Retinoblastoma presenting as metastasis

The purpose of this study was to evaluate the frequency of metastatic retinoblastoma on initial presentation. Prospective study. Supra Regional Centre for Retinoblastoma, Department of Ophthalmology, Khyber Teaching Hospital Peshawar Pakistan from 1[st] July 1999 to 31[st] January 2003. Data was collected from 80 registered Retinoblastoma patients admitted and examined under anaesthesia for tumours assessment. Diagnosis was supported with the help of CT scan and confirmed by histopathology of the enucleated specimen for evidence of optic nerve invasion by the tumour. Twenty [25%] patients were presenting as Metastasis on initial presentation. Mean age was 3.5 years, range was 7 months to 12 years. Out of these 20 patients with metastasis, 10 were male and 10 were female. Eighteen [90%] of them were from lower socio-economic group. Failure in early diagnosis of retinoblastoma, advance age and unilateral disease are associated with extraocular spread; this tragic scenario can be prevented best be early detection and prompt treatment plan implementation

Unilateral blindness as a presenting symptom of lung cancer treated with erlotinib

A non-smoker young man presented to the ophthalmologist with loss of vision in his left eye. Clinical work-up revealed metastatic deposits in left retina. Broadened workup also showed metastatic disease in the skull and brain. The search for the primary concluded on the histopathological evidence of Non-Small Cell Lung Carcinoma [NSCLC] in the upper lobe of the left lung. After the diagnosis and ascertaining disease extent, localized radiotherapy to whole skull and retina was given, followed by conventional chemotherapy [Gemcitabine, Carboplatin]. The results of radiation and chemotherapy were not satisfactory, therefore, patient was placed on a new agent [tyrosine kinase inhibitor] Erlotinib [150 mg per day orally in a single dose]. The response was evaluated using clinical and radiological parameters and was found to be satisfactory