Vitreoretinal lymphoma occurring after systemic chemotherapy for primary conjunctival diffuse large B cell lymphoma: A case report.

INTRODUCTION: Ocular adnexal lymphoma and vitreoretinal lymphoma are rare forms of non-Hodgkin lymphoma. They are regarded as distinct disease entities due to the differences in molecular mechanism, management, and outcome. We present a rare case of conjunctival diffuse large B cell lymphoma (DLBCL) that developed to vitreoretinal lymphoma after systemic chemotherapy. PATIENT CONCERNS: A 60-year-old man presented with a left salmon-colored conjunctival mass. DIAGNOSIS: A biopsy was performed, and histopathologic examination showed DLBCL. Immunohistochemical staining was positive for CD20 with increased κ to λ light chain ratio. INTERVENTIONS: Bone marrow biopsy also revealed DLBCL. Gallium-67 scintigraphy showed abnormal uptake only in the left orbital lesion. Ann Arbor stage was estimated as IV. The patient underwent systemic combination chemotherapy and immunotherapy. OUTCOMES: Four months after the last course of chemotherapy, primary conjunctival DLBCL relapsed, manifesting vitreous opacity. Diagnostic vitrectomy confirmed a diagnosis of vitreoretinal lymphoma. LESSONS: Conjunctival DLBCL and vitreoretinal lymphoma are both DLBCL. After systemic chemotherapy for conjunctival DLBCL, the lymphoma may relapse in intraocular sites as secondary vitreoretinal lymphoma.

INTRAVITREAL MELPHALAN FOR TREATMENT OF VITREOUS SEEDING FROM CHOROIDAL MELANOMA.

PURPOSE: To report treatment of vitreous seeding of choroidal melanoma with monthly injections of intravitreal melphalan. METHODS: Case report. RESULTS: A 70-year-old white woman noted floaters in her left eye, and further examination revealed visual acuity of 20/30 in both eyes. Funduscopically, there was a mushroom-shaped choroidal melanoma in her left eye, measuring 9 mm in basal dimension and 4.8 mm in thickness. Notably, there was apical retinal invasion of melanoma with mild vitreous hemorrhage, without vitreous seeding. The tumor was treated with iodine-125 plaque radiotherapy using an apex dose of 70 Gy over 99 hours, designed to include the retinal invasion. The melanoma demonstrated complete regression into a nearly flat scar of 1 mm and remained stable over 4 years. Five years after radiotherapy, there were diffuse vitreous pigmented seeds of presumed melanoma origin, emanating from the site of retinal necrosis. This progressively worsened over the following 18 months, suspicious for viable melanoma cells, as visual acuity concurrently declined to 20/100. Treatment with intravitreal melphalan (10 µg/0.05 mL) was delivered on a monthly basis for 12 cycles, resulting in vitreous seeds regression, and preservation of the eye. Final visual acuity was 20/200. There were no treatment-related complications. CONCLUSION: Intravitreal melphalan can be considered in cases of vitreous seeding from uveal melanoma.

SIMULTANEOUS CHOROIDAL AND RETINAL METASTASES FROM LUNG CARCINOMA.

BACKGROUND: Intraocular metastasis is most commonly found within the choroid because of its luxurious blood supply, whereas metastasis to the retina, from a separate blood supply, is very rare. We report a rare case of synchronous metastases from lung carcinoma to the choroid of the right eye and the retina of the left eye and a complaint of low vision in the right eye. METHODS: We report a 63-year-old woman with progressive reduction of vision in her right eye for 1 year without previous history of cancer. The patient underwent comprehensive ophthalmic examination that included a multimodal evaluation: near-infrared reflectance scanning laser ophthalmoscopy, blue autofluorescence, and enhanced-depth imaging spectral domain optical coherence tomography (EDI SD-OCT; Heidelberg Engineering, Heidelberg, Germany). RESULTS: Ophthalmoscopic examination revealed a yellow choroidal mass measuring 6 × 6 mm with overlying subretinal fluid and involving the macular area in the right eye. In the left eye, there was a superior juxtapapillary yellow-colored mass involving the retina and measuring 1 × 1 mm. Optical coherence tomography revealed the subretinal fluid contouring a dome-shaped choroidal mass in the right eye and intraretinal nodular tumor superior to the optic disk of the left eye. Chest computed tomography revealed a pulmonary nodule measuring 2.5 mm × 1.4 mm, and biopsy of the liver metastasis confirmed the diagnosis of mucinous lung carcinoma. CONCLUSION: The final diagnosis was presumed choroidal metastasis in the right eye and retinal metastasis in the left eye from underlying mucinous carcinoma of the lung.

