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Sarcoid masquerading as optic nerve sheath meningioma
E B Ing1, J A Garrity, S A Cross
1Department of Ophthalmology, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clinic Proceedings
|January 1, 1997
Summary
Optic nerve sarcoidosis presenting as a tumor is rare and often misdiagnosed as optic nerve sheath meningioma. Biopsy is crucial for accurate diagnosis, especially when systemic disease is absent.
Area of Science:
- Ophthalmology
- Neurology
- Pathology
Background:
- Sarcoidosis typically affects multiple organs, but isolated optic nerve involvement without systemic disease is uncommon.
- Optic nerve sarcoidosis can mimic other orbital tumors, leading to diagnostic challenges.
Observation:
- A case of a 22-year-old woman with progressive vision loss in one eye.
- MRI showed optic nerve thickening and enhancement, suggestive of optic nerve sheath meningioma.
- Optic nerve biopsy revealed sarcoidosis, with no evidence of systemic disease post-biopsy.
Findings:
- 17 similar cases reported, often misdiagnosed preoperatively as optic nerve sheath meningioma.
- Neuroimaging and clinical features do not reliably differentiate optic nerve sarcoid from meningioma.
- Biopsy is essential for definitive diagnosis of optic nerve sarcoidosis.
Implications:
- Optic nerve sarcoidosis should be considered in the differential diagnosis of orbital tumors, even without systemic signs.
- Accurate diagnosis through biopsy is critical for appropriate management and preventing misdiagnosis.
- Further research may elucidate specific markers to differentiate optic nerve sarcoidosis from other optic nerve pathologies.