zografos tumors and pseudotumors of the optic disc

Leonidas ZografosLausanne

4th Thessaloniki International Vitreo-Retinal Summer School, 16-21. 6.2014, Electra Palace

Tumors and pseudotumors of the optic disc

Tumors and pseudo-tumors of the optic disc

1. Congenital anomalies of the O.D.2. Pigmented tumors and pseudo-tumors3. Tumors of the pigment epithelium of the retina4. Vascular tumors5. Glial tumors of the optic disc6. Tumors of the retina7. Metastatic tumors8. Leukemia and lymphoma9. Optic disc invasion from primary tumors of the

optic nerve

Congenital anomalies of the optic disc

Optic pitMorning glory disc anomalyOptic nerve coloboma

Prepapillary vascular anomalies

Arterial loops

Venous loops

Pigmented tumors and pseudo-tumors

Optic disc melanocytosisMelanocytomaJuxtapapillary melanomaPrimary melanoma of the optic disc

Optic disc Melanocytomas

Edema of the optic disc 48%

Ophthalmoscopy +

Fluorescein angiography +

24%

Ophthalmoscopy –

Fluorescein angiography +

24%

ICG 2:08 ICG 50:48

Fluo 0:37

ICG 10:02

Fluo 0:50

07.2001

03.2003

Visual field defects

Acuate and peripheral scotomas

27%

Enlargement of the blind spot

16%

Visual field defects

Tubular vision 8%

Obs. per. 2 y.

Obs. per. 6 y. Obs. per. 8 y.

Optic disc melanocytoma

Visual field defect

Melanocytoma of the optic disc

Juxtapapillary CNVSurgical excision

Obs. Period 8 yearsVis. Ac. 0.1

Melanocytoma of the optic disc

Documented tumor growth

Obs. period ≥ 6 years 65%

Malignant transformation

Obs. period ≥ 10 years 5%

Juxtapapillary melanoma

Juxtapapillary melanoma

Proton Beam irradiationObs. Period. 1 year Vis. Ac. 04

11.2004 10.2011 Vis. Ac. 0.2Vis. Ac. 1.0

Peripapillary melanoma

Epipapillary melanoma

Invasion of the optic disc

Retinoinvasive melanoma

Primary melanoma of optic disk

Tumors and pseudo-tumors of the retinal pigment epithelium

Congenital hypertrophy of the RPE

Combined hamartomas of RPE

Adenoma / Ca of the juxtapapillary RPE

Adenoma / Ca of the juxtapapillary RPE

Biopsy + proton beam irradiationObs. Period 7 years Vis. Ac. 0.01

Adenoma / Ca of the juxtapapillary RPE

Vascular tumorsCavernous hemangioma of the optic discCapillary hemangioma of the optic discRacemose hemangiomatasisWyburn-Mason Syndrome

Parapapillary hemangioblastoma

Sessile ExophyticEndophytic

M. 19 yearsIsolated hemangioblastoma

Vis. Ac. 0.6

Obs. period 1 year Vis. Ac. 0.7

Obs. period 5 years Vis. Ac. 0.6

Laser 4 sessions

F. 30 yearsIsolated hemangioblastoma

Vis. Ac. 0.4

Obs. period 2 years Vis. Ac. 0.5

Laser +2 sessions

M. 12 yearsIsolated hemangioblastoma

Vis. Ac. 1.0

Obs. period 3 years Vis. Ac. 0.01

Obs. period +2 m. Vis. Ac. 0.05

Obs. period +5 m. Vis. Ac. 0.4

1 year post treatment Vis. Ac. 0.5

2 years post treatment Vis. Ac. 0.5

17 years post treatment Vis. Ac. 0.5

Laser 4 sessions

M. 16 years

v. Hippel – Lindau s.Pheochromocytoma

19 years Vis. Ac. 0.1

Laser 4 sessionsSurgical excision

Vis. Ac. 0.2

1 m. post treatment Vis. Ac. 0.1

Photodynamic Therapy (PDT)

1.5 yeras post treatment Vis. Ac. LP

F. 35 years

v. Hippel – Lindau s.Cerrebellar hemangioblastoma

Vis. Ac. 0.1

Proton beam radiotherapy

Vis. Ac. 0.1

6 month Vis. Ac. LP

7 years Vis. Ac. LP

Vis. Ac. 0.8 Vis. Ac. 0.8

Obs. period 10 years

M. 17 yearsv. Hippel – Lindau s.Cerrebellar hemangioblastoma

Vis. Ac. 0.1

Racemose hemangiomatasisWyburn-Mason Syndrome

Glial tumors of the optic disc

Astrocytic hamartoma

Noncalcified astrocytic hamartoma

Calcified astrocytic hamartoma

Astrocytic hamartoma

Calcified astrocytic hamartoma

Solitary progressive astrocytoma

Primary tumors ofthe retina

Retinoblastoma

Choroidal metastasis

Invasion of the optic disc

Lymphomas and

Leukemias

Optic disc invasion from primary tumors of the optic nerve

Optic nerve gliomaOptic nerve meningioma

Conclusions

May be localized to the optic discAll this conditions are rare or extremely rare

Various- Benign and malignant- Primary and metastatic- Tumors and pseudo-tumors