may wish to take a biopsy from the optic nerve if the vision is
decreasing rapidly or the eye is blind, and there is an urgency
to determine if the lesion is inflammatory or neoplastic. Sarcoid
of the optic nerve may be associated with sarcoid of the central
nervous system: the diagnosis of central nervous system sarcoid
may provoke aggressive therapy.
optic nerve is a tract of the central nervous system, and as such,
the tumors arising from the optic nerve are central nervous system
tumors (mainly optic nerve gliomas and meningiomas).
is important that the ophthalmologist performing the biopsy communicate
to the pathologist the exact location of the biopsy sample.
general, optic nerve gliomas are not tumors that spread beyond the
dura (they remain intradural).
nerve meningiomas may be either intradural or extradural.
nerve gliomas in children who have neurofibromatosis may comingle
with surrounding arachnoidal tissue, stimulating an arachnoidal
hyperplasia that may be indistinguishable from meningioma histologically.
However, even the arachnoidal hyperplasia of the optic nerve in
neurofibromatosis-associated gliomas remains intradural.
nerve biopsies should be processed as one would process biopsy samples
from the central nervous system.
optic nerve gliomas are pilocytic astrocytomas. Most primary optic
nerve menigniomas are meningothelial meningiomas. The pathologist
should try to understand from the surgeon the location of the biopsy
sample (extradural vs. intradural) before making the diagnosis of
optic nerve meningioma in a child. Gliomas of the optic nerve in children
with neurofibromatosis may be associated with meningeal hyperplasia
that may be histologically indistinguishable from meningioma.
astrocytoma of the optic nerve in a child
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