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Choroidal metastasis in disseminated lung cancer: Frequency and risk factors
Abstract
To determine frequency, risk factors, and benefit of a prospective screening for intraocular metastasis in patients with metastatic lung cancer.
Consecutive observational case series.
An ophthalmologic screening was performed on 84 consecutive patients suffering from metastatic lung cancer. Medical history and disease stage were evaluated in regard to the risk for intraocular metastasis.
In six patients (7.1%) choroidal metastasis (CM) was detected. Choroidal metastasis was present only when at least two other organ system were affected by metastasis (P =.03). The choroid was the sixth common site of organ metastasis. Mean remaining life span in patients with CM was 1.9 (0.2-5.9) months.
Choroidal metastasis is common in advanced metastatic lung cancer. However, due to the short survival of affected individuals, a systematic screening of at-risk patients for CM seems to be of limited benefit.
... 4 Th erefore, routine ophthalmologic screening for ocular metastases in patients with cancer has not been pursued in asymptomatic patients. 5 Ophthalmological evaluation is recommended in symptomatic patients. Metastatic involvement of two or more other organs was found to be a risk factor for development of choroidal metastasis in patients with lung cancer though in our patient no evidence of other organ involvement was found. ...
... Metastatic involvement of two or more other organs was found to be a risk factor for development of choroidal metastasis in patients with lung cancer though in our patient no evidence of other organ involvement was found. 5 Th e most common site of metastases in patients with NSCLC with ocular metastases was found to be the liver. Choroidal metastases was reported to be the sixth common site of metastases in patients with lung cancer. ...
... Choroidal metastases was reported to be the sixth common site of metastases in patients with lung cancer. 5 Treatment of ocular manifestations has been generally confi ned to surgical resection or radiation therapy, but advances in chemotherapy and development of novel targeted agents have shown promising results. 7 Median life expectancy after a diagnosis of uveal metastases was reported to be 12 months in a retrospective study, which is similar to the reported median survival in metastatic NSCLC. ...
... Metastatic tumors are the most common ocular malignancy, although they are relatively underdiagnosed in patients with other symptoms related to their primary cancer and other life-threatening metastases. This explains why post-mortem histopathological studies on patients who died from cancer revealed a higher prevalence of ocular metastases than that reported in living cancer patients [11][12][13][14][15][16][17]. Except for vitreous metastasis, which are revealed by the presence of vitreous cells, ocular metastases are usually seen as achromatic, hypervascular masses. ...
... Metastatic tumors are the most common ocular malignancy, although they are relatively underdiagnosed in patients with other symptoms related to their primary cancer and other life-threatening metastases. This explains why post-mortem histopathological studies on patients who died from cancer revealed a higher prevalence of ocular metastases than that reported in living cancer patients [11][12][13][14][15][16][17]. ...
Ocular metastases are the most frequent ocular malignant tumors; their prevalence is estimated around 5–10% and is even higher in patients with breast or lung cancer. They represent various clinical situations, but they share the same hierarchical multidisciplinary therapeutic challenge with respect to the way systemic and local therapies should be selected in combination or sequentially in the personalized medical history of a patient. The challenges include tumor control, eye preservation, and the minimization of iatrogenic damage to sensitive tissues surrounding the tumor in order to preserve vision. These aims should further contribute to maintaining quality of life in patients with metastases. Many patients with choroidal metastases have systemic molecular treatment for their primary tumor. However, secondary resistance to systemic treatment is common and may ultimately be associated with cancer relapse, even after an initial response. Therefore, it makes sense to propose local treatment concomitantly or after systemic therapy to provide a more sustainable response. The aim of this review is to present current therapeutic strategies in ocular metastases and discuss how to tailor the treatment to a specific patient.
... The two most common sites of primary causes for ocular metastasis are the breast followed by the lung [1], [2]. The incidence of choroidal metastasis is reported to be 7% from the lung [3]. The patient can present with blurred vision, floaters, flashes, and defective field of vision [4]. ...
... The most common site of primary causes for ocular metastasis is the breast, followed by the lung [1], [2]. It has been reported that the incidence of choroidal metastasis from breast cancer is 37-41%, and from the lung 7% [3]. The patients usually present with one or more symptoms of blurred vision, floaters , flashes, and defective field of vision [4]. ...
We report a case of a 65-year-old female who presented to us with diminution of vision in the right eye. She was only able to perceive light in the right eye, and the left eye had a vision of 20/20, N6. Anterior segment examination in both eyes was unremarkable except for senile cataract in the left eye. Posterior segment examination revealed features of choroidal metastasis in both eyes and exudative retinal detachment in the right eye. Multimodal imaging helped in the further confirmation of metastatic lesions. Right-eye fundus autofluorescence showed hyperautofluorescent lesions, ultrasound B-scan showed an elevated mass lesion in the choroid with moderate to high internal echogenicity, and optical coherence tomography showed a lumpy-bumpy appearance of the retinal pigment epithelium as well as an elevated choroidal mass lesion beneath it. On detailed systemic evaluation, the primary site of cancer was found to be the lungs. The patient was referred to a pulmonologist and an oncologist for chemotherapy and further management.
... For breast cancer, combined lung and brain metastases are higher risk factors for CM, and its incidence may increase from 5% to 11%. 22,23 In breast cancer, most CM are generally asymptomatic. 22 Conversely, the clinical manifestations of CM in lung cancer are significant. ...
... To differentiate from uveal melanoma as the most common malignant tumor and CM, slit lamp microscopy, B-mode ultrasound, fundus fluorescein angiography (FFA), optical coherence tomography (OCT) and orbit magnetic resonance imaging (MRI) auxiliary tests would be routinely performed. 5,23,30 For example, the ultrasonography features of CM are flat or slightly elevated, with the medium to high homogeneity reflectivity that is higher than that of most uveal melanomas. MRI appears isointense on T1WI and hypointense on T2WI, unlike uveal melanoma exhibits high signal intensity on T1WI. ...
The incidence of lung cancer with intraocular metastasis is low, of which choroidal metastasis is the most painful metastatic lesion. The clinical symptoms resulting from choroidal metastasis from lung cancer easily detected although they are rarely identified prior to the diagnosis of the primary malignancy. The quality of life of patients is inevitably impaired. Some lung cancer patients complain of ocular symptoms as the first manifestation of lung cancer. Early diagnosis and treatment can significantly overcome or delay the visual impairment and improve prognosis. The main therapeutic modalities include systemic and local treatments, while observation is also a treatment option. Currently, the feasibility and effectiveness of various treatment options are controversial worldwide. Herein, we summarize the underlying mechanisms, epidemiology, clinical features, auxiliary examinations, diagnosis, and recent treatment options for intraocular metastases.
... Herein, we report the characteristics of seven patients with choroidal metastasis from a cohort of 83 consecutive EGFRmutant NSCLC patients (8.4%). Based on published data, the prevalence of choroidal metastases in NSCLC patients has been reported to vary from 0.2% [1,8] to 7% [9] in historical series, reaching 10% in post-mortem histopathological studies [10]. We take charge of nearly 300 new metastatic lung cancer patients each year in our department, pertaining to a 945-bed tertiary University Hospital in the North of Paris, covering a population of roughly 4.0 million inhabitants. ...
... Our patients had at least one more metastatic site, which is consistent with Kreusel et al.'s series, in which the only risk factor of developing choroidal metastases in univariate analysis was the presence of at least two other metastatic sites [9]. ...
Background
Choroidal metastases are the most common eye metastatic site. The prevalence of choroidal metastases in NSCLC patients has been reported to vary from 0.2 to 7% in historical series. Although previously reported, little is known about choroidal metastasis in Epidermal Growth Factor Receptor (EGFR)-mutant Non-small cell lung cancer (NSCLC). This study sought to describe the prevalence of choroidal metastases among patients with EGFR-mutated NSCLC and their characteristics, and to estimate their impact on prognosis.