A CASE OF RETINAL METASTASIS OF LARYNGEAL SQUAMOUS CELL CARCINOMA WITH HISTOPATHOLOGIC CONFIRMATION BY VITRECTOMY-ASSISTED EN BLOCK EXTRACTION.

BACKGROUND/PURPOSE: To present a case report of retinal metastasis of laryngeal squamous cell carcinoma that was diagnosed by a histopathologic finding from the surgically extracted tumor tissue. METHODS: A 66-year-old man, who was suffered from the treatment-resistant laryngeal carcinoma, was referred to our department because of visual field defect in his right eye. A fundus examination revealed a parafoveal white retinal lesion, which rapidly expanded to the central fovea and decreased the visual acuity. A tissue extraction by 27G pars plana vitrectomy was performed to confirm the diagnosis. RESULTS: The abnormal retinal tissue was extracted en block through 10-mm sclerocorneal tunnel during pars plana vitrectomy. The histopathologic findings revealed that the retinal lesion was retinal metastasis of laryngeal carcinoma. CONCLUSION: We must keep in mind that retinal metastasis can be one of the differential diagnoses for white retinal lesions of unknown cause.

Characterization of NCC-RbC-51, an RB cell line isolated from a metastatic site.

Retinoblastoma (RB) is a childhood eye tumor, caused by the RB1 gene mutation. Since RB is a rapidly proliferating tumor, the patient presents with a Group-D/E tumor at the time of diagnosis. Enucleation is preferred in most unilateral cases to prevent metastasis. Various cell lines have been established to study the tumor's growth pattern and target the cancer cells. The commonly used cell lines are WERI-Rb-1 and Y79, both isolated from the primary tumor of RB. Cell lines established from the metastatic site of RB have not been characterized before. In this study, we have characterized NCC-RbC-51, derived from RB tumor to cervical lymph node site and investigated its potential to represent a highly aggressive and metastatic tumor. We compared the proliferative and invasive properties of NCC-RbC-51 with a cell line isolated from the primary site, WERI-Rb-1. NCC-RbC-51 had higher rates of proliferation and apoptosis and had better invasive ability. Copy number variation analysis and the pathways predicted from these show that the pathways altered in NCC-RbC-51 could contribute to its metastatic nature. In all, the results suggest that NCC-RbC-51, a cell line isolated from metastatic site, could be a potential model to study aggressive/invasive RB.

Retinochoroidal findings and lung cancer: first report in mexican population. / Alteraciones retinocoroideas y cáncer pulmonar: primer reporte en población mexicana.

