Choroidal metastasis from chondrosarcoma

Abstract

Health Organization (WHO) grades I to III according to the histological appearance. Distant metastasis are exceptional in grade I but account for 10% of grade II and for 71% of grade III chondrosarcoma; these occurs in the lung, femur, sternum, liver, pleura and ureter. The presence of metastasis is associated with a 5-year survival rate of 18%. Heart and brain metastasis are exceptionally rare and scarcely documented [1]. Herein we report a case of chest-wall chondrosarcoma with metastasis to the lung, brain, and choroid.A 53-year-old female was referred to the department of ophthalmology because of progressive visual loss in her right eye (OD) for the 2 previous months. Her past medical history was significant for a rib chondrosarcoma grade II treated with excisional surgery 10 years before, and a recent mestastasic lesion in the right lung tissue which was being treated with chemotherapy using adriamycin.Her best-corrected visual acuity was 20/60 in the OD and 20/25 in the left eye. Fundus examination revealed an elevated yellowish choroidal lesion within the macular area in her OD (Fig. 1a). The left eye was unremarkable. In the OCT we observed a serous detachment with a swelling of macula (Fig. 1b). Fluorescence angiography was performed, revealing early hypofluorescence with late pinpoint hyperfluorescence (Fig. 1c 1-3 ).Standardized B-scan ultrasonography of the OD demonstrated a plateau-shaped choroidal mass of 8 ×3 mm (Fig. 2a). Cerebral magnetic resonance imaging showed metastatic lesions in the right cerebellum hemisphere and the OD choroid (Fig. 2b). Fine needle aspiration biopsy and photodynamic therapy was refused by the patient, who was lost to follow-up.Metastasic cells reach the eye exclusively by the hematogenous route, since there are no intraocular lymphatic channels. The most frequently affected ocular tissue is the choroid, which has the highest metastatic efficiency index of any tissue [2], because of its marked vascularization and its high blood flow. We are unaware of previously reported cases of chondrosarcoma metastatic to the choroid in the indexed literature [3]. This case report has not been presented at any conference.

Brain Metastasis in Bone and Soft Tissue Cancers: A Review of Incidence, Interventions, and Outcomes

“…Chondrosarcoma is a malignancy of mesenchyme that is a common primary bone tumor subsequent to osteosarcoma in frequency [ 39 ]. It has been classified based on histological appearance into slow growing, benign grade I to malignant grade III [ 39 , 40 ].…”

“…Chondrosarcoma is a malignancy of mesenchyme that is a common primary bone tumor subsequent to osteosarcoma in frequency [ 39 ]. It has been classified based on histological appearance into slow growing, benign grade I to malignant grade III [ 39 , 40 ]. Distant metastases account for 10% of grade II and 71% of grade III [ 40 ], commonly occurring to lungs, other bones, and liver, resulting in a mere 5-year survival of 18% [ 39 ].…”

Chondrosarcoma Metastasis to the Choroid

“…To our knowledge, there have been 9 published cases of intraocular metastases from bone sarcoma [5, 6, 8-14], only 2 of which were from chondrosarcoma [5, 6]. In 1996, George and Zamber [5] described the first case of chondrosarcoma metastatic to the eye.…”

“…The patient presented with a 3-day history of eye pain and decreased vision in one eye and eventually required enucleation for painful blind eye from end-stage mechanical glaucoma. The second case of chondrosarcoma metastatic to the choroid was published in 2012 [6], though the choroidal mass was never biopsied as the patient was lost to follow-up.…”

“…The most common sites of metastatic spread of chondrosarcoma are the lungs. To our knowledge, only 2 prior cases in the literature describe intraocular chondrosarcoma metastasis [5, 6], suggesting even greater scarcity of intraocular involvement of this rare malignancy. Herein, we describe a case of biopsy-proven chondrosarcoma metastatic to the choroid.…”