Methods
We conducted a single-center retrospective study including all consecutive metastatic EGFR-mutant NSCLC patients, from Sept. 2015 to Oct. 2018. The EGFR-mutant NSCLC patients were identified via the Department of Genetics’ files. Patients who exhibited choroidal metastases were compared to patients without choroidal metastases. Kaplan-Meier analysis and log-rank test were conducted to assess median overall survival (OS) from diagnosis for the two groups. The study was approved by the IRB as CEPRO number #2020–010.
Results
Prevalence of choroidal metastases in EGFR-mutated NSCLCs was 8.4% (7/83). Five were women, and four current or former smokers. Molecular analysis showed three tumors with exon 19 deletion, three with L858R mutation, and one with complex exon 21 mutation. The choroidal metastases were symptomatic in six/seven patients. Visual disturbances decreased in all but one symptomatic cases upon EGFR TKI, and the choroidal response was maintained over time.
Median follow-up was 42.2 mo (95%CI [37.2–47.1]). Median OS in the choroidal metastasis group was 23.4 mo (95%CI [0.1–51.4]) versus 27.9 mo (95%CI [16.9–38.9]) in the non-choroidal metastasis group (p = 0.32). In the choroidal metastasis group, 2-year and 5-year OS were 47.6 and 0%, respectively, versus 55.8 and 26.3% in the non-choroidal metastasis subset.
Conclusions
Choroidal metastases in NSCLC EGFR-mutant patients are rare but should be systematically suspected in case of visual disturbance. TKIs are efficient for treating visual symptoms. Whether choroidal metastases confer a worse prognosis remains unclear owing to the third-generation EGFR TKI osimertinib first-line registration.
... The prevalence of intraocular metastases has been studied using two different methods: systematic post-mortem histopathological examination of ocular globes in cohorts of patients who died of cancer (Bloch and Gartner, 1971;Eliassi-Rad et al., 1996;Nelson et al., 1983), and complete ophthalmologic examination in cohorts of patients diagnosed with cancer (Albert et al., 1967a;Barak et al., 2007;Kreusel et al., 2002;Mewis and Young, 1982;Su et al., 2008;Wiegel et al., 1998). The prevalence of metastases estimated from post-mortem examination ranged from 4 to 10%. ...
... These findings suggest that the presence of uveal metastases in a patient without Albert et al. (1967a) All cancers 213 5 (2.3%) 10 patients with ocular metastases overall Mewis and Young (1982) Breast 250 67 (26.8%) Wiegel et al. (1998) Breast 120 6 (5.0%) Kreusel et al. (2002) Lung 84 6 (7.1%) Barak et al. (2007) Breast and Lung 169 patients (77 breast, 92 Lung) 2 (1.2%) Only among patients with breast cancer Su et al. (2008) Lung 8484 11 (< 1%) Fig. 1. ...
The most frequent site of ocular metastasis is the choroid. The occurrence of choroidal metastases has increased steadily due to the longer survival of metastatic patients and the improvement of diagnostic tools. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy. There is currently no consensus on the treatment strategy. Most patients have a limited life expectancy and for these complex treatments are generally not recommended. However, recent advances in systemic therapy have significantly improved survival of certain patients who may benefit from an aggressive ocular approach that could preserve vision. Although external beam radiation therapy is the most widely used treatment, more advanced forms of radiotherapy that are associated with fewer side effects can be proposed in select cases. In patients with a shorter life expectancy, systemic therapies such as those targeting oncogenic drivers, or immunotherapy can induce a regression of the choroidal metastases, and may be sufficient to temporarily decrease visual symptoms. However, they often acquire resistance to systemic treatment and ocular relapse usually requires radiotherapy for durable control. Less invasive office-based treatment, such as photodynamic therapy and intravitreal injection of anti-VEGF, may also help to preserve vision while reducing time spent in medical settings for patients in palliative care. The aim of this review is to summarize the current knowledge on choroidal metastases, with emphasis on the most recent findings in epidemiology, pathogenesis, diagnosis and treatment.
... Our patient's presentation was unorthodox, with vision loss from a metastatic choroidal mass with exudative retinal detachment in the right eye and optic nerve involvement in the left. Metastases from other primary sites are the most frequent intraocular tumor in adults, with the choroid being the most common intraocular site for metastases due to its high vascular supply [5]. However, metastases to the optic nerve were shown to be extremely rare. ...
Purpose:
To report a rare case of left-sided metastatic optic nerve infiltration and right-sided choroidal mass with exudative retinal detachment caused by EGFR exon 19 deletion positive non-small-cell lung adenocarcinoma that responded to targeted therapy with osimertinib (EGFR-TKI). Our patient demonstrated an excellent response with reduced size of the metastatic choroidal mass of the right orbit and improved visual acuity, in addition to systemic disease control.
Case:
A 66-year-old male patient with a history of diabetes mellitus, hypertension, and tobacco use presented with sudden vision loss in the left eye secondary to optic nerve infiltration and subacute vision loss in the right eye secondary to exudative retinal detachment from a choroidal metastasis. He was found to have a right lung mass, multiple metastatic pulmonary nodules, and liver and bone metastases. Biopsy from a mediastinal lymph node confirmed the diagnosis of metastatic lung adenocarcinoma. He was found to have exon 19 deletion on next-generation sequencing. We treated him with local radiation therapy to the left eye and systemic osimertinib (EGFR-TKI).
Conclusion:
To our knowledge, our case is the first report of a patient who initially presented with acute vision loss and was found to have metastatic retrobulbar optic nerve infiltration in one eye and metastatic choroidal lesion with exudative retinal detachment in the fellow eye secondary to lung adenocarcinoma. Due to the rarity of this condition, literature regarding effective treatment is scarce. Our patient demonstrated significant improvement in visual acuity and resolution of exudative retinal detachment in the right eye following osimertinib treatment and radiation therapy to the left eye. Further investigation into the role of tyrosine kinase inhibitors and radiation therapy in treating intraocular metastasis involving the optic nerve is needed.
... Los signos y síntomas de presentación ocular son variables dependiendo del tamaño, localización y efectos secundarios producidos por el tumor. La visión borrosa y el dolor ocular suelen ser los síntomas más frecuentes 8,9 . En nuestro caso debemos destacar la disociación entre el gran deterioro de la agudeza visual y los hallazgos encontrados en el fondo de ojo. ...
... 5 Among patients with NSCLC, epidermal growth factor receptor (EGFR) mutations are found in 30-40% of Asian patients and 5-20% of Caucasian patients. 6 It has been reported that the prevalence of choroidal metastases ranges from 0.2 to 7% in cases with NSCLC 7,8 with a recent case series showing the prevalence to be 8.4% in NSCLC cases with an EGFR mutation. 9 Tyrosine kinase inhibitors (TKIs) targeting the EGFR pathway have become the gold standard of treatment for EGFR-mutated NSCLC. ...
Purpose
Describe the use of osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, as the first-line treatment in a patient with choroidal and central nervous system metastases from EGFR-mutated non-small cell lung cancer.
Observations
A 68-year-old man presented with an amelanotic choroidal lesion in the left eye concerning for choroidal metastasis. Systemic evaluation identified widely metastatic adenocarcinoma of the lung with EGFR exon 19 mutation. Within one month of initiating treatment with osimertinib, there was complete resolution of the subretinal fluid over the choroidal lesion and decreased thickness of the lesion. At follow-up after three months of treatment, the lesion was clinically involuted. Positron emission tomography at two months and magnetic resonance imaging of the brain at three months showed significant interval decrease in size and activity of the primary right lung lesion, central nervous system lesions, and other metastatic sites with no new metastatic lesions. After 17 months of follow up, the lesion remained involuted.
