Choroidal metastasis in a patient with small cell lung cancer discovered during treatment with chemotherapy

Abstract

A 56-year-old male patient complaining of productive cough, hoarseness, and fatigue was found to have extensive disease of small cell lung cancer (ED-SCLC), with staging of cT4N3M1(PUL). He was treated with chemotherapy. While undergoing treatment with chemotherapy, he complained of a right visual disturbance, and choroidal metastasis was diagnosed. Because the primary site responded well to chemotherapy alone and the visual disturbance did not worsen, the patient refused radiotherapy to the choroidal metastasis. Two months after the first diagnosis of the choroidal metastasis, while he was receiving the first treatment regimen for SCLC, the visual disturbance suddenly worsened; emergent radiotherapy was started, with a total dose of 40 Gy, given as 2.0 Gy/fraction per day. The visual disturbance never improved, and the patient lost 80% of his right visual field. Within 6 months of diagnosis, the patient became blind in his right eye. The patient died of septic shock related to treatment received during his third chemotherapy regimen. Choroidal metastasis is very rare with extraocular malignant tumors, though it is common with intraocular malignant tumors. Choroidal metastasis secondary to SCLC has a poor prognosis, but in order to maintain quality of life during the patients' remaining lifespan, aggressive treatment would appear appropriate for these patients, because SCLC is a chemo-sensitive cancer.

Alectinib for choroidal metastasis in a patient with crizotinib-resistant ALK rearranged positive non-small cell lung cancer

“…Cancer associated low vision has a differential diagnosis, and we should consider carcinoma associated retinopathy syndrome, brain metastasis, and chemotherapy-induced optic neuropathy in these patients. 13 Funduscopic examination and electroretinography are useful for diagnosis.…”

Metastasis manners and the underlying mechanisms of ALK and ROS1 rearrangement lung cancer and current possible therapeutic strategies

“…Thus, the choroid is the most common ocular tissue affected by metastatic disease. 55,56 Lu and colleagues reported a case of a patient with ROS1-rearranged NSCLC that presented with choroidal metastases and did not respond to initial chemotherapy but had a rapid and complete response to crizotinib. 57 Feng and colleagues reported a similar case in an ALK-positive patient.…”

Small-cell lung carcinoma metastasis to the iris – case presentation

“…Breast and lung are the most common primary locations of metastasizing cancer. Among lung cancers, adenocarcinomas [4] are much more likely to produce distant metastases to the iris than small-cell carcinomas [5]. However, there are some reports of iris metastases originating from cancers of kidneys, pancreas and endometrium or cervix of the uterus [2].…”