Babu Kalpana, Bhimewar Shrutika
Department of Uvea and Ocular Inflammation, Prabha Eye Clinic and Research Centre and Vittala International Institute of Ophthalmology, Bengaluru, India.
Ocul Immunol Inflamm. 2025 Sep;33(7):1489-1494. doi: 10.1080/09273948.2025.2495083. Epub 2025 Apr 28.
We report a rare case of cancer associated retinopathy with multimodal imaging, as an initial presentation of biopsy proven prostate acinar adenocarcinoma and a lung nodule with granulomatous inflammation.
MATERIALS & METHODS: Retrospective case report with review of literature.
A 71-year-old man with decrease in vision in left eye was diagnosed to have outer retinal involvement (OU) on autofluorescence and spectral OCT. PET CT scans showed enlargement of prostate with patchy areas of prostate specific membrane antigen avidity and a lung nodule. Biopsy of the prostate showed acinar adenocarcinoma while that of the lung nodule showed granulomatous inflammation, negative for AFB on culture and PCR. Inspite of intravenous methylprednisolone followed by oral steroids and therapeutic trial of antitubercular therapy, progression in the right eye threatening the fovea was noted in 9 days. Intravitreal ozurdex was given (OU) following which there was no progression. He also received mycophenolate mofetil 2 gm/day and hormonal therapy for the adenocarcinoma of the prostate. His serology was positive for carbonic anhydrase II autoantibodies (western blot) and showed strong staining of the IS-OS junction(on immunohistochemistry). At 1 year follow-up, the eye was stable with no improvement or further deterioration of vision or onset of fresh lesions.
Cancer associated retinopathy due to prostatic acinar adenocarcinoma is very rare. The autofluorescence and OCT show characteristic outer retinal involvement at the level of the RPE and photoreceptors. Intravitreal dexamethasone implant is a good option to prevent further vision loss.
我们报告一例罕见的癌症相关性视网膜病变，伴有多模态成像，其最初表现为经活检证实的前列腺腺泡腺癌和一个伴有肉芽肿性炎症的肺结节。
回顾性病例报告并复习文献。
一名71岁男性，左眼视力下降，经自发荧光和光谱光学相干断层扫描（OCT）诊断为外层视网膜受累（双眼）。正电子发射断层扫描（PET）CT扫描显示前列腺增大，有前列腺特异性膜抗原摄取的斑片状区域以及一个肺结节。前列腺活检显示为腺泡腺癌，而肺结节活检显示为肉芽肿性炎症，培养及聚合酶链反应（PCR）检测抗酸杆菌均为阴性。尽管给予了静脉注射甲泼尼龙，随后口服类固醇，并进行了抗结核治疗的试验性治疗，但9天内右眼仍出现进展，威胁到黄斑中心凹。随后给予玻璃体内注射奥曲肽（双眼），之后病情未再进展。他还接受了霉酚酸酯2克/天的治疗以及针对前列腺腺癌的激素治疗。他的血清学检查碳酸酐酶II自身抗体呈阳性（蛋白质印迹法），免疫组织化学显示内节-外节连接部有强染色。随访1年时，眼部情况稳定，视力无改善或进一步恶化，也未出现新病变。
前列腺腺泡腺癌所致的癌症相关性视网膜病变非常罕见。自发荧光和OCT显示在视网膜色素上皮（RPE）和光感受器水平有特征性的外层视网膜受累。玻璃体内注射地塞米松植入物是预防进一步视力丧失的良好选择。
