Retinal and vitreous metastases from hepatocholangiocarcinoma

Abstract

BackgroundTo report a case of metastatic hepatocholangiocarcinoma to the vitreous and retina.Case presentationA 70-year-old male, who was recently diagnosed with hepatocholangiocarcinoma, was complaining of floaters in his right eye over the past 5 months and was referred to the Liverpool Ocular Oncology Centre. On presentation, his visual acuity in the right eye was 6/24. Fundus exam revealed a whitish, unilateral, full-thickness retinal lesion at the inferotemporal arcade of his right eye, with vitreous infiltration and subretinal fluid. The patient underwent 25G pars plana vitrectomy with biopsy, resection of the lesion and intravitreal bevacizumab injection. Histopathology testing of the surgical specimens confirmed the diagnosis of metastatic carcinoma to the eye. Two months postoperatively his visual acuity had improved to 6/7.5 and there was no sign of active disease in his right eye, while 9 months postoperatively his visual acuity decreased to 6/9.5 due to developing nuclear sclerotic cataract in his right eye.ConclusionThe current report presents the first case of a hepatocholangiocarcinoma metastasis to the vitreous and retina.

<p>Sixth Cranial Nerve Palsy as the Presenting Sign of Metastatic Cholangiocarcinoma</p>

“…4 There have also been two reports of cholangiocarcinoma metastasizing to the orbit presenting with eye pain, 5 and one report of a combined hepatocellular carcinoma/cholangiocarcinoma metastasizing to the retina and vitreous. 6 This case is also distinctive because the patient had normal bilirubin levels and no other abnormal physical examination findings or subjective complaints other than mildly elevated liver enzymes, sixth cranial nerve palsy, and diplopia. The most common presenting symptoms of cholangiocarcinoma are jaundice, pruritis, abdominal pain, weight loss, malaise, or night sweats.…”

“…[1][2][3] Even more rare are neuro-ophthalmologic and ocular presentations of cholangiocarcinoma, with only eight such cases in the literature. [4][5][6] We report a woman with isolated sixth cranial nerve palsy from an invasive brain metastatic sellar/suprasellar mass as the presenting feature of cholangiocarcinoma, which to our knowledge has not been previously reported.…”

“… 4 There have also been two reports of cholangiocarcinoma metastasizing to the orbit presenting with eye pain, 5 and one report of a combined hepatocellular carcinoma/cholangiocarcinoma metastasizing to the retina and vitreous. 6 …”

Systemic Tumors and Retina

“…[51,52] Enfeksiyöz retiniti andıran tam kat beyaz retinal lezyonlar görülebilmektedir. [53] Karsinom tanısı almış hastalarda bu şekilde retinal infiltratların varlığında, retina metastazı olabileceği düşünülmelidir. Tanı için vitreus incelemesi ve retina biyopsisi gerekebilir.…”

The Vitreous Body and Its Role in the Diagnosis of Eye Pathologies

“…Isolated cases of metastasis of primary lung, breast, liver, cervix, gastric and melanoma and lymphoma have been reported. [20][21][22][23][24][25][26] The symptoms are nonspecific, which makes the diagnosis difficult and requires a high level of suspicion and an extension study aimed at the most frequent neoplasms in the patient's age range. Therapeutic vitrectomy and diagnostic biopsy of vitreous aspirates with cytologic to immunohistochemical cell identification are sometimes required.…”