Choroidal metastasis from breast cancer in a male patient treated successfully with systemic chemotherapy

Abstract

Introduction:To present a case of chemotherapeutic regression of metastasis of breast carcinoma to the choroid in a male patient. Case Report: A 63yearold male, with a past medical history of breast cancer, presented with blurred vision and progressive loss of visual acuity. Fundoscopy of the right eye revealed a choroidal mass in the upper temporal arcade associated with pigment epithelium impairment. Optic disc was normal and macular edema was not present. The patient was treated with systemic chemotherapy (epirubicin, cyclophosphamide, 5fluorouracil), every three weeks, for six cycles. Five months into treatment, the patient reported a partial improvement in visual symptoms. A complete regression of the choroidal mass was noted with both magnetic resonance imaging and fundoscopy. Conclusion: In male as in female patients, breast carcinoma may metastasize to the choroid. Such metastasis must be suspected whenever a patient with a past history of breast cancer suffers from impaired vision. An appropriate ophthalmologic examination including fundoscopy should be performed. Treatment strategy is still based essentially on radiotherapy and should be modified individually depending on size, localization and presence of metastases to other organs and general condition of the patient.

Use of systemic therapy in the treatment of choroidal metastases from breast cancer

“…Patients with choroidal metastases from breast cancer have a poor prognosis with a mean survival of approximately 21 months from diagnosis 2 3. The role of screening has been considered in a number of recent studies, which have reported the incidence rates of asymptomatic lesions in patients with breast cancer as low as 0%, while older series have reported incidence as high as 9% 4 5.…”

Secondary ocular malignancies: A review

“…Chemotherapy or hormonal therapy has been shown to be effective in treatment of choroidal metastases in particular if the disease is disseminated 30,31 . The advantages of this treatment are that potentially the primary lesion and metastatic lesions are treated simultaneously.…”

“…Chemotherapy or hormonal therapy has been shown to be effective in treatment of choroidal metastases in particular if the disease is disseminated. 30,31 The advantages of this treatment are that potentially the primary lesion and metastatic lesions are treated simultaneously. When patients are asymptomatic with peripheral choroidal metastases it may be wise to first see if systemic therapy will cause regression of ocular disease prior to starting external beam radiation.…”