Title
ASTROCYTIC HAMARTOMA IN ROUTINE EYE EXAMINATION: A CASE SERIES
Introduction
Retinal Astrocytic Hamartoma (AH) is a benign tumor of the retinal nerve fiber layer or of the optic disk composed of glial cells, predominantly astrocytes.They represent 3% of leukocoria cases in children.
Methods
We report a case series of 03 patients accidentally diagnosed with astrocytic hamartoma during routine eye examination.
Results
Our first case was a male patient,10 years old,referred to us for a routine eye examination.Personal antecedent:tuberous sclerosys.Best corrected visual acuity (BCVA):20/20.Right eye fundus(RYF):whitish multilobular retinal lesion above the optic disk.Left eye fundus(LYF):normal.USG B-scan:retinal mass lesion measuring3,6x4,0x2,5mm.Acoustic shadowing was observed in multilobular calcified areas. Our second case was a female patient,age 61,no visual complains.BCVA 20/30P.RYF: subretinal white,flat,translucent,well defined and noncalcified lesion.LYF:normal findings. Our third case was a female patient,age 71.BCVA: 20/30.RYF: normal.LYF:retinal lesion consisting of glistening yellowish spherules of calcification surrounded by a sessile and slightly elevated lesion along the inferotemporal arcade.USG A-scan:hyper-reflective lesion, measuring1,5 disc diameters.
Discussion
Morphologically,AH can be classified as one of two types:1-Large, whitish(calcified)nodular masses–commonly referred to mulberry lesions;2-most common-flat,translucent smooth tumors.More than half of these tumors go undetected,due to its asymptomatic features.It can,however,cause"mass effect"and may cause retinal detachment/vitreous seeding. Our third case previously described showed a type 1 AH. Mulberry-like calcification is pathognomonic of tuberous sclerosis,such as observed in our 10 year-old patient.They are the most common ocular finding of tuberous sclerosis complex.However,may cause doubt when appearing as a small,translucent noncalcified thickening of the nerve fiber layer.In these cases Retinoblastoma and myelinated nerve fibers must be considered in the differential diagnosis.
Keywords
glial tumors;calcification;hamartoma;retina
Area
CLINICAL CASE
Authors
Fernanda Salata Antunes, Paulo Henrique Horizonte, Andréia Novelli, Andre Marcelo Vieira Gomes, Rafael Garcia, Henrique Leber, Carolina Maria Barbosa Lemos, Gabriella Marranghello Mingione