Choroidal metastasis from an occult primary diagnosed by fine‐needle aspiration: A case report

Bandyopadhyay, Sudeshna; Adrean, Sean D.; Puklin, James E.; Feng, Jining

doi:10.1002/dc.20918

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…For 11 of these 31 patients, the published report mentioned administration of chemotherapy, but the drugs used were not specified. 8,9,17,26,38,66,67,69,70,83,86 Twelve (21.8%) patients received thoracic radiation, and in 6 cases it was the only modality used (without systemic chemotherapy) for lung lesions. 2,14,26,77,79 Targeted therapy was used in 3 patients (including 2 index patients).…”

Section: Results Of the Literature Reviewmentioning

confidence: 99%

Choroidal Metastasis as a Presenting Manifestation of Lung Cancer

Singh

Kulkarni²,

Aggarwal³

et al. 2012

Medicine

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Symptomatic choroidal metastasis is a rare presenting manifestation of lung cancer. We describe here 3 patients with non-squamous non-small cell lung cancer who presented with choroidal metastasis and who were diagnosed and treated by the authors. We performed a systematic literature review of the previously reported patients with choroidal metastasis from lung cancer in the English-language literature. We excluded case series lacking individual patient data and identified 75 patients. In 23 of these patients, choroidal metastasis was not the presenting manifestation of lung cancer. Therefore, we included 55 patients (3 index and 52 previously reported) in the analysis. We present the demographic profile, histology, disease stage, ocular and lung lesions, diagnostic and treatment (systemic and ocular) modalities, and treatment outcomes. The majority of patients were male (67.3%) and were current or ex-smokers (78.3%); the mean age was 55.1 (standard deviation 11.2) years. Adenocarcinoma (n = 23) was the most common histologic type followed by squamous (n = 11) and small cell (n = 8). Left eye (n = 32) involvement was more common than right eye (n = 19) or bilateral (n = 4). Among patients for whom the location of primary lesion was specified, the left upper lobe (n = 13) was the most common site. The most common diagnostic modalities were bronchoscopic lung biopsy (n = 15) and enucleation (n = 13), while the liver (30.9%) was the most common extraocular metastatic site identified. Systemic chemotherapy was given in 56.4% of cases, and disease progression was the most common outcome among evaluable patients. Ocular treatment modalities included radiation (n = 23), enucleation (n = 14), and systemic steroids (n = 8). Regression of choroidal metastases with treatment was observed in 66.7% of patients who did not undergo enucleation as the primary treatment modality. Of the 3 index patients, 2 each received pemetrexed-cisplatin (as first-line therapy), gefitinib or erlotinib (as second- or third-line therapy), and intravitreal bevacizumab; and 1 patient received systemic bevacizumab. Two patients had partial response radiologically with systemic treatment, and all 3 patients had regression of choroidal metastases with ocular treatment. Recommendations regarding systemic and local (ocular) management of patients with choroidal metastasis as the presenting manifestation of lung cancer are provided.

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Section: Results Of the Literature Reviewmentioning

confidence: 99%

Choroidal Metastasis as a Presenting Manifestation of Lung Cancer

Singh

Kulkarni²,

Aggarwal³

et al. 2012

Medicine

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“…In a large series of uveal metastases the distribution of primary sites included breast (47% of cases), lung (21% of cases), and GI tract (4% of cases) [71]. Interestingly, lung is the most likely primary site of uveal metastatic carcinoma in patients with no known primary at presentation [71,[75][76][77][78]. In contrast, uveal metastases from breast carcinoma usually occur late in the natural history and are associated with disseminated disease in patients with a known breast primary [73,79].…”

Section: Uveal Metastasesmentioning

confidence: 97%

Radiation Therapy: Uveal Tumors

Seregard

Pelayes

Singh

2013

Ophthalmic Radiation Therapy

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Among primary uveal tumors, uveal melanoma is the most frequently occurring malignant neoplasm, albeit much less common than skin melanoma and indeed most other cancers. Traditionally, uveal melanoma was treated by enucleation of the globe, but is now increasingly been managed by an eye-preserving option, which saves vision without compromising the life of patients. More than 90% of eyes now preserved have some form of radiotherapy; most often episcleral brachytherapy that is easily accessible at many ophthalmic centers. Conversely, teletherapy in the form of charged particle irradiation, stereotactic radiotherapy or radiosurgery is only available at a comparatively small number of centers. Radiotherapy for uveal melanoma causes significant side effects and complications, but the vast majority of patients can keep their eye with some remaining function. This is of significant benefit to the quality of life for many patients. The side effects of radiotherapy are intimately related to the size of the irradiated tumor, hence early detection and identification of tumors that need to be treated is critical to improve the functional outcome. Experience gained from treating uveal melanoma has been expanded to treat benign uveal tumors such as choroidal hemangioma and other malignant tumors such as uveal lymphoma and uveal metastasis.

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“… 110 Fine Needle Aspiration Biopsy (FNAB) Abundant vacuolated cytoplasm and eccentrically located nuclei with prominent nucleoli, loosely large epithelioid cells; IHC: positive for cytokeratin (AE1/AE3) and mucicarmine; CK7 or CK20 staining help to localize a primary lesion in upper or lower gastrointestinal tumors; Estrogen, progesterone receptors may support primary breast tumor; TTF-1 is a useful stain in support of a lung primary tumor. 111 FISH or gene testing: detection of EGFR, ALK, ROS or Her-2, ER, PR. A relatively bland cellular appearance; Cytoplasmic melanin; Mixed cell type, spindle B cell 112 and epithelioid cells; IHC: positive for S 100, HMB-45, and MART-1.…”

Section: Auxiliary Examinations and Characteristic Performancesmentioning

confidence: 99%

“… A relatively bland cellular appearance; Cytoplasmic melanin; Mixed cell type, spindle B cell 112 and epithelioid cells; IHC: positive for S 100, HMB-45, and MART-1. 111 FISH or Gene testing: loss of one chromosome 3 (monosomy 3), chromosome 8q gain, chromosome 1p loss, chromosome 6 rearrangements. Notes: # Because the tumor cells are rich in pigments, the absorption of sound energy is reduced.…”

Section: Auxiliary Examinations and Characteristic Performancesmentioning

confidence: 99%

A Comprehensive Understanding of Choroidal Metastasis from Lung Cancer

Qu¹,

Liu²,

Zhu³

et al. 2021

OTT

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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.

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Choroidal metastasis from an occult primary diagnosed by fine‐needle aspiration: A case report

Cited by 4 publications

References 14 publications

Choroidal Metastasis as a Presenting Manifestation of Lung Cancer

Choroidal Metastasis as a Presenting Manifestation of Lung Cancer

Radiation Therapy: Uveal Tumors

A Comprehensive Understanding of Choroidal Metastasis from Lung Cancer

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