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Photo Essay

Presumed solitary circumscribed retinal astrocytic proliferation

Dubey, Devashish; Shanmugam, Mahesh; Ramanjulu, Rajesh

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doi: 10.4103/ijo.IJO_894_19
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A 40-year-old lady came to the clinic with presbyopic complaints since 1 month. Her best corrected visual acuity was 20/20, N6 (OU). Anterior segment evaluation as well as Intraocular pressure was within normal limits (WNL). Fundus examination of left eye (OS) revealed a well circumscribed, elevated and opaque lesion 3 × 2.4 mm in size along the inferior arcade [Fig. 1a]. Right eye fundus was WNL. Autofluorescence showed moderate hyperaurofluorescence of the mass [Fig. 1b]. Optical coherence tomography (OCT) through the lesion showed an elevated non-calcified lesion arising from superficial retinal layers with obscuration of deeper retinal layers with intense posterior shadowing [Fig. 1c]. On OCT-A the mass appeared avascular with superficial retinal vessels of normal caliber traversing through or around it with obscuration of deeper retinal vessels [Fig. 1d]. There were no systemic features of Tuberous sclerosis or Neurofibromatosis. On one year follow-up, the visual acuity remained stable with no observed growth.

Figure 1
Figure 1:
Color fundus photo showing a white opaque elevated well-circumscribed mass along the inferior arcade (a). On autofluorescence the mass is mildly hyperautofluorescent with hypoautofluorescent borders (b). OCT reveals the mass to be elevated and arising from superficial retinal layers with obscuration of deeper layers and intense backshadowing (c). OCT-A revealed an avascular mass lesion with retinal blood vessels passing through or around the lesion, which were not dilated or tortuous and deeper retinal vasculature was obscured (d)

Shields et al.[12] described such a lesion as presumed solitary circumscribed retinal astrocytic proliferation. These lesions are solitary, superficial, well circumscribed white lesions in eyes with clear media and no prior ocular insults. Patients are asymptomatic and the mass tends to remain stable with no documented growth.

This lesion should be differentiated from Retinal Astrocytic Hamartomas (RAH) which usually are associated with Tuberous Sclerosis or Neurofibromatosis.[3] RAH are nodular yellow lesions with less well-defined margins, which may or may not be calcified usually presenting in pediatric age group.[14]

Another retinal glial tumor that PSCRAP should be differentiated from is acquired retinal astrocytoma. ARA is a vascular tumor exhibiting a more aggressive clinical course, with enlargement and profuse exudation with resultant visual impairment.[5]

This photo essay highlights the unique clinical features and imaging signatures of PSCRAP and outlines the important differentiating features from other retinal glial tumors.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

1. Shields JA, Shields CLShields JA, Shields CL. Glial tumors of the retina and optic disc Intraocular Tumors: An Atlas and Textbook. 20082nd ed Philadelphia, PA Lippincott Williams & Wilkins:406–27
2. Shields JA, Shields CL Intraocular Tumors: A Text and Atlas. 2006 Bangalore WB Saunders Company
3. Rishi P, Hirawat RS, Verma A. Association of bilateral, multiple presumed retinal astrocytic proliferations with combined hamartoma of retina and retinal pigment epithelium in a 9-year-old male child with neurofibromatosis type 2 Indian J Ophthalmol. 2016;64:850
4. Demirci H, Shields CL, Shields JA, Honavar SG. Spontaneous disappearance of presumed retinal astrocytic hyperplasia Retina. 2002;22:237–9
5. Shields CL, Shields JA, Eagle RC Jr, Cangemi F. Progressive enlargement of acquired retinal astrocytoma in 2 cases Ophthalmology. 2004;111:363–8

PSCRAP; retinal glial proliferation; retinal glial tumor

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