INTRODUCTION: Lung cancer (LC) is the most common tumour, and the leading cause of cancer-related death worldwide. Although cases of choroidal metastasis and cancer-associated retinopathy have been reported in LC, no studies have been conducted on the Mexican population to describe retinochoroidal findings during the course of LC, and the relationship with its stage. OBJECTIVE: To evaluate patients with a diagnosis of LC, and to describe the posterior segment findings in relationship to the stage of LC. MATERIALS AND METHODS: A cross-sectional and descriptive study was conducted on 50 patients with LC (100 eyes). The demographic data included age, gender, histological type, evolution time, stage, treatment, and comorbidities. The measurement variables included visual acuity (LogMAR), anterior segment biomicroscopy, retinal photography, fluorescein retinal angiography, optical coherence tomography, and electroretinogram. All patients were evaluated by two ophthalmologists. RESULTS: The study included a total of 26 men and 24 women, with a mean age of 65 years, and a mean time from LC diagnosis of 6 months. The principal histological type was adenocarcinoma (70%), and most (50%) were in stage II at the time of evaluation, with 15 (30%) patients having a metastasis (stage IV). The changes in the posterior segment included choroidal metastasis (16%), retinal metastasis (10%), cancer-associated retinopathy (6%), and vascular occlusions (4%). The majority of patients who presented with posterior segment alterations were in stage IV. CONCLUSIONS: Vascular occlusions, cancer-associated retinopathy, choroidal and retinal metastases may be found in LC, with an incidence higher than that reported in the literature, especially in advanced stages of LC, although they can be found from stage II in asymptomatic patients.

RETINAL METASTASIS FROM SQUAMOUS CELL CARCINOMA OF THE LUNG: A CASE PRESENTATION.

BACKGROUND/PURPOSE: To present a case with retinal metastasis from squamous cell carcinoma of the lung. METHODS: Case report. RESULTS: A 54-year-old man presented with blurry vision in his left eye. His medical history was significant for Stage IV squamous lung carcinoma. He was undergoing chemotherapy and had a known metastasis. He had a slightly elevated whitish lesion associated with retinal hemorrhages in the left posterior pole. Optical coherence tomography showed a full-thickness retinal mass. No involvement of the choroid could be detected. Further investigation demonstrated a de novo metastasis in the right frontal lobe of the brain. CONCLUSION: The lesion showed remarkable regression with subsequent systemic chemotherapy.

Alteraciones oftalmológicas del segmento posterior en pacientes con cáncer testicular en población latino-mestiza del Hospital General de México / Ophthalmological changes of the posterior segment in patients with testicular cancer in a mixed-race population of the General Hospital of Mexico

INTRODUCCIÓN: En la actualidad la curación del tumor testicular es factible en más del 95% de los pacientes y en el 80% de los que tienen metástasis. Hasta hoy no existe ningún estudio o series de casos que describan las alteraciones oculares del segmento posterior asociadas a cáncer testicular. OBJETIVO: Evaluar a pacientes con diagnóstico de cáncer testicular para determinar la presencia de alteraciones en el segmento posterior y su relación con el estadio. MATERIAL Y MÉTODO:Estudio observacional, transversal y escriptivo de 21 pacientes masculinos (42 ojos) con diagnóstico de cáncer testicular. Se registró edad, tipo histológico, tiempo de evolución, estadio, tratamiento y comorbilidades, así como medición de la agudeza visual (LogMAR), biomicroscopia del segmento anterior, registro fotográfico de polo posterior y retina periférica. RESULTADOS: La edad promedio fue de 29 años (18-43 años), el 100% de los pacientes fueron tratados quirúrgicamente, el tipo histológico más frecuente fue el seminoma clásico (42,8%) seguido por el tumor germinal mixto (38%) el estadio II se presentó en el 42,8% al momento de la evaluación, el 23,8% presentaron metástasis a distancia. Las alteraciones del segmento posterior fueron: tortuosidad vascular (14,2%), retinopatía asociada a cáncer (9,5%), metástasis a coroides (9,5%), cambios pigmentarios del epitelio pigmentario de la retina (9,5%) y metástasis a retina (4,7%). CONCLUSIONES: Es posible encontrar cambios a nivel de epitelio pigmentario de la retina, tortuosidad vascular, retinopatía asociada al cáncer y metástasis a coroides y/o retina

