Lung Cancer Presenting with Choroidal Metastasis in a Pregnant Woman.

A 28-year-old, non-smoker pregnant woman who was initially diagnosed to have deep vein thrombosis and pulmonary thromboembolism earlier in pregnancy, presented at 22 weeks of gestation with dyspnoea, visual loss initially in the right eye and then in the left eye. Fundoscopic examination revealed metastatic foci, suggestive of choroid metastases. Computed tomography of the chest revealed a right hilar mass. Fibreoptic bronchoscopy and bronchoscopic biopsy confirmed lung adenocarcinoma. As the patient and family wished to continue with the pregnancy, chemotherapy with cisplatin and was administered from the 31st week of pregnancy and she had undergone Caesarian section in the 32nd week and the baby was healthy. We report this case as it is probably the first reported case of lung cancer presenting with choroidal metastasis in a pregnant woman.

A case report of bilateral choroidal metastases of epithelial carcinoma of pancreas / Um relato de caso de metástases de coroide bilaterais de carcinoma epitelial de pâncreas

A 49-year-old woman with acute loss of vision in her left eye was examined in our clinic. Two months before arriving at out clinic, she was diagnosed with pancreatic endothelial carcinoma. Her visual acuities were 20/20 for the right and 20/200 for the left eye. Fundus examination and fundus fluorescein angiography showed bilateral subretinal solitary mass. Multiple metastases to lung, pleura, liver, spleen, and abdominal lymph nodes were detected during the initial diagnosis. The patient underwent chemotherapy during the period when the visual symptoms were observed. No additional treatment was offered because of the extent of the disease and poor general health. Although pancreatic endothelial carcinoma usually spreads to the abdominal visceral organs and lungs, choroidal metastases are rarely observed.

Uma mulher de 49 anos de idade, com perda visual aguda de seu olho esquerdo, que teve diagnóstico de carcinoma endotelial de pâncreas há dois meses, foi examinada em nossa clínica. Suas acuidades visuais eram 20/20 no olho direito e 20/200 no olho esquerdo. O exame de fundo de olho e a angiofluoresceinografia mostraram massa solitária sub-retiniana bilateral. Múltiplas metástases do pulmão, pleura, fígado, baço e nódulos linfáticos abdominais foram detectados no diagnóstico inicial. A paciente foi submetida a quimioterapia durante o tempo que os sintomas visuais foram observados. Nenhum tratamento adicional foi oferecido por causa da extensão da doença e problemas de saúde em geral. Embora o carcinoma endotelial de pâncreas normalmente se espalhe para órgãos abdominais e pulmões, este pode ser uma causa rara de metástases de coroide.

Choroidal metastasis as the first sign of bronchioloalveolar lung cancer: case report / Metástase coroidal como primeira manifestação de carcinoma bronquioloalveolar: relato de caso

Metastatic tumors are the most common intraocular malignances and choroid is by far the most common site. Breast and lung cancer are the first cause in women and men respectively. We report the case of a 71-year old woman who had choroidal tumor in her left eye. Further image body scans demonstrated several lesions in both sides of the lungs with dissemination to other organs. Diagnosis of a brochioloalveolar carcinoma established after a biopsy carried out. The patient died before initiating a proper treatment.

Tumor metastático é a neoplasia ocular mais frequente, e a coroide é o local mais comum desta. Tumor de mama seguido de tumor pulmonar são as causas mais comuns de metástases oculares em mulheres e homens, respectivamente. Relatamos o caso de uma paciente de 71 anos com tumor coroidal no olho esquerdo. Posteriormente, estudos de imagem mostraram lesões pulmonares em ambos os pulmões e disseminação a outros órgãos. O diagnóstico de carcinoma bronquioloalveolar foi feito por biópsia. A paciente foi a óbito antes de se iniciar tratamento adequado.

Papillary Thyroid Carcinoma: Bilateral Choroidal Metastases with Extrascleral Extension

Here, we present the case of a patient with bilateral choroidal metastases with extraocular extension in one eye. Metastasis of papillary thyroid carcinoma to the uvea is extremely rare, with only 6 patients reported in the literature. A 62-year-old man with a prior history of papillary thyroid carcinoma suffered the rapid loss of vision in his right eye. He had neovascular glaucoma, total retinal detachment, and a solitary choroidal mass. A month later, his left visual acuity also decreased because of a small macular choroidal mass. The right eye was enucleated and a nodular lesion over the sclera representing extraocular extension was observed. This tumor and the intraocular lesion were composed of papillary excrescences and cystic spaces and stained positively for thyroid transcription factor 1 and thyroglobulin, all confirming the diagnosis of metastatic papillary thyroid carcinoma. The tumor in the left eye was successfully treated with diode laser transpupillary thermotherapy. The patient expired within a month as a result of widespread pulmonary metastases. Papillary thyroid carcinoma may metastasize to the uvea bilaterally, cause rapid visual function loss, erode the sclera, and may extend outside the globe similar to choroidal melanoma. This aggressive ocular involvement was associated with a dismal prognosis in our patient.

