Cancer-associated retinopathy associated with invasive thymoma

• Published in: American journal of ophthalmology Vol. 134; no. 3; pp. 383 - 389
• Main Authors: Katsuta, Hideto, Okada, Morio, Nakauchi, Tadashi, Takahashi, Yutaka, Yamao, Satoshi, Uchida, Sunao
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2002; Elsevier
• Subjects: Adult; Autoantibodies - blood; Biological and medical sciences; Calcium-Binding Proteins - immunology; Electroretinography; Eye Proteins; Female; Fluorescein Angiography; Glucocorticoids - therapeutic use; Hippocalcin; Humans; Lipoproteins; Medical sciences; Myasthenia Gravis - complications; Neoplasm Invasiveness; Nerve Tissue Proteins; Ophthalmology; Paraneoplastic Syndromes - diagnosis; Paraneoplastic Syndromes - etiology; Paraneoplastic Syndromes - physiopathology; Plasmapheresis; Pneumology; Pulse Therapy, Drug; Recoverin; Retinal Diseases - diagnosis; Retinal Diseases - etiology; Retinal Diseases - physiopathology; Retinopathies; Thymectomy; Thymoma - complications; Thymoma - pathology; Thymoma - therapy; Thymus Neoplasms - complications; Thymus Neoplasms - pathology; Thymus Neoplasms - therapy; Tumors and pseudotumors of the eye, orbit, eyelid, lacrimal apparatus; Tumors of the respiratory system and mediastinum; Vision Disorders - etiology; Visual Acuity; Thymus pathology; Case study; Human; Eye disease; Association; Retinopathy; Thymoma; Mediastinum disease; Female; Malignant tumor
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(02)01598-2

PURPOSE: To report a case of cancer-associated retinopathy associated with invasive thymoma. DESIGN: Interventional case report METHOD: A 41-year-old Japanese woman was observed between February 1998 and May 2001. Ophthalmologic examinations and systemic examinations were performed. The patient received treatment including corticosteroid pulse therapy, plasmapheresis, and thymectomy. RESULTS: The patient developed progressive visual dysfunction including bilateral visual acuity loss, concentric contraction of visual fields, and color vision loss. In both eyes, retinal vessel attenuation and retinal pigment epithelium degeneration were observed with fundus ophthalmoscopy and fluorescein angiography. Response in electroretinogram was reduced, suggesting both rod and cone dysfunction. Autoantibody against 23-kD cancer-associated retinopathy (CAR) antigen (antirecoverin antibody) was detected in the patient’s serum. A mediastinal tumor that was histopathologically diagnosed as invasive thymoma was detected and was surgically resected. During more than 3 years of follow-up, no other malignancy was detected despite extensive systemic evaluation. The patient also suffered from subclinical myasthenia gravis. Although temporary improvement of visual function was observed after treatment with steroid pulse therapy and plasmapheresis’ light perception of each eye was lost in the end. CONCLUSIONS: The patient was diagnosed as having CAR. Invasive thymoma was considered to be the causative tumor because there had been no evidence that suggested other systemic malignancy during more than 3 years of follow-up.