INTRODUCTION: The curing of a testicular tumour is currently feasible in more than 95% of patients, and in 80% of those with metastases. Until now, there has been no study or series of cases that describe the ocular changes of the posterior segment associated with testicular cancer. OBJECTIVE: To evaluate patients with a diagnosis of testicular cancer in order to determine the presence of changes in the posterior segment and the relationship to the stage. MATERIAL AND METHOD: An observational, cross-sectional, and descriptive study was conducted on 21 male patients (42 eyes) with a diagnosis of testicular cancer. Age, histological type, time of evolution, stage, treatment, and comorbidities were recorded, as well as visual acuity measurement (LogMAR), biomicroscopy of the anterior segment, and photographic records of the posterior pole and peripheral retina. RESULTS: The mean age was 29 years (18-43 years). All (100%) of the patients were treated surgically. The most frequent histological type was classic seminoma (42.8%), followed by the mixed germinal tumour (38.0%). At the time of evaluation, 42.8% of patients had a stage II, and 23.8% had distant metastasis. The changes in the posterior segment were: vascular tortuosity (14.2%), retinopathy associated with cancer (9.5%), choroidal metastasis (9.5%), pigmentary changes of the retinal pigment epithelium (9.5%), and retinal metastasis (4.7%). CONCLUSIONS: It is possible to find changes at the level of retinal pigment epithelium, as well as vascular tortuosity, retinopathy associated with cancer, and choroidal and/or retina metastases

Ophthalmological changes of the posterior segment in patients with testicular cancer in a mixed-race population of the General Hospital of Mexico. / Alteraciones oftalmológicas del segmento posterior en pacientes con cáncer testicular en población latino-mestiza del Hospital General de México.

INTRODUCTION: The curing of a testicular tumour is currently feasible in more than 95% of patients, and in 80% of those with metastases. Until now, there has been no study or series of cases that describe the ocular changes of the posterior segment associated with testicular cancer. OBJECTIVE: To evaluate patients with a diagnosis of testicular cancer in order to determine the presence of changes in the posterior segment and the relationship to the stage. MATERIAL AND METHOD: An observational, cross-sectional, and descriptive study was conducted on 21 male patients (42 eyes) with a diagnosis of testicular cancer. Age, histological type, time of evolution, stage, treatment, and comorbidities were recorded, as well as visual acuity measurement (LogMAR), biomicroscopy of the anterior segment, and photographic records of the posterior pole and peripheral retina. RESULTS: The mean age was 29 years (18-43 years). All (100%) of the patients were treated surgically. The most frequent histological type was classic seminoma (42.8%), followed by the mixed germinal tumour (38.0%). At the time of evaluation, 42.8% of patients had a stage II, and 23.8% had distant metastasis. The changes in the posterior segment were: vascular tortuosity (14.2%), retinopathy associated with cancer (9.5%), choroidal metastasis (9.5%), pigmentary changes of the retinal pigment epithelium (9.5%), and retinal metastasis (4.7%). CONCLUSIONS: It is possible to find changes at the level of retinal pigment epithelium, as well as vascular tortuosity, retinopathy associated with cancer, and choroidal and/or retina metastases.

CASE OF METASTATIC UROTHELIAL CARCINOMA OF THE RETINA AND VITREOUS.

PURPOSE: To report a rare case of vitreo-retinal metastasis from urothelial carcinoma of the bladder. METHODS: Case report. RESULTS: A 55-year-old man with a history of bladder cancer developed atypical vitritis and a white fundus mass. Intravenous fluorescein angiography demonstrated connection between the retinal and tumor vasculature consistent with a retinal malignancy. Cytologic analysis of the vitreous sample revealed large, atypical cells with pleomorphic nuclei, mucin vacuoles, and rare mitotic figures. The cells were immunoreactive for cytokeratin markers AE1/AE3, CK7, and CK20 and the urothelial carcinoma marker GATA3. Review of the patient's initial bladder tumor revealed an anaplastic epithelial neoplasm with dyscohesive cells that appeared histologically identical to those in the vitreous biopsy. Despite external beam radiation therapy, the patient's vision declined and the eye became painful and was ultimately enucleated. CONCLUSION: Retinal metastasis from systemic adenocarcinoma is an extremely rare occurrence with poor prognosis for vision.

BILATERAL METASTATIC CUTANEOUS MELANOMA TO RETINA AND VITREOUS AFTER IPILIMUMAB TREATED WITH PARS PLANA VITRECTOMY AND RADIOTHERAPY.

