case_images: PMC11787045_01
case_images: A) Case report patient's right eye OCT macula with loss of the outer retinal layers (arrow) including the photoreceptor layer. B) Normal OCT macula of a healthy right eye, demonstrating well-preserved outer retinal layers.
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case_images: PMC11787045_01_cureus-0017-00000076759-i01.jpg
case_images: FIG1
case_images: Optical coherence tomography (OCT) testing showed retinal nerve fiber layer atrophy of his bilateral optic nerves and OCT macula showed a near absence of the outer retinal layers, including the photoreceptors (Figure 1).
case_images: CT chest abdomen pelvis.. Showing elongated, irregular, spiculated mass in the right upper lobe, measuring 5x1.6 cm in greatest axial dimension (white arrow).
case_images: cureus-0017-00000076759-i02.jpg
case_images: PMC11787045_01_cureus-0017-00000076759-i02.jpg
case_images: FIG2
case_images: Due to concerns for a paraneoplastic process, he had a CT chest, abdomen, and pelvis that revealed an irregular spiculated mass (5x1.5cm) in the right lung upper lobe, with mediastinal and cervical lymphadenopathy (Figure 2).
case_images: MRI brain coronal reconstruction view with IV contrast. . Right frontal lobe cavernoma measuring 14mm (white arrow), no evidence of metastatic disease in the brain.
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case_images: PMC11787045_01_cureus-0017-00000076759-i03.jpg
case_images: FIG3
case_images: A brain (Figure 3) and orbit (Figure 4) MRI did not show intracranial metastases nor evidence of inflammatory or neoplastic processes directly involving the optic nerves but did demonstrate optic nerve atrophy as previously seen on OCT testing.
case_images: MRI orbit axial T2-weighted with fluid attenuated inversion recovery.. Shows left greater than right optic nerve atrophy with nonspecific, high signal in the posterior intraorbital segment and canicular segment of the left optic nerve (white, dotted arrow).
case_images: cureus-0017-00000076759-i04.jpg
case_images: PMC11787045_01_cureus-0017-00000076759-i04.jpg
case_images: FIG4
case_images: A brain (Figure 3) and orbit (Figure 4) MRI did not show intracranial metastases nor evidence of inflammatory or neoplastic processes directly involving the optic nerves but did demonstrate optic nerve atrophy as previously seen on OCT testing.
case_images: Histopathology images.. A) Cohesive clusters of tumor cells with high nuclear to cytoplasmic ratios and moulding. Diff-Quik stain at 400X magnification. B) Clusters of tumor cells with salt and pepper chromatin and nuclear fragility. Papanicolaou stain at 600X magnification. C) Small cells with scant cytoplasm, hyperchromatic nuclei, moulding, and apoptotic debris. Hematoxylin & eosin stain at 400X magnification. D) Tumor cells expressing neuroendocrine marker synaptophysin. Synaptophysin immunohistochemistry at 200X magnification. E) Tumor cells expressing neuroendocrine marker chromogranin. Chromogranin immunohistochemistry at 400x magnification. F) High Ki-67 proliferation index of approximately 90%. Ki-67 immunohistochemistry at 200x magnification.
case_images: cureus-0017-00000076759-i05.jpg
case_images: PMC11787045_01_cureus-0017-00000076759-i05.jpg
case_images: FIG5
case_images: During his initial work-up and treatment for CAR, he underwent a mediastinal lymph node biopsy (Figure 5), which showed clusters of tumor cells that were diffusely positive for synaptophysin, chromogranin, and CD56, with a Ki-67 proliferation index of 90%.