Branch retinal vein occlusion as the presenting feature of germ cell tumour

Abstract

Branch retinal vein occlusion as the presenting feature of germ cell tumour Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy. RVO stands as one of the common causes of visual morbidity and blindness in the elderly population. RVO can be classified into central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) based on the site of vascular occlusion. The incidence of BRVO is generally higher than the incidence of CRVO. Systemic hypertension, hyperlipidemia, and increased body mass index are important risk factors for BRVO in young patients, 1 similar to older population. Recent studies of RVO and thrombophilic factors showed that only hyperhomocysteinemia and anticardiolipin antibodies play a pivotal role in the pathogenesis of RVO. Testicular cancer, although rare, is the most common malignancy in men aged 20À34 years, and 95% of malignant tumours arising in the testes are germ cell tumours (GCTs), and seminomas are the most common type of testicular GCTs. The typical presentation in testicular seminoma is a painless testicular lump with duration of several days to months, and the patient may be subfertile or may present with a hydrocele. Scrotal ultrasonography may identify a nonpalpable testis tumour. Several placental and fetal proteins are secreted by these tumours. Two of these, human chorionic gonadotropin and alpha-fetoprotein, have been shown to be useful for the diagnosis of these GCTs .These tumour markers are also used to assess the disease activity during therapy and for detection of recurrences. Few cases of vascular thromboembolism have been reported in GCT. 2 The vascular events are either sequelae of chemotherapy and radiotherapy used for treatment or due to occult metastasis. No case of BRVO/RVO has been reported in GCTs to the best of our knowledge. We report an unusual association of BRVO and GCT in a 25-year-old patient. A 25-year-old man presented to our outpatient department with complaints of sudden, painless diminution of vision in the right eye for 2 days. There was no significant ocular or medical history. His family history was not significant. On ocular examination, his uncorrected distance visual acuity was 6/18 in the right eye and 6/60 in the left on Snellen's chart. The best-corrected visual acuity was 6/18 (right eye) with +0.50 DS/À1.00 DC at 20°and 6/6 (left eye) with 0.00 DS/À2.50 DC at 160°. The near visual acuity was N6 in both eyes. Slit-lamp examination was unremarkable. Fundus examination of right eye revealed flame hemorrhages, dot-and-blot hemorrhages, cotton wool spots, hard