Conclusions
and Importance: Osimertinib may be considered as a first-line treatment option in patients with choroidal metastases from an EGFR-mutated non-small cell lung cancer.
... Choroid is the most common ocular segment affected by metastasis, with lung carcinoma being the most common cause in men (40%) and breast carcinoma (68%) in women. 1 Ocular metastasis may be seen in 0.2%-7% of lung carcinoma patients. 2 Usually NSCLC progresses less rapidly and has delayed metastasis compared with the small cell type. 3 Lung carcinoma tend to have unilateral, unifocal ocular metastasis, whereas bilateral, multifocal metastases are more common in breast carcinoma. ...
... The expansion and diffusion of metastasis generally occur via the blood and the lymphatics. Easy metastasis to other tissue or organs, like spleen, liver, choroidal, bone, brain, etc., is most common in advanced lung cancer (Thomford et al., 1965;Kinoshita et al., 1995;Kreusel et al., 2002;Kagohashi et al., 2003;Riihimäki et al., 2014). Metastasis is a rather complicated biological process and its exact mechanism remains unclear. ...
Epithelial-mesenchymal transition (EMT), the epithelial cells transdifferentiation into the mesenchymal cells, has been involved in cancer metastasis. Nannocystin ax (NAN) is a cyclodepsipeptide initially isolated from Myxobacterial genus, Nannocystis sp. with anticancer activities. This study was designed to explore the effect of NAN on TGF-β1-induced EMT in lung cancer cells. The morphological alteration was observed with a microscope. Western blotting and immunofluorescence assays were used to detect the protein expression and the localization. The adhesion and migration were evaluated by adhesion assay and wound healing assay. The mRNA expression of TGF-β receptor type I (TβRI) was determined by real-time PCR. NAN significantly restrained TGF-β1-induced EMT morphological changes, the protein expression of E-cadherin, N-cadherin, and Vimentin, etc. TGF-β1 activated phosphorylation and nuclear translocation of Smad2/3 were inhibited by NAN. Furthermore, NAN suppressed adhesion and migration triggered by TGF-β1. In addition, NAN significantly down-regulated TβRI on the transcriptional level directly. In summary, these results showed that NAN restrained TGF-β1-induced epithelial-mesenchymal transition, migration, and adhesion in human lung cancer cells. The underlying mechanism involved the inhibition of Smad2/3 and the TβRI signaling pathway. This study reveals the new anticancer effect and mechanism of NAN.
... The tumor can metastasize to the eye via the hematogenous route, and hence the posterior choroid is frequently the site of metastatic spread due to its abundant vasculature. A previous study of 84 patients with lung cancer showed that choroidal metastases occurred in 7.1% several months after the primary tumor was diagnosed (22). Another publication reported that in approximately one-third of patients, lung cancer was confirmed after the patient was diagnosed with a choroidal metastasis (23). ...
Background:
Due to the variety of clinical presentation, some tumors may be concealed and easily misdiagnosed, leading to delays in management. We report a series of patients who initially presented to an Ophthalmic Clinic with ocular symptoms and were subsequently diagnosed with extraocular tumors.
Methods:
Patients who presented to the ophthalmic outpatient clinic at the Joint Shantou International Eye Center with ocular symptoms between April 2013 and December 2019 and were subsequently diagnosed with intracranial or systemic tumors were reviewed retrospectively. Clinical data, including ocular symptoms and signs, ophthalmic and systemic imaging examinations, and the results of tumor biopsies were collected and analyzed.
Results:
Twenty-three patients were included in this study, of which 16 were female (69.6%) and 7 were male (30.4%). Chief complaints at the first visit included visual loss (n=20), proptosis (n=2), and diplopia (n=1). Ocular examination revealed disc pallor (n=8) and swelling (n=3), choroidal mass with or without chorioretinal detachment (n=5), and proptosis (n=2). Visual field (VF) examination was performed in 11 patients of which hemianopia (n=4) and non-specific field loss (n=7) were noted. Brain CT or MRI, together with histopathological findings from surgical biopsies confirmed the diagnosis of the intracranial tumors in 18 cases, including pituitary adenoma (n=7), meningioma (n=2), oligodendroglioma (n=1), sellar tumor (n=1), suprachiasmatic arteriovenous aneurysm (n=1), orbital glioma (n=1), multiple intracranial tumors (n=1), and sphenoid ossifying fibroma (n=1). Nasopharyngeal carcinoma (NPC) (n=3) was diagnosed with brain MRI and nasal endoscopy. Five patients were confirmed as choroidal metastasis secondary to lung cancer (n=3), hepatoma (n=1), and breast cancer (n=1).
Conclusions:
Patients with extraocular tumors may present initially to an ophthalmologist with ocular symptoms. It is important to identify and appropriately manage these patients to avoid unnecessary delays in future treatment.
... Chemotherapy, radiotherapy, hormone therapy, immunotherapy, or palliative treatment can be used as the last resort for the management of neoplastic disease, depending on the extent and number of organs affected by metastasis. [16][17][18] However, our case report indicated that exudative retinal detachment may occur without metastasis and is visible on imaging tests. Thus, gamma globulin, plasmapheresis, and interleukin-2 receptor blockade, with a specific monoclonal antibody is the proposed first-line treatment in such cases. ...
Rationale:
In this report, we present an extremely rare case of recurrent monocular exudative retinal detachment without concomitant ocular metastases. This turned out to be the first symptom of squamous cell lung cancer.
Patient concerns:
A 63-year-old woman was referred to our ophthalmology clinic by her primary care physician with a complaint of deteriorating vision in her right eye that had started four months prior, without concomitant pain.
Diagnoses:
We observed a detachment in the lower part of the retina during her ophthalmoscopy. We did not find any tears, holes, or degenerative changes in the periphery of the retina of the right eye during the surgery. In addition, plaques, tumor masses, and metastases were absent. Therefore, we diagnosed her with unilateral paraneoplastic exudative retinal detachment. Imaging tests performed before surgery revealed perihilar density with a visible air bronchogram in the middle field of the left lung. This turned out to be squamous cell carcinoma.
Interventions:
Patient underwent pars plana vitrectomy and routine laboratory and imaging tests before the procedure that utilized 20-gauge instrumentation. The subretinal fluid and was drained and a tamponade using Densiron (Fluoron Co, Neu-Ulm, Germany) was applied. After ophthalmic treatment, patient underwent complex oncological treatment based on chemotherapy and radiotherapy.
Outcomes:
Despite the application of heavy silicone oil (Densiron) into the vitreous chamber, we observed a recurrence of retinal detachment in the right eye during the follow-up visit, 13 months after the first ophthalmic surgery. Following subsequent pars plana vitrectomy, the Densiron and subretinal membranes were removed. Despite oncological treatment, the patient died, twenty months after the appearance of the first ocular symptoms.
Lessons:
Exudative retinal detachment without tumor metastasis to the eyeball can be one of the first signs of lung cancer in rare cases. Multidisciplinary care and imaging methods with greater accuracy will provide comprehensive care to the patients. It will not only facilitate timely detection and treatment of lung tumors but also for a plethora of oncological diseases.
... Vitreous metastases are more commonly seen in melanoma. (8) A case reported by Lemaitre et al. described a 46-year-old patient with a history of adenocarcinoma of the lung treated with chemotherapy, radiotherapy, and prophylactic brain radiation, who later developed a vision problem. Diagnostic vitrectomy revealed malignant cells, likely metastasized from the lung. ...
