[Reticulum cell sarcoma of the brain with bilateral ocular involvement, a case report]

This paper describes an unusual case of primary reticulum cell sarcoma of the brain in the left temporal lobe which was considered to be metastasized to the right frontal lobe and bilateral eyes. The patient is a 60-year-old man who was completely well until Nov. 1979 when he developed headache which was accompanied by nausea. He was admitted to our service on Dec. 17th, when his general condition was well. Neurological examination revealed disorientation to time and place, sensory aphasia, right upper quadrantic hemianopsia and slight weakness of the right upper extremity. Ophthalmological examination disclosed no abnormalities except for subretinal exudate in the right eye which was caused by old central retinopathy. Routine laboratory examinations including blood cell counts, urinalysis, serum electrolytes, serum electrophoretic studies, plain chest x-rays, ECG and plain skull x-rays were all within normal limits. CT-scan on Dec. 20th showed a mass lesion in the left temporal lobe which was uniformly enhanced by the contrast medium. CAG confirmed the presence of left temporal tumor which was hypovascular. On Dec. 24th 1979, left frontotemporal craniotomy and subtotal removal of the tumor was performed. Histopathological diagnosis of the tumor was reticulum cell sarcoma of the brain. Postoperatively he was treated by a combination of 60Co irradiation of total dose of 5,100 rads and methyl-CCNU 250 mg every 6 weeks. The follow up ophthalmological examination in May 1980 revealed subretinal white spots in the left eye. In Jun., the white spots increased in number and fused together. The subretinal perivascular exudate and retinal bleeding accompanied. His right eye was also involved. Echogram of the eyes showed a mass lesion in the fundus of the left eye. CT-scan taken at the same period of time revealed a tumor in the right frontal lobe. 67Ga-citrate whole body scan demonstrated no spot of abnormal uptake except for the right frontal lobe. We suspected that the lesions in the bilateral eyes and the right frontal lobe were metastasis from the primary reticulum cell sarcoma of the left temporal lobe. The bilateral eyes and the right frontal lobe were irradiated with a total dose of 4200 rads. CT scan following the second radiotherapy showed complete disappearance of the tumor in the right frontal lobe. Echogram revealed a marked reduction in size of the mass lesion at the left ocular fundus.