Abstract Details

Title Optic Neuropathy Related to Esophageal Carcinoma

Topic Neuro-oncology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-018

Objective Case presentation of bilateral optic neuropathy in a patient with known esophageal cancer.

Background

Optic neuropathies have diverse underlying pathologies. Malignant processes include optic nerve glioma, lymphoma and paraneoplastic disease, all of which can cause infiltration of the optic nerve.

Design/Methods The patient is a 58-year-old man with stage IIIC esophageal adenocarcinoma. He underwent initial neo-adjuvant chemo-radiotherapy with carboplatin and paclitaxel, followed by surgical resection. He was subsequently, enrolled in an observational trial of nivolumab (humanized anti-PD-1 monoclonal antibody) versus placebo, 10 months prior to current presentation with visual deficits. He had complaints of slight blurring of images, more prominent in the left eye, and occasional double vision. He denied any other neurological symptoms and examination showed significant papilledema in the left eye but the visual acuity was 20/25 bilaterally. A gadolinium-enhanced head MRI was unrevealing but subsequent MR of the orbits with fat suppression showed bilateral optic nerve sheath enhancement. A lumbar puncture revealed elevated opening pressure of 30 cm of water and the CSF had 18 nucleated cells and normal protein/glucose. Infectious and systemic inflammatory work-up was unrevealing. Cytology was positive for malignant cells with morphology consistent with esophageal cancer. The CSF was also sent for testing of anti-AQP4, anti–MOG and anti-CMRP5 antibodies for the evaluation of autoimmune optic neuropathy.

Results On out-patient follow up, the patient reported subjective improvement in his vision but examination showed continued papilledema. His sequential visual field perimetry studies revealed an enlarging blind spot. He was planned for whole brain radiotherapy with coverage of posterior third of the eyes based on malignant infiltration of the optic nerves and positive CSF cytology for malignant cells.

Conclusions

Patients with solid tumor malignancies can develop infiltrative optic nerve complications and evaluating for this possibility can be important and could impact management.

Authors/Disclosures
Sasmit Sarangi, MD, MBBS (Rhode Island Hospital/Brown University) PRESENTER	The institution of Dr. Sarangi has received research support from Fore biotherapeutics.
Marc A. Bouffard, MD (Beth Israel Deaconess Medical Center)	No disclosure on file
Eric T. Wong, MD, FAAN (Rhode Island Hospital)	Dr. Wong has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novocure. Dr. Wong has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ZaiLab. Dr. Wong has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Turning Point Therapeutics. Dr. Wong has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Imvax. The institution of Dr. Wong has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novocure. The institution of Dr. Wong has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Turning Point Therapeutics. The institution of Dr. Wong has received research support from Novocure. Dr. Wong has received intellectual property interests from a discovery or technology relating to health care. Dr. Wong has received publishing royalties from a publication relating to health care.

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