Unilateral malignant optic glioma following glioblastoma multiforme in the young: a case report and literature review

Abstract

Background: Malignant optic gliomas are rare, but they rapidly become lethal visual pathway tumors. We present the clinical course, treatment, and prognosis of a case of unilateral malignant optic glioma in a young man with a history of brain glioblastoma multiforme (GBM).

Case presentation: A 21-year-old man, who had GBM 7 years ago complained of a transient shadow in his vision and presented with normal visual acuity but optic disc edema and an enlarged blind spot in the right eye (oculus dexter, OD). Magnetic resonance imaging (MRI) showed a right intraorbital optic nerve tumor without a brain lesion. Chiasm involvement and severe vision deterioration occurred 3 months later. A biopsy of the right optic nerve revealed glioblastoma. Concurrent chemoradiotherapy (CCRT) prevented involvement of the fellow eye 1 year after symptom onset.

Conclusion: This report demonstrated that a regular ocular exam should be recommended for several years after GBM. In young healthy patients who are able to undergo chemotherapy and radiotherapy, visual function in the fellow eye can be preserved.

Keywords: Glioblastoma multiforme; Malignant optic glioma; Optic disc edema; Young.

Fig. 1

Fundus imaging showed (a) a swollen optic disc in the right eye, (b) a normal optic disc in the left eye. Humphrey automated perimetry (SITA) revealed (c) an enlarged blind spot in the right eye at the initial symptom onset and (d) severe constriction with only central area preservation in the right eye 3 months after symptom onset

Fig. 2

T1 weighted contrast – enhanced MRI showed (a, b) original right frontoparietal glioblastoma (c) without right optic nerve involvement. At the initial symptom onset, T1 weighted contrast – enhanced MRI with fat suppression showed (d) no evidence of brain tumor recurrence but (e, f) right pre-chaismatic enhanced fusiform optic nerve tumor. At 3 months after symptom onset, T1 weighted contrast – enhanced MRI with fat suppression showed (h, i) right fusiform enlargement and an enhanced optic nerve tumor intraorbitally extending towards the optic chiasm even (g) no brain tumor recurrence. At 11 months after symptom onset, T1 weighted contrast – enhanced MRI with fat suppression showed (k, l) right optic nerve tumor extending to the optic chiasm and progressing in size (j) without brain tumor recurrence