PURPOSE: To report a patient with bilateral metastatic cutaneous melanoma to the retina and vitreous presenting as a right panuveitis. METHODS: A 63-year-old woman with metastatic malignant cutaneous melanoma treated with ipilimumab and prolonged high-dose steroids presented with a right panuveitis and right blurred vision. Dilated fundus examination revealed bilateral, off-white, large, globular vitreous opacities and bilateral retinal lesions. These retinal lesions had a pale yellow appearance with a cuff of haemorrhage. The unpigmented appearance of the vitreous opacities raised the suspicion of candida endophthalmitis. RESULTS: Bilateral, sequential pars plana vitrectomy with pathomorphologic examination of the vitreous specimen demonstrated metastatic melanoma. Ocular radiotherapy followed by cataract surgery resulted in the regression of retinal lesions in both eyes and no recurrence of the vitreous metastases. CONCLUSION: The development of vitreous and retinal metastases despite a systemic response to ipilimumab identifies the challenge of immunotherapy in an immune privileged site. Treatment is challenging, and outcomes are variable. A local approach of bilateral pars plana vitrectomy, external beam radiotherapy, and subsequent bilateral cataract surgery provided an excellent visual result with no recurrence at 12 months.

Successful management of retinal metastasis from renal cancer with everolimus in a monophthalmic patient: a case report.

BACKGROUND: The retina is an uncommon site for metastases, in particular from solid tumors. Some authors have reported a recent increase in the incidence of metastases in infrequent sites, such as brain or bone, probably due to the expanded treatment options and the resulting improved survival. Choroidal metastasis is the most common type of intraocular malignancy. The most common primary sites associated with choroidal metastasis are breast cancer in women and lung cancer in men. Treatment options are limited, but they must be discussed and adapted to the patient profile. CASES PRESENTATION: We report a case of a 62-year-old Moroccan man with a history of monophthalmitis secondary to a war injury of 30 years' duration. He has been followed for 28 months for metastatic clear-cell renal carcinoma. The first-line treatment was effective for 24 months, before disease progression as retinal metastasis and accentuation of lung metastases. A second-line treatment with everolimus resulted in marked improvement of symptoms, complete recovery of visual function, and partial response in retinal localization. CONCLUSIONS: Choroidal metastasis of renal cancer is a rare situation that must be actively sought in order to arrive at a suitable therapeutic approach.

[One Case about Primary Pulmonary Squamous Cell Carcinoma 
with Retinal Metastasis].

Lung cancer is a common malignant tumor in clinic. Morbidity and mortality are the first place in cancer, which seriously threaten the health of human beings. Due to the lack of effective and specific screening methods, most patients were found already at an advanced stage, and often combined with bone, brain, liver, adrenal and other parts of the metastasis. Symptoms of patient resulted from the primary tumor, metastatic spread, or paraneoplastic syndrome commonly cause the medical attention. For the syndrome related to the distant metastatic spread as the first manifestation, diagnosis would be a challenge. Retinal metastasis is very rare as the first symptom of squamous cell carcinoma of the lung. This paper reviewed a case, in which a patient developed the retinal metastasis as the inital presentation. After systemic evaluation, our patient was managed in multidisciplinary treatments, including surgery and chemotherapy. Now, the patient has a good short-term prognosis and is still in fellow-up condition. Later, we summarized the characteristics of the diagnosis and treatment of this case and provided experience for clinicians. At the same time, reviewing the relevant literature on tumor metastasis provides a window for our understanding of the rare manifestations of lung cancer.

Ocular metastasis as initial presentation in breast cancer.

Two patients presented to their ophthalmologists with vision disturbances. On ocular examination, retinopathic lesions were observed. On subsequent examination, these lesions were diagnosed as metastases of breast cancer. Neither patient had a history of breast cancer. In patients with breast cancer and multiple metastases, ocular metastases are well described. However, the latter is uncommon as a presenting complaint.