Non-small cell lung carcinoma (NSCLC) is a leading cause of cancer-related death, and some patients can present with advanced metastatic disease mostly involving the brain, bones, liver, or adrenal glands. Eye is an extremely rare site of metastasis. We present a case of a patient with NSCLC with rare vitreal metastasis. A 70-year-old female was admitted to the hospital with hypertensive crisis and on further imaging, was found to have a 4.5 cm spiculated nodule in the upper lobe of the right lung. Outpatient bronchoscopy and biopsy confirmed lung adenocarcinoma and she underwent right upper lobe wedge resection and mediastinal lymph node dissection. The surgical staging for the cancer was pT1a pN0, placing her in stage IA. The cells from the tumor were positive for epidermal growth factor receptor (EGFR) mutations: G719X and S768I. Unfortunately, six months later, she started to experience decreased visual acuity and floaters. Vitrectomy was done, and cytology showed atypical cells concerning for malignancy. These malignant cells were also positive for the same mutations as the lung adenocarcinoma. She was then treated with EGFR inhibitor afatinib to prevent relapse. She currently remains asymptomatic.
... A study on 50 lung cancer patients in mexican subjects observed that posterior segment changes are associated to Lung cancer rarely at the advanced stages [57]. As per the study , the kind of alterations such as choroidal metastates , retinal metastates [54,55] , cancer-associated homoeopathy CAR [56], vascular occlusion are observed in LC patients (approximately 36% out of 50 patients). The key issue here is that the ocular alterations in relation to Lung cancer cannot be predicted earlier but can be detected at the later stages. ...
... The presence of other sites metastatic is very often associated. CM in bronchopulmonary cancer come second place after breast cancer [4]. ...
Ocular metastasis is rare. They represent 4 to 8% of secondary localization, essentially choroidal (88%), the pulmonary origin came in second line after breast as primary carcinoma, the prevalence of pulmonary ocular metastasis is estimated at 7.1% [1]Ocular metastasis is usually asymptomatic. Sometimes they cause a loss of visual acuity, metamorphopsia, phosphenes or eye pain, complete unilateral blindness, secondary to a metastatic localization on the macula. A total detachment of the retina is rarely reported.Ocular metastasis diagnosis is based on multiples modality, the ocular examination coupled to angiography, ocular sonography and MRI are the key diagnosis. Ultrasonography determines tumor allows differentiation of metastases from other intraocular neoplasms, particularly melanomas. They appear as a high echoic mass rarely cavitary variant has been describe 0.5% of choroidal metastasis present with a mushroom of collar-button aspect and the thickness is related to the origin in melanoma metastasis the measuring is 1 mm, breast 2 mm, lung and prostate 3 mm, and gastrointestinal and kidney measuring 4 mm. MRI often shows a well-demarcated choroidal mass that appears isointense on T1-weighted images and hypointense on T2-weighted images enhanced after gadolinium injection.[2]The differential diagnosis of ocular metastasis includes choroidal melanoma, hemangioma, granuloma, osteoma and sclerochoroidal calcification [2]Treatment is usually based on radiochemotherapy of the primary cancer. Treatment of symptomatic choroidal metastases should be conservative as long as possible to preserve quality of life in the short term. Hormonal therapy can be effective on hormone-sensitive cancers like breast and prostate.
... The incidence for the breast cancer is reported to be 37-41%, while lung cancer is considered to be responsible for no more than 7% of choroidal metastases. 4,5 Multiple foci and bilateralism are important features of metastatic choroidal tumours. In 20% to 40% of cases, lesions are bilateral. ...
... Although choroidal metastasis can be treated with conventional chemotherapy or other adjunctive treatment modalities such as radiotherapy, brachytherapy, or transpupillary thermotherapy [6,10], presence of choroidal metastasis usually implies poor prognosis, with a 5-year survival rate of 16% [12]. Several studies calculated life expectancy after diagnosis of choroidal metastases, and the results varied: 12 months A C B [9], 7.5 months [13], and 1.9 months if asymptomatic [14] and 13 months if symptomatic [15]. This variation may be due to an advanced stage of lung cancer with multiple metastases and overlooked ocular symptoms due to poor general condition. ...
... Choroidal metastases account for 88% of cases followed by metastases to the iris and the ciliary body. Breast (37-41%), lung (7%) and colon carcinomas are common malignancies which cause choroidal secondaries (1,2). The overall incidence of choroidal metastases is 9-12% in all cancers and commonly present with decreased visual acuity (3). ...
Background:
Patients with cancer may develop metastases to the orbit causing distressing symptoms. External beam radiation therapy (RT) is an effective palliative treatment for patients with orbital and ocular metastases. The aim of treatment is to preserve vision and to reduce pain. Delivery of 30 to 40 Gy in 2 Fr fractions is a practice in many oncology centres. The aim of this study is to evaluate the outcome of shortcourse palliative radiotherapy in the management of orbital and ocular metastases.
Methods:
A retrospective study to review all patients with orbital metastases treated in 2016 to 2018 were performed. The primary outcomes were a change in visual acuity and tumor response. Secondary outcomes included toxicities of radiotherapy, symptomatic response and survival.
Results:
Fifteen patients with 19 eyes were included. The most common presenting symptoms were decreased vision, periorbital swelling, and pain. The median follow-up period was 8 months. Visual acuity improved in 11 out of 13 (84.6%) of patients and remained stable in the remaining 2 patients. Partial and complete response (CR) of tumor was observed in 14 out of 15 (93.3%) of patients while one (6.6%) patient had stable disease. The overall response rate (ORR) was 100%. Two (13.3%) patients had grade 2 conjunctivitis. There were no grade 3-4 toxicities and no long-term toxicities observed. The median survival was 9.1 months from diagnosis of choroidal metastases.
Conclusions:
Short course palliative RT is effective and well tolerated in patients with orbital and ocular metastases. The current review showed that it effectively preserves vision and improves orbital symptoms with minimal radiation-induced toxicity. Short course radiotherapy will help to minimize the traveling time to the hospital and relieve the burden of a long treatment course in this palliative patient population.
... [3] . The uvea is the most common site for intraocular metastasis, followed by the choroid, iris, and ciliary body [4,5] . Between 11% and 23% of patients are asymptomatic [5] . ...
Background:
The eye is a rare site for lung cancer metastasis. Indeed, ocular metastasis is one of the greatest challenges to quality of life in a cancer patient. Here we present a patient with lung adenocarcinoma and ocular metastasis.
Case summary:
The patient was a 70-year-old man diagnosed with lung adenocarcinoma who developed eye metastasis mimicking anterior scleritis. Brain magnetic resonance imaging showed an abnormal signal in the right eye. Based on next generation sequencing of the surgical specimen, the patient was shown to have a KRAS point mutation (p.G12D).
Conclusion:
Multidiscipline expertise collaboration is needed to make the early diagnosis and determine the prompt treatment in patients. We hope to increase the awareness of the possibility of lung cancer metastasizing to the eye.
... Choroidal metastasis show no preference for either the right or left eye [13]. Kreusel et al. [14] studied 84 patients with primary lung cancer where the prevalence of the choroidal metastases was estimated to be 7.1%. ...
Clinical reports of symptomatic choroidal metastasis as the initial presentation of lung cancer are rare. Here, we report such a presentation in a female patient of non small cell lung cancer. She presented with loss of vision in her left eye. On further analyses, the patient was diagnosed with a lung adenocarcinoma.
... The incidence for the breast cancer is reported to be 37-41%, while lung cancer is considered to be responsible for no more than 7% of choroidal metastases. 4,5 Multiple foci and bilateralism are important features of metastatic choroidal tumours. In 20% to 40% of cases, lesions are bilateral. ...
... Choroidal metastases are rarely revealer of lung cancer as in our case but most often they are present at an advanced stage of the disease [2]. According to the kreusel et al., series of 84 patients with lung cancer [3], the prevalence of choroidal metastasis is estimated at 7.1%. The Survey of Shields et al., That concerns 520 eyes with ocular metastasis, finds that 88% are choroidal metastasis and only 21% of them were carriers of CBP [4]. ...
