Atypical hypertrophy of retinal pigment epithelium manifesting as the first sign of familial adenomatous polyposis

BMJ Case Rep. 2023 Nov 14;16(11):e254350. doi: 10.1136/bcr-2022-254350.

Abstract

A female patient in her 20s presented to a routine ophthalmology appointment. Medical history was unremarkable. Family history was notable for intestinal cancer of a second-degree relative, diagnosed in her late 60s. Fundus examination revealed bilateral, multiple, flat, oval, pigmented lesions with an irregular halo of atrophy. The patient was diagnosed with atypical congenital hypertrophy of retinal pigmented epithelium. Investigation of extraocular associations was performed, including upper and lower endoscopy, which revealed 500-1000 colonic polyps with a maximum size 25 mm. Pathology did not reveal submucosal invasion. Genetic testing detected an adenomatous polyposis coli mutation (heterozygotic variant c.3183_3187delACAAA p.(Gln1062*)).

Keywords: Colon cancer; Gastroenterology; Ophthalmology; Retina.

Publication types

  • Case Reports

MeSH terms

  • Adenomatous Polyposis Coli* / complications
  • Adenomatous Polyposis Coli* / diagnosis
  • Adenomatous Polyposis Coli* / genetics
  • Female
  • Fundus Oculi
  • Genetic Testing
  • Humans
  • Hypertrophy / congenital
  • Retinal Pigment Epithelium* / pathology