Metástasis coroidea de cáncer pulmonar: reporte de un caso / Choroidal metastasis from lung cancer: case report

Introducción: El compromiso ocular en el cáncer sistémico es diverso y ampliamente conocido en la literatura internacional, pero en la nacional hay carencia de información al respecto. La coroides es la estructura ocular donde con mayor frecuencia se encuentran metástasis tumorales dentro del ojo, siendo el cáncer de pulmón el más comúnmente diagnosticado en pacientes que debutan con metástasis coroidea. En esta localización, los síntomas más frecuentes son la visión borrosa y dolor ocular, siendo la presentación asintomática infrecuente. Este tipo de lesiones se produce en la fase final de la enfermedad, donde la supervivencia no supera los 6 meses. Presentación del caso: Paciente portador de cáncer pulmonar, que debutó con metástasis coroidea, siendo la primera sintomatología compatible con desprendimiento de retina. Las claves para el diagnóstico fueron la ultrasonografía ocular, resonancia nuclear magnética, y la biopsia realizada tras la enucleación del ojo afectado que es informada como adenocarcinoma tubular y papilar. De acuerdo a este resultado, se estudia con tomografía computada (TAC) de tórax, abdomen y pelvis, cintigrama óseo, revelándose la imagen de un nódulo pulmonar sospechoso y metástasis pulmonares y extrapulmonares. Tras 8 meses desde el hallazgo de la metástasis coroidea, y 6 meses desde el diagnóstico de cáncer pulmonar, el paciente fallece. Finalmente, se revisó la bibliografía pertinente acerca de la clínica, aproximación diagnóstica, imágenes y consideraciones sobre el tratamiento de las metástasis coroideas. Discusión: Es importante conocer la aproximación diagnóstica de las metástasis coroideas de tumores primarios para tener un alto índice de sospecha.

Introduction: Ocular involvement in systemic cancer is diverse and widely known in the international literature, but in our country there is lack of information. The choroid is the structure of the eye where they most often metastatic tumor within the eye are found, being lung cancer the most commonly diagnosed in patients presenting with choroidal metastasis. At this location, the most common symptoms are blurred vision and eye pain. Asymptomatic presentation is uncommon. This type of injury occurs in the final stage of the disease, where survival does not exceed 6 months. Case report: Patient with lung cancer, which debuted with choroidal metastasis, whose first symptoms consistent in retinal detachment. The keys to diagnosis were ocular ultrasonography, magnetic resonance imaging, and biopsy performed after enucleation of the affected eye, which was reported as tubular and papillary adenocarcinoma. According to this result, he was studied with chest, abdomen and pelvis CT, bone scintigraphy, revealing the image of a suspicious lung nodule and pulmonary and extrapulmonary metastases. After 8months since the finding of choroidal metastases, and 6 months after diagnosis of lung cancer, the patient dies. Reviewed the relevant literature on the clinical diagnostic approach, images and considerations on the treatment of choroidal metastases. Discussion: It is important to know the approach to diagnosis of choroidal metastases from primary tumors to have a high index of suspicion.

Tumor metastático uveal: revisão de literatura sobre a neoplasia ocular maligna mais comum / Uveal metastatic tumor: literature review about the most common eye malignancy

Metástases uveais são consideradas hoje a principal neoplasia maligna ocular. Seu diagnóstico possibilita adoção de medidas que proporcionam redução da tumoração ocular e melhoram a qualidade visual. Diversos tratamentos têm sido propostos para esses fins. Nesse artigo, revisamos as características clínicas, meios de diagnóstico, acompanhamento e padrões nos exames complementares, além dos tratamentos utilizados em pacientes acometidos por essa metástase.

Choroid metastasis have been considered the most common ocular malignancy. Early detection allows arrangements to provide tumor reduction and to improve visual quality. Many treatments have been proposed to aim these objectives. This work reviews clinical characteristics, diagnosis and monitoring methods, characteristics of complementary exams, and treatments used in patients with this disease.