... Shields et al reported that, in 56% of patients with intraocular lung cancer metastasis, the diagnosis of the primary tumor was made afterwards, highlighting the importance of early recognition of intraocular metastasis [4]. However it was estimated in a study by Kreusel et al that in patients with metastatic lung carcinoma, just 7.1% presented with ocular involvement [15]. The symptomology can range from blurry vision, photopsia, red eye, floaters and visual field defects [9]. ...
... melanoma or retinoblastoma (5,6). According to the literature, 7.1-9% of patients with lung cancer develop choroidal metastases (7,8). In 2010, Burgess et. ...
... The incidence of ocular metastases from lung cancer is reported to be 0.1-7% in the global literature [1][2][3], with adenocarcinoma and small cell lung cancer accounting for the highest proportions of these cases [1,2]. The majority of cases involve metastasis to more than one other distal organ in addition to the eye [4,5]. ...
Background:
The incidence of ocular metastasis from lung cancer is reported to be 0.1-7%, with adenocarcinoma and small cell lung cancer accounting for the highest proportions of these cases. The majority of cases involves metastasis to more than one other distal organ in addition to the eye. Here, we report for the first time, a case of lung squamous cell carcinoma with solitary symptomatic ocular metastasis as the initial manifestation that was managed by a multidisciplinary treatment (MDT).
Case presentation:
A woman presented at the ophthalmology department of hospital with a 1-week history of left eye pain and blurred vision. Systemic examination led to the diagnosis of central lung cancer in the right lower lobe with ocular metastasis. After consultations with an MDT, including specialists from the surgery, internal medicine, ophthalmology, radiotherapy and imaging departments, the patient underwent surgery and chemotherapy. Her eye symptoms disappeared, and the ocular lesion was well controlled without any specific ocular treatment. The patient demonstrated a prolonged progression-free survival.
Conclusion:
This is the first report of a rare case with solitary ocular metastasis as the initial manifestation of lung squamous cell carcinoma. This rare patient was treated based on evidence-based medicine, indicating the importance of cooperation within an MDT. The successful treatment of this case was reported as a new therapeutic reference for clinicians who encounter similar cases in the future.
... Primary lung tumours are the second most common tumours to metastasize to the eye [15], with the most common histologic type being adenocarcinoma, usually originating in peripheral lung tissue [16,17]. Metastasis to the choroid from a lung primary can also be the presenting symptom [18,19]. Moreover, of all patients reported to have choroidal metastasis as the presenting symptom of an extraocular primary, the majority (almost 60%) had lung cancer [20]. ...
Purpose of the study:
To describe the clinical and histopathological features of an aggressive ciliary body adenocarcinoma with pulmonary metastases and skull base spread.
Procedures and results:
A 45-year-old female patient presented with a post-traumatic phthisical eye that was eviscerated. This showed an unexpected carcinoma (positive for cytokeratins and melanocytic markers), the histological differential diagnosis for which included a primary ciliary body adenocarcinoma or a metastasis. The patient developed rapid post-surgical localized recurrence that required an orbital exenteration. This showed identical tumour to the evisceration specimen, with vascular invasion in orbital blood vessels and a contaminated orbital soft tissue margin. Staging imaging revealed multiple lung metastases, which were biopsied and shown to be a disseminated ciliary body adenocarcinoma rather than a disseminated primary lung carcinoma. The tumour spread locally to the skull base for which radiotherapy was given. Unfortunately, the patient passed away a few weeks later.
Conclusions:
To our knowledge, this is the first case of ciliary body adenocarcinoma with bilateral lung metastases. The malignant potential of these tumours should be considered as a possibility, and appropriate screening and staging tests should therefore be considered to guide appropriate management.
... [1] 。眼部转移 (ocular metastasis)是肺癌少见转移之一，肺癌眼部转移 发生率大约0.1%-7% [2][3][4] 。恶性肿瘤葡萄膜转移是最常见 的眼内转移 [5] ，其中以脉络膜转移最为常见，其次是虹 膜转移、睫状体转移，此外，眼眶转移、眼睑转移、结 膜转移 [6] 、视网膜转移 [7] 以及视神经转移均有报道。恶性 肿瘤眼部转移的症状 [5] 包括视物模糊/视力下降、疼痛、 飞蚊症、视野缺损，肿块、红眼、闪光感、复视等， 亦有大约11%-23%患者是无症状的 [5,8] 。由于肿瘤转移导 ...
Background:
Eye is a rare site of lung cancer metastasis, and ocular metastasis is one of the largest challenges to cancer patients' quality of life (QOL). Here we present our experience on ocular metastasis of lung cancer and review relevant literature in an attempt to investigate the clinical features, treatment, and prognosis of these tumors.
Methods:
The records of 9 patients with ocular metastasis of lung cancer treated at our hospital were analyzed. A literature review identified 42 cases reported in the last 10 years and their medical records were retrospectively estimated.
Results:
The median age of our patients was 51 years (range 41-61). Diagnosis of lung cancer included non-small cell lung carcinoma (NSCLC) in 7 patients, in which adenocarcinoma (ADC) were recorded in 6 patients, small cell lung carcinoma (SCLC) in 1 patient, and unknown in 1 patient. The site of ocular metastasis included choroid (n=8) and iris (n=1). In the literature review, SCLC constituted 21.4% (n=9) and ADC constituted 47.6% (n=20). Choroid presented to be the most common site for eye metastasis (66.7%, n=28). As for disease control rate, systemic chemotherapy for lung cancer patients with ocular metastasis presented to be only 28%. Meanwhile, combination of systemic treatment with ocular treatment could improve patients' eye symptoms effectively.
Conclusions:
The most common lung cancer that metastasizes to the eye is ADC. The choroid is the most common site for ocular metastasis. Ocular treatment can improve patients' eye symptoms, while the effect of systemic chemotherapy treatment is limited.
... 30 Lung and breast tumors commonly metastasize to the choroid, which is the most vascularized layer of the eye. 31,32 Increasing research demonstrates that changes in the eye correlate with disease onset. Indeed, the retinal capillaries are among the smallest in our body and changes affecting the vascular system (circulation) are reflected in the smallest blood vessels first. ...
Karin Roesch, Tristan Swedish, Ramesh Raskar MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA Abstract: Most current diagnostic devices are expensive, require trained specialists to operate and gather static images with sparse data points. This leads to preventable diseases going undetected until late stage, resulting in greatly narrowed treatment options. This is especially true for retinal imaging. Future solutions are low cost, portable, self-administered by the patient, and capable of providing multiple data points, population analysis, and trending. This enables preventative interventions through mass accessibility, constant monitoring, and predictive modeling. Keywords: next-generation imaging technology, early disease indicators, predictive health assessment, predictive analysis, mass accessibility
... Uveal tract is most commonly involved in the ocular metastasis with choroid (88%) being the most common site of involvement among the tract followed by iris (9%), and cilliary body (2%) [5]. Breast is the most common site among female for intraocular metastasis constituting 37%-41%, whereas, the incidence of lung primary with choroid metastasis in female is not more than 7% [6,7]. Choroid metastasis involves choroid layer of the eye. ...
Vision impairment as an initial presentation detecting choroid metastasis in primary lung cancer is rare. Prevention or treatment of visual
loss and improvement in quality of life can be achieved by treatment of intraocular metastasis. The survival of the patient in choroid
metastasis with lung primary is poor with the median survival being 3.3 months. However, proper treatment may increase the quality of life
and survival to an extent. We report a case of adenocarcinoma of lung in a female patient, presented initially with visual impairment as a
result of choroidal metastasis and treated with external beam radiotherapy for choroidal metastasis followed by palliative chemotherapy.
The patient was survived with improved vision and quality of life since last 12 months of diagnosis.
... Breast and lung carincoma account for the majority of cases, with 2% to 9% of lung and breast cancers causing clinically significant uveal metastases [71]. These tumors usually present later in the course of cancer, with an subsequent life expectancy of a median 6 to 9 months [72,73]. Patients are mostly asymptomatic, and often present with a sudden change in vision, most commonly complaining of blurred vision and sometimes scotoma or pain. ...
