseudoneoplastic diffuse retinal gliosis can occur as massive glial proliferation in eyes with prior trauma, Coats disease, retinal angiomatosis and other conditions and often occurs in blind eyes. Pseudoneoplastic focal retinal gliosis is characterized by a very superficial, white, noncalcified lesion in otherwise normal eye in somewhat older individuals. Recognition of these glial lesions is important because they can resemble malignant tumors and have different clinical courses and complications.

Presumed transient reactive astrocytic hyperplasia in immature retina

PURPOSE

To describe the appearance and clinical course of small, white, endophytic calcific, peripheral lesions in developing retina of premature infants.

METHODS

Retrospective review of all patients evaluated for retinopathy of prematurity (ROP) at a level I neonatal intensive care unit (NICU) in San Jose, CA, between January 1, 2003, and December 31, 2004. Patients were examined either in the NICU or the affiliated outpatient clinic. Clinical examination consisted of dilated fundus examination with 360 degree scleral depression. Lesions were identified if they were white, calcific, peripheral, and transient. Ancillary testing and examination of family members was performed as indicated.

RESULTS

A total of 302 unique patients were screened for ROP. Ten lesions were identified in seven eyes. Three eyes had two lesions each. All lesions were unilateral. The size of the lesions was estimated to range between 500 and 700 microm. All lesions were located anterior to the vascularized retina, had minimal elevation on scleral depression, and demonstrated a predilection for the nasal and temporal raphe. Ultrasound findings demonstrated an elevated, hyperechoic mass with orbital shadowing. Computed tomography and magnetic resonance imaging tests did not demonstrate the lesions. Lesions involute slowly over a period of 6 months. There were no systemic findings or familial dispositions.

CONCLUSION

Immature retina in premature infants may predispose to the formation of transient reactive astrocytic hyperplasia. Development of mature retinal vascularization and spontaneous resolution of lesions should alleviate concerns regarding a more malignant diagnosis.

Solitary retinal astrocytoma in an infant

A 5-month-old infant presented with a solitary retinal astrocytoma that clinically and ultrasonographically mimicked retinoblastoma. The diagnosis was established on histopathologic examination. There was no systemic evidence of tuberous sclerosis or neurofibromatosis. Thus, solitary, large, retinal astrocytomas can occur in the absence of any systemic manifestations.