Choroidal metastasis of gastric adenocarcinoma as a first sign of systemic disease recurrence: case report / Metástase de adenocarcinoma gástrico para a coróide como um primeiro sinal de recorrência de doença sistêmica: relato de caso

To describe a patient with unilateral metastatic choroidal gastric adenocarcinoma as a first sign of systemic dissemination. A 54-year-old woman presented with a 7-month history of progressive pain and decrease in vision in her left eye. She had undergone total gastrectomy due to gastric adenocarcinoma two years previously. Examination of the left eye revealed an elevated creamy yellow choroidal tumor infiltrating the macular area and extending around the optic nerve head, suggesting metastasis. Treatment was enucleation of the affected eye. There was orbital recurrence of the tumor, leading to exenteration. Orbital and intraocular metastasis are generally associated with a bad prognosis. This patient represents a rare occurrence of metastatic gastric adenocarcinoma to the choroid, developing as a first sign of systemic recurrence.

Descrever um paciente com metástase coroidal de um adenocarcinoma gástrico como primeira manifestação de disseminação sistêmica. Uma mulher de 54 anos apresentou história de dor e diminuição progressiva da visão no olho esquerdo há sete meses. Ela havia sido submetida a uma gastrectomia total há dois anos devido a um adenocarcinoma gástrico. Exame do olho esquerdo revelou uma massa coroidal de coloração amarelada infiltrando a área macular e estendendo-se ao redor do disco óptico, sugerindo metástase. Foi realizada enucleação do olho afetado. Posteriormente, houve recorrência orbitária do tumor, levando à exenteração. Metástases orbitárias e intraoculares estão geralmente associadas a um grave prognóstico. Esta paciente representa uma rara ocorrência de adenocarcinoma gástrico metastático para a coróide, apresentando-se como um primeiro sinal de recorrência sistêmica.

Metástase de coróide simulando síndrome de efusão uveal: relato de caso / Choroidal metastasis simulating uveal effusion syndrome: case report

Descrição de um caso de efusão uveal secundária a metástase de coróide e revisão dos principais diagnósticos diferenciais. Uma paciente com baixa da acuidade visual, no olho esquerdo, apresentou nódulos ao nível da coróide, dispersão pigmentar retiniana e descolamento seroso da retina. O exame angiofluoresceinográfico demonstrou padrão "leopard spots", semelhante ao encontrado nos casos de efusão uveal. A ecografia ocular demonstrou a presença do descolamento seroso da retina, presença de espessamento e nódulos na coróide e a tomografia de coerência óptica evidenciou ruptura do epitélio pigmentado da retina, presença de nodulações coroidianas hiperrefletivas e áreas de descolamento de retina seroso. Após ser submetido a exames diagnósticos de imagem, constatou-se a presença de nódulo único no ápice pulmonar esquerdo. As metástases de coróide podem levar a um quadro similar à síndrome de efusão uveal. Esta possibilidade deve sempre ser pensada diante de um quadro de efusão uveal atípica e avaliação sistêmica para pesquisa de carcinoma deverá ser solicitada.

We report a case of choroidal metastasis simulating uveal effusion syndrome. This patient with uveal metastasis from lung carcinoma presented with decreased vision in the left eye. Fundoscopic examination revealed pigmentary clumping, multiple choroidal nodules and serous retinal detachment. Fluorescein angioraphy revealed a leopard spots pattern similar to uveal effusion syndrome. Ultrasound revealed the presence of choroidal nodules with moderate internal reflectivity, choroidal thickening and serous retinal detachment. Optical coherence tomography showed retinal pigment epithelium tear and hyper-reflective nodules within the choroid and areas of serous retinal detachment. Image investigation demonstrated the presence of a solitary pulmonary nodule at the left apical lung. Choroidal metastasis can lead to a scenario that simulates uveal effusion syndrome. This possibility must be considered when having an atypical uveal effusion symptomatoloy and a systemic screening for systemic cancer should be performed.

A Case of Diode Laser Photocoagulation in the Treatment of Choroidal Metastasis of Breast Carcinoma

To report a single case of improvement on choroidal metastasis of breast cancer after laser photocoagulation. A 52-year-old female patient who complained of visual disturbance of the right eye with multiple states of metastasis of breast carcinoma. On initial examination, the right best-corrected visual acuity was 0.63. Right fundoscopy revealed an elevated mass-like lesion temporal to the macule with serous retinal detachment. The mass had a 3.5-disc diameter. A right fluorescein angiogram revealed hypofluorescence during the prearterial and arteriovenous phase and hyperfluorescence during the venous phase. The venous phase showed almost total masking of background choroidal fluorescence at the elevated lesion because of leakage and neovascularization. The patient was treated 4 times by diode laser photocoagulation in addition to chemotherapy. Fifty days after the diode laser treatments, the funduscopy examination and fluorescein angiogram revealed that the serous retinal detachment had been absorbed, the choroid had become flat, the lesion had been reduced in size and hyperfluorescence. The right best-corrected visual acuity was improved to 0.8. Laser photocoagulation appears not to cause any problems for the patient and may be an efficient treatment for patients with choroidal breast carcinoma.