Photodynamic therapy (PDT) has been used in ophthalmology for various vascular conditions affecting the retina and choroid since the late 1990’s. As of 2000, verteporfin (Visudyne; CIBA Vision Corp, Duluth, Ga) photosensitizer for ocular conditions was used in treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD), pathologic myopia, and presumed ocular histoplasmosis syndrome
... Survival and prognosis depends on primary tumour type and stage at the time of presentation. 7 If the patient has visual symptoms, treatment should be offered as soon as possible in order to maintain and, in many cases, improve visual acuity. Timely diagnosis and early treatment with radiotherapy prevents further visual loss, dissemination and morbid enucleation. ...
Introduction:
Metastasis to intraocular structures is a serious problem in lung cancer. Due to its rarity, however, limited information is available regarding the outcomes of treatment and prognosis. Literature often suggests a poor prognosis. We review current literature on the outcomes of systemic therapy and prognostic factors.
Methods:
We conducted a systematic review of English literature published during 2009 to 2022 identified via Medline and Google Scholar search. Publications reporting on tumor response in the eyes or overall survival of patients with intraocular metastasis due to lung cancer were included. Pooled analysis of patients receiving systemic therapy was performed, utilizing individual-level patient data.
Results:
A total of 79 publications contributed 92 patients into the analysis. Choroid was the most affected intraocular structure, in 82% of patients. Histology was small cell in 13% and non-small cell in 87%. Targeted therapy was utilized in 45% of patients. A pooled analysis demonstrated that the median overall survival was 27 months (95% CI: 21.8-32.2). Visual response among those with reported assessment showed that 92% of them had stable or improved vision while 8% experienced worsening of vision. Several factors including the year of treatment, age, targeted therapy, and radiation showed a significant association with survival. The strongest predictor of improved survival was the receipt of targeted therapy, with a hazard ratio of 0.31 (95% CI: 0.14-0.71), P = .005.
Conclusions:
For lung cancer patients with intraocular metastasis, systemic therapy can produce a favorable outcome. Particularly when a targeted therapy is feasible, long-term survival can be achieved.
Lung cancer is one of the leading causes of cancer related mortality worldwide. Currently, it is the third most common cancer behind prostate and breast cancer. Approximately 85% of all lung cancers are non-small-cell lung cancers (NSCLC). Adenocarcinoma and squamous cell carcinoma are the most common subtypes, accounting for 50% and 30% of NSCLC cases, respectively. Lung cancer is often initially found on chest x-rays and diagnosed via biopsy of the lesion. It is often diagnosed at the time of advanced or metastatic disease. The majority of lung cancers metastasize to locations such as bone, brain, adrenal glands and liver. Multiple case reports have been reported with ocular metastases, such as the choroid, iris and retina. We present a 87-year-old women whose initial emergency department presentation of squamous cell type lung cancer was an intraocular mass. To our knowledge this is the first reported case of this presentation and diagnosis within the emergency department setting.
Background: Choroidal metastases are the most common eye metastatic site. The prevalence of choroidal metastases in NSCLC patients has been reported to vary from 0.2% to 7% in historical series. Although previously reported, little is known about choroidal metastasis in Epidermal Growth Factor Receptor (EGFR)-mutant Non-small cell lung cancer (NSCLC). This study sought to describe the prevalence of choroidal metastases among patients with EGFR-mutated NSCLC and their characteristics, and to estimate their impact on prognosis.
Methods: We conducted a single-center retrospective study including all consecutive metastatic EGFR-mutant NSCLC patients, from Sept. 2015 to Oct. 2018. The EGFR-mutant NSCLC patients were identified via the Department of Genetics’ files. Patients who exhibited choroidal metastases were compared to patients without choroidal metastases. Kaplan-Meier analysis and log-rank test were conducted to assess median overall survival (OS) from diagnosis for the two groups. The study was approved by the IRB as CEPRO number #2020-010.
Results: Prevalence of choroidal metastases in EGFR-mutated NSCLCs was 8.4% (7/83). Five were women, and four current or former smokers. Molecular analysis showed three tumors with exon 19 deletion, three with L858R mutation, and one with complex exon 21 mutation. The choroidal metastases were symptomatic in six/seven patients. Visual disturbances decreased in all but one symptomatic cases upon EGFR TKI, and the choroidal response was maintained over time.
Median follow-up was 42.2 mo (95%CI [37.2 - 47.1]). Median OS in the choroidal metastasis group was 23.4 mo (95%CI [0.1 - 51.4]) versus 27.9 mo (95%CI [16.9 - 38.9]) in the non-choroidal metastasis group (p=0.32). In the choroidal metastasis group, 2-year and 5-year OS were 47.6% and 0%, respectively, versus 55.8% and 26.3% in the non-choroidal metastasis subset.
Conclusions: Choroidal metastases in NSCLC EGFR-mutant patients are rare but should be systematically suspected in case of visual disturbance. TKIs are efficient for treating visual symptoms. Whether choroidal metastases confer a worse prognosis remains unclear owing to the third-generation EGFR TKI osimertinib first-line registration.
Background: Choroidal metastases are the most common eye metastatic site. The prevalence of choroidal metastases in NSCLC patients has been reported to vary from 0.2% to 7% in historical series. Although previously reported, little is known about choroidal metastasis in Epidermal Growth Factor Receptor (EGFR)-mutant Non-small cell lung cancer (NSCLC). This study sought to describe the prevalence of choroidal metastases among patients with EGFR-mutated NSCLC and their characteristics, and to estimate their impact on prognosis.
Methods: We conducted a single-center retrospective study including all consecutive metastatic EGFR-mutant NSCLC patients, from Sept. 2015 to Oct. 2018. The EGFR-mutant NSCLC patients were identified via the Department of Genetics’ files. Patients who exhibited choroidal metastases were compared to patients without choroidal metastases. Kaplan-Meier analysis and log-rank test were conducted to assess median overall survival (OS) from diagnosis for the two groups. The study was approved by the IRB as CEPRO number #2020-010.
Results: Prevalence of choroidal metastases in EGFR-mutated NSCLCs was 8.4% (7/83). Five were women, and four current or former smokers. Molecular analysis showed three tumors with exon 19 deletion, three with L858R mutation, and one with complex exon 21 mutation. The choroidal metastases were symptomatic in six/seven patients. Visual disturbances decreased in all but one symptomatic cases upon EGFR TKI, and the choroidal response was maintained over time.
Median follow-up was 42.2 mo (95%CI [37.2 - 47.1]). Median OS in the choroidal metastasis group was 23.4 mo (95%CI [0.1 - 51.4]) versus 27.9 mo (95%CI [16.9 - 38.9]) in the non-choroidal metastasis group (p=0.32). In the choroidal metastasis group, 2-year and 5-year OS were 47.6% and 0%, respectively, versus 55.8% and 26.3% in the non-choroidal metastasis subset.
Conclusions: Choroidal metastases in NSCLC EGFR-mutant patients are rare but should be systematically suspected in case of visual disturbance. TKIs are efficient for treating visual symptoms. Whether choroidal metastases confer a worse prognosis remains unclear owing to the third-generation EGFR TKI osimertinib first-line registration.
Background: Although previously reported, little is known about choroidal metastasis in Epidermal Growth Factor Receptor (EGFR)-mutant Non-small cell lung cancer (NSCLC).
Methods: In this single-center retrospective cohort including 83 consecutive metastatic EGFR-mutant NSCLC patients, from Sept. 2015 to Oct. 2018, six exhibited symptomatic choroidal metastases. All brain MRI scans performed in the EGFR-mutant patients were reviewed, with one case of asymptomatic choroidal metastasis identified. Kaplan-Meier analysis and log-rank test were conducted to assess median overall survival (OS) from diagnosis for the two groups, with or without choroidal metastases.
