Choroidal metastasis presenting with tumour surface orange lipofuscin pigment

Abstract

Background and Objective: In ocular oncology, orange-color lipofuscin is commonly associated with choroidal melanoma. We herein report a case series of choroidal metastases with overlying lipofuscin pigment. Methods: A retrospective case series of 3 consecutive patients with choroidal metastasis with overlying orange-color pigment. Results and Discussion: Three women who presented to the London Ocular Oncology Service with suspicious choroidal lesions were included in this study. Median age of presentation was 59 years old (mean: 58). On clinical examination, visual acuity of the affected eyes was 6/24 in 2 cases and counting fingers in one. All lesions were pale and showed subretinal fluid, and orange color lipofuscin overlying the tumours, which was also demonstrated as speckled hyperflourescence on autofluorescence. At presentation to our service, 2/3 patients were already diagnosed with metastatic disease from primary breast and lung cancer, and one had no known extraocular malignancy, but was diagnosed with metastatic lung cancer following systemic workup. Conclusion: Findings of this study suggest that orange lipofuscin pigment, although commonly associated with choroidal melanoma, can also be found overlying choroidal metastasis. In case both entities are considered part of the differential diagnosis, presence of orange pigment should be carefully interpreted and further ocular and extraocular evaluation is advised.