Congenital Cystic Eye Associated With A Low-grade Cerebellar Lesion That Spontaneouslyearsegressed.
Cefalo, M. G., Colafati, G. S., Romanzo, A., Modugno, A., De Vito, R., & Mastronuzzi, A. (2014). Congenital cystic eye associated with a low-grade cerebellar lesion that spontaneously regressed. BMC ophthalmology, 14, 80. https://doi.org/10.1186/1471-2415-14-80
View Original Source →Abstract
Congenital cystic eye is an exceedingly rare ocular malformative disease, originated from the failure in the invagination of the optic vesicle during the fetal period and it can be associated with other ocular and non-ocular abnormalities. Diagnosis is based on clinical, radiological and histological features. We report a case of a congenital cystic eye associated with a cerebellar lesion accidentally detected at magnetic resonance imaging. Biopsy of the mass has not been performed due to parental rejection. Based on radiologic features and absence of clinical signs, a low-grade glioma diagnosis was hypothesized, but histological characterization was not obtained. Follow-up neuro-imaging 6 months after diagnosis showed that intracranial lesion spontaneously regressed without any treatment. Our report stresses the importance of early MRI in children with ocular malformations, in order to detect associated intracranial defects, also of non-malformative origin. Additionally, we debate the clinic-radiological features of the intracranial lesions that could allow a wait-and-see policy. We also recommend a strict clinical and neuro-imaging follow-up for these lesions. Finally, biological mechanisms at the base of spontaneous regression of the brain lesions are discussed.
Case Details
Disease Location
Left congenital cystic eye with cerebellar lesion
Personal Characteristics
6 months old with congenital cystic orbital mass at birth
Clinical Characteristics
Ophthalmologic examination revealed a left empatienty socket and a cystic lesion protruding from the left orbit, stretching upper eyelids. No ocular structures seen. Genetic analysis negative. No globe seen on us. Brain and orbit MRI suggested a non-infiltrative extraconal superior lesion - fluid aspiration and partial resection done: evidence of neuroglial tissue. Ihc exam positive for nse, synapatientophysin consistent with congenital cystic eye. Follow up MRI after 1 years of surgery showed 8mm cerebellar lesion (likely low grade glioma based on radiology findings)- parents refused biopsy and 1 months follow up MRI. MRI at 6 months showed spontaneous regression.
Remission Characteristics
Spontaneous regression of cerebellar lesion at 6 months from time of diagnosis and confirmed at 24 months.
Treatment & Mechanisms
Proposed Remission Mechanisms
Partial resection of congenital cyst may expose previously hidden antigens and induce immune resposnes. Also change in vascularity and gliosis as a reaction to partial resection.
Clinical Treatment
No treatment of cerebellar lesion