Results: Prevalence of choroidal metastases in EGFR-mutated NSCLCs was 8.4% (7/83). Five were women, and four current or former smokers. Molecular analysis showed three tumors with exon 19 deletion, three with L858R mutation, and one with complex exon 21 mutation. The choroidal metastases were symptomatic in six/seven patients. Visual disturbances decreased in all but one symptomatic cases upon EGFR TKI, and the choroidal response was maintained over time. Median follow-up was 42.2 mo (95%CI [37.2 - 47.1]). Median OS in the choroidal metastasis group was 23.4 mo (95%CI [0.1 - 51.4]) versus 27.9 mo (95%CI [16.9 - 38.9]) in the non-choroidal metastasis group (p=0.32). In the choroidal metastasis group, 2-year and 5-year OS were 47.6% and 0%, respectively, versus 55.8% and 26.3% in the non-choroidal metastasis subset.
Conclusions: Choroidal metastases in NSCLC EGFR-mutant patients are rare but should be systematically suspected in case of visual disturbance. TKIs are efficient for treating visual symptoms. Whether choroidal metastases confer a worse prognosis remains unclear owing to the third-generation EGFR TKI osimertinib first-line registration.
Background: Although previously reported, little is known about choroidal metastasis in EGFR-mutant NSCLC.
Methods: In this single-center retrospective cohort including 83 consecutive metastatic EGFR-mutant NSCLC patients, from Sept. 2015 to Oct. 2018, six exhibited symptomatic choroidal metastases. All brain MRI scans performed in the EGFR-mutant patients were reviewed, with one case of asymptomatic choroidal metastasis identified. Kaplan-Meier analysis and log-rank test were conducted to assess median overall survival (OS) from diagnosis for the two groups, with or without choroidal metastases.
Results: Prevalence of choroidal metastases in EGFR-mutated NSCLCs was 8.4% (7/83). Five were women, and four current or former smokers. Molecular analysis showed three tumors with exon 19 deletion, three with L858R mutation, and one with complex exon 21 mutation. The choroidal metastases were symptomatic in six/seven patients. Visual disturbances decreased in all but one symptomatic cases upon EGFR TKI, and the choroidal response was maintained over time. Median follow-up was 42.2 mo (95%CI [37.2 - 47.1]). Median OS in the choroidal metastasis group was 23.4 mo (95%CI [0.1 - 51.4]) versus 27.9 mo (95%CI [16.9 - 38.9]) in the non-choroidal metastasis group (p=0.32). In the choroidal metastasis group, 2-year and 5-year OS were 47.6% and 0%, respectively, versus 55.8% and 26.3% in the non-choroidal metastasis subset.
Conclusions: Choroidal metastases in NSCLC EGFR-mutant patients are rare but should be systematically suspected in case of visual disturbance. TKIs are efficient for treating visual symptoms. Whether choroidal metastases confer a worse prognosis remains unclear owing to the third-generation EGFR TKI osimertinib first-line registration.
Lung carcinoma is the second most common malignancy in both men and women, and may metastasize to the orbit relatively early in the disease course. Metastasis to the optic nerve or its sheath is an exceedingly rare occurrence, and diagnosis may be complicated by nonspecific clinical and radiographic features. The authors present a case of squamous cell lung cancer metastatic to the optic nerve sheath, initially diagnosed as optic neuritis based on its equivocal clinical and radiographic features. This is the first histopathologically confirmed case of squamous cell lung cancer metastatic to the optic nerve sheath in the literature.
Introduction
Lung cancer (LC) is the most common tumor, 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.
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.
The eye like any other organ in the body can harbor tumors of different types. Given the diverse anatomy of the eye, each distinct structure within the eye can be the site for primary tumors; that is, those tumors arising from the native tissue or metastatic tumors: those that arise from a distant site in the body. With reference to the eye and adnexa, metastatic tumors have been documented in the orbit, the extraocular muscles, conjunctiva, subconjunctival tissue, iris, and the retina with the most common site being the choroid [1]. This chapter presents in detail the clinical presentation, diagnosis, imaging findings, and treatment of retinal and choroidal metastases.
Objective
The purpose of the present study is to review the frequency of intraocular metastases as first presentation of systemic disease, and to identify clinical and tumour characteristics.
Methods
Retrospective study of consecutive cases diagnosed of intraocular metastasis at a referral intraocular tumours unit between 1993 and 2014. General, epidemiological and ophthalmological characteristics were recorded.
Results
A total of 21 patients, with a mean age 62.7 years (31–89) were diagnosed with intraocular metastasis between 1993 and 2014. Both eyes were affected in 4 cases. Location was choroid in 20 cases. The intraocular tumour was the first manifestation of the systemic disease in 13 patients (61.9%). Primary tumour was breast in 47.6% and lung in 23.8%. Diagnosis of the primary tumour was performed by systemic studies, and only 1 patient required intraocular biopsy. Regarding the treatment, the majority of cases were controlled with systemic therapy, with 4 cases requiring additional external beam radiotherapy, and only one enucleation. No clinical differences were found between the cases with known and unknown systemic neoplasia, except in exudative retinal detachment, which was more frequent in the second group.
Conclusions
Although intraocular metastases are the most frequent intraocular tumour, they are not a frequent cause of consultation. In more than half of the cases it is the first presentation of unknown systemic neoplasia as a solitary non-pigmented intraocular mass. Early diagnosis is crucial to establish the appropriate treatment, preserve visual function, and improve the prognosis of the patient.
Objective:
The purpose of the present study is to review the frequency of intraocular metastases as first presentation of systemic disease, and to identify clinical and tumour characteristics.
Methods:
Retrospective study of consecutive cases diagnosed of intraocular metástasis at a referral intraocular tumours unit between 1993 and 2014. General, epidemiological and ophthalmological characteristics were recorded.
Results:
A total of 21 patients, with a mean age 62.7 years (31-89) were diagnosed with intraocular metástasis between 1993 and 2014. Both eyes were affected in 4 cases. Location was choroid in 20 cases. The intraocular tumour was the first manifestation of the systemic disease in 13 patients (61.9%). Primary tumour was breast in 47.6% and lung in 23.8%. Diagnosis of the primary tumour was performed by systemic studies, and only 1 patient required intraocular biopsy. Regarding the treatment, the majority of cases were controlled with systemic therapy, with 4 cases requiring additional external beam radiotherapy, and only one enucleation. No clinical differences were found between the cases with known and unknown systemic neoplasia, except in exudative retinal detachment, which was more frequent in the second group.
Conclusions:
Although intraocular metastases are the most frequent intraocular tumour, they are not a frequent cause of consultation. In more than half of the cases it is the first presentation of unknown systemic neoplasia as a solitary non-pigmented intraocular mass. Early diagnosis is crucial to establish the appropriate treatment, preserve visual function, and improve the prognosis of the patient.
A 64-year-old man who presented with photopsia was found to have elevated intraocular pressure in one eye and optic disc swelling in the other eye. He was initially diagnosed with neurocysticercosis and later metastatic lung adenocarcinoma. The purpose of this paper is to report a rare case of bilateral glare as the first sign of diffusely metastatic cancer and to raise clinical suspicion for systemic malignancy in the presence of multiple ocular manifestations.
Persons with ectodermal dysplasias classically have defects in hair, teeth, nails, and sweat glands. Other tissues derived from ectoderm may also be involved. Ocular involvement in ectodermal dysplasias primarily occurs in anhidrotic forms.
We describe a father and son with hidrotic ectodermal dysplasia.
Both patients had recurrent corneal epithelial defects from birth, corneal neovascularization, and strabismus. The father had cataracts with crystalline and amorphous inclusions at an early age. Both patients also had alopecia and skin abnormalities.