Choroidal metastasis from renal cell carcinoma presenting with cataract

We report a case of rare involvement of the eye with choroidal metastasis from renal cell carcinoma presenting 08 years after the primary tumor was removed. The patient initially presented with cataract most probably induced by the tumor. After cataract extraction, tumor was detected when it induced vitreous involvement and retinal detachment. Enucleation was performed and an extraocular mass was also excised. Histopathology confirmed the diagnosis of metastasis from renal cell carcinoma in the ocular tumor, extraocular mass and the vitreous

Metástases de coróide de origem testicular: relato de caso / Choroid metastasis of testicular primary site: case report

Descrição do caso de um paciente masculino de 22 anos de idade, cor parda, com decréscimo da acuidade visual em olho esquerdo e com diagnóstico de tumor testicular e metástases para pulmão e rim. Avaliação da evolução da lesão coroideana compatível com metástase ocular de tumor testicular por meio de exame oftalmológico e ecográfico. Houve resolução da lesão intra-ocular juntamente com melhora radiológica pulmonar após quimioterapia durante aproximadamente 4 meses de acompanhamento. Apesar da remissão da lesão ocular, o paciente faleceu por complicações decorrentes de metástase cerebral. Abordada na literatura como rara, não foi encontrado qualquer relato de caso sobre a metástase de coróide com sítio testicular, sendo esta, talvez, sua primeira descrição.

Description of a male patient case, 22 years old, presenting visual acuity decrease in the left eye associated with the diagnosis of metastatic testicular tumor to lung and kidney. Evaluation of the evolution of a choroid lesion compatible with ocular metastasis of testis tumor through ophthalmologic and echographic examinations. There was resolution of the intraocular lesion together with lung radiologic improvement after chemotherapy during approximately 4 months of follow-up. In spite of the remission of the ocular lesion, the patient died due to complications of cerebral metastasis. Approached in the literature as rare, no report was found of a case of choroidal metastasis of a testicular site, this being, perhaps, its first description.

Papillary carcinoma thyroid presenting as a choroidal metastasis. Report of a case and brief review of literature.

A patient of papillary thyroid carcinoma, who initially presented with a choroidal metastasis and secondary intractable glaucoma is reported. The orange-coloured tumour posed a diagnostic difficulty, until histopathology of the enucleated eye confirmed the metastasis from the thyroid. The initial presentation of distant metastasis in patients with thyroid cancer is rare.

Metástasis coroídea de carcinoma papilar de tiroides: subtipo tall cell / Choroidal metastasis of papillary thyroid carcinoma: tall cell subtypes

Se presenta un caso de metástasis coroidea de un cáncer papilar de tiroides. La metástasis es el mecanismo más frecuente de la aparición de patología ocular maligna. Sin embargo el tumor primario más frecuente es el de la mama y del pulmón seguido por riñón, testículo, próstata e intestino. El cáncer de tiroides es raro y menos frecuente aún es que envíe metástasis a la coroides. El paciente presentaba además metástasis a huesos largos, tórax y cerebro. La lesión coroidea fue tratada con radioterapia con mal resultado

Choroidal metastasis from primary adenocarcinoma of the esophagus--a case report.

Primary adenocarcinoma of the esophagus is uncommon and the incidence in the middle third is rare, accounting for about 0.7 percent to 1.5 percent. Metastasis of carcinoma to the eye is a rare occurrence. We report here a case of primary adenocarcinoma of the middle third of the esophagus with choroidal metastasis.

Evolución del cáncer de mama en pacientes menores de 35 años / Evolution of the breast cancer in patients under 35 years

Desde octubre de 1980 a mayo de 1992 se diagnosticaron 18 casos de cáncer de mama en pacientes menores de 35 años (rango 24-35). El estadio de presentación fue E I: 22 por ciento; E II: 67 por ciento; E III: 11 por ciento. En el 50 por ciento (9/18) hubo compromiso axilar (con más de tres ganglios en cinco). Doce pacientes efectuaron QT adyuvante; 7 sin y 5 con antraciclinas. El período libre de enfermedad de las primeras fue 74,4 meses y el de las segundas 20,8 meses. El 60 por ciento presentó metástasis hepáticas; el 40 por ciento pulmonares; el 30 por ciento en SNC y el 20 por ciento en coroides. A la fecha de cierre sobreviven 11/18 pacientes: Nueve libres de enfermedad, 1 en respuesta parcial y 1 en progresión. El promedio de SBV de las 11 pacientes es de 56,5 meses.