A father and son with a previously unreported hidrotic ectodermal dysplasia and unusual corneal findings are described.
Boys with X-linked hypohidrotic ectodermal dysplasia and their families were studied. Many suffered severe illness in early childhood and nearly 30% died; many had feeding problems, severe fever, atopic disease, and recurrent respiratory infections. Some infants failed to thrive. We found no consistent common endocrine or immunological abnormality, although, most had abnormal immunoglobulin production. This may be related to the abnormal mucosa of the gastrointestinal and respiratory tracts which exacerbates the chronic obstructive airways disease found later in life in those who smoke. Mental handicap was not a feature, although convulsions sometimes occurred during fever. Early diagnosis is important to avoid attacks of severe fever and so that rational management may be planned for other problems that arise. Dental advice should be sought before school age and genetic counselling may also be required. Many female carriers may be recognised at clinical examination: their affected sons can then be diagnosed more readily.
Of 227 cases of carcinoma metastatic to the eye or orbit, the predominant involvement was in the eye in 196 cases, the orbit in 28, and in the optic nerve in 3 cases. There was no preponderance of left sided involvement. The primary sites accounting for the most cases were the breast (40%) and the lung (29%). Of the 217 patients regarding whom followup information was obtainable, 192 were known to have died of metastatic tumor. The median survival time was 7.4 mth from the time of ocular/orbital operation. Data are presented suggesting that, contrary to prevailing opinion, the most common malignant tumor of the eye is metastatic carcinoma, rather than primary uveal malignant melanoma.
In order to study the incidence of metastasis to the eye and orbit, 213 adult patients with proven metastatic disease were examined. Choroidal metastases were observed in five patients and orbital metastases were found in five additional patients. Breast carcinoma accounted for seven metastases, bronchogenic carcinoma for two and prostatic carcinoma for one. Orbital and ocular metastasis appear to be more common than previous studies demonstrate.
A case of anhidrotic ectodermal dysplasia associated with relapsing uveitis in both eyes is reported. To our knowledge, no similar case has been reported.
We present a casual review of 154 ectodermal dysplasias (EDs) as classified into 11 clinical subgroups. The number of EDs in each subgroup varies from one to 43. The numbers of conditions due to autosomal dominant, autosomal recessive, and X-linked genes are, respectively, 41, 52, and 8. In 53 conditions cause is unknown; 35 of them present some causal (genetic) suggestion.
The American Cancer Society's Department of Epidemiology and Statistics reports its 30th annual compilation of cancer incidence, survival, and mortality data for the United States and around the world.
To examine the frequency of intraocular metastases in patients who had died of cancer, in an eye bank and necropsy population sample.
The first group included 302 cancer cases received from the Wisconsin Eye Bank between 1988 and 1993. In the second group, ocular pathology records at the Wilmer Institute from 1976 to 1980 were analysed for ocular metastases in necropsy subjects dying of cancer. Nonocular cancer was the cause of death in 741 cases; among these, 510 were attributed to carcinomas.
In the Wisconsin Eye Bank group, three cases (1%) had gross metastases. Out of 255 carcinoma cases, one (0.4%) had gross metastases. In the Wilmer Institute group, gross metastases were observed in 35 (4.7%) cases. Of the 510 patients dying of carcinomas, six (1.2%) had macroscopic metastases. Ocular metastases were detected histopathologically in 93 of 741 (12.6%) of cases.
Even though it is difficult to assess the true frequency of ocular metastases in patients dying of cancer, the answer to this question was attempted by determining the frequency of ocular metastasis in patients who died of cancer and who donated their eyes to the Wisconsin Eye Bank or had postmortem examination at the Johns Hopkins Hospital. Microscopic metastases were found in 12.6% of cases. The frequency of gross metastases has decreased over the past 12 years from 4.7% to 1% (p value = 0.005) owing to improved treatment of leukaemia; however, the frequency of macroscopic metastases due to carcinomas has not changed (p value = 0.38).
The purpose of this investigation is to report the clinical features of patients with uveal metastases seen at a major ocular oncology center.
A retrospective chart review was performed on all patients with uveal metastases evaluated at an ocular oncology outpatient facility over a 20-year period.
To assess the systemic and ophthalmic features of uveal metastases.
A total of 950 uveal metastases were diagnosed in 520 eyes of 420 consecutive patients. Of the 950 metastatic foci, the uveal involvement included iris in 90 (9%), ciliary body in 22 (2%), and choroid in 838 (88%). The total number of uveal metastases per eye was 1 (71%) in 370 eyes, 2 (12%) in 63 eyes, and 3 or more (17%) in 87 eyes. The mean number of uveal metastases per eye was two (median, one). Iris metastases presented most often as a yellow-to-white solitary nodule in the inferior quadrant. Ciliary body metastases typically presented as a solitary, sessile, or dome-shaped yellow mass in the inferior quadrant, but were difficult to visualize directly. The choroidal metastases typically were yellow in color, plateau shaped, and associated with subretinal fluid. In the 479 eyes with choroidal metastases, the epicenter of the main tumor was found in the macular area in 59 eyes (12%), between the macula and equator in 383 eyes (80%), and anterior to the equator in 37 eyes (8%). The mean size of the main (largest) choroidal tumor in each eye was 9 mm in base and 3 mm in thickness. At the time of ocular diagnosis, 278 patients (66%) reported a history of a primary cancer and 142 patients (34%) had no history of a cancer. Subsequent evaluation of these 142 patients after the ocular diagnosis of uveal metastasis showed a primary tumor in the lung in 50 patients (35%), breast in 10 (7%), others in 9 (6%), and no primary site was found in 73 patients (51%). Nearly half of the patients with no known primary site eventually died of diffuse metastatic disease. In the entire group of 420 patients, the uveal metastasis came from a primary cancer of the breast in 196 (47%), lung in 90 (21%), gastrointestinal tract in 18 (4%), kidney in 9 (2%), skin in 9 (2%), prostate in 9 (2%), and other cancers in 16 (4%). In 73 cases (17%), the primary site was never established despite systemic evaluation by medical oncologists.
Iris, ciliary body, and choroidal metastases have typical clinical features that should suggest the diagnosis. The choroid is the most common site for uveal metastases, and the tumors occur most often in the posterior pole of the eye with an average of two tumors per eye. Approximately one third of patients have no history of primary cancer at the time of ocular diagnosis. Breast and lung cancers represent more than two thirds of the primary tumor sites.
To determine the frequency of visually asymptomatic choroidal metastasis in patients with disseminated breast cancer and its dependence on the incidence of metastasis by number and site of other organ metastases.
From January 1995 until April 1997 120 patients irradiated for disseminated breast cancer underwent ophthalmological screening for choroidal metastasis. No patient was symptomatic for ocular disease. 68 out of 120 patients were found to have metastases in one organ and 52 patients had metastases in more than one organ. 80% of the patients had bone metastases, 25% lung metastases, 22% liver metastases, 15% brain metastases, and 22% had metastases in other organs.
Six patients (5%) were found to have asymptomatic choroidal metastases. Five patients had unilateral and one patient bilateral metastases. 52 patients with more than one involved organ had a significantly higher risk for asymptomatic choroidal metastasis (6/52, 11%) than 68 patients with metastases in only one organ (0/68) (p = 0.006). In univariate analysis a significantly higher risk was seen for patients with lung metastases (14% choroidal metastases versus 2% in patients without lung metastases, p = 0.03) and for patients with brain metastases (17% choroidal metastases versus 3% in those without brain metastases, p = 0.04).
In disseminated breast cancer the incidence of asymptomatic choroidal metastases was 5% and increased to 11% when more than one organ was involved in metastatic spread. Risk factors for choroidal metastases were dissemination of disease in more than one organ and the presence of lung and brain metastases.
Radiotherapy for choroidal metastases
- Wiegel