Diagnosis Of Choroidal Metastasis Research Articles

Bilateral Choroidal Metastases In Triple-Negative Breast Cancer: Radiotherapy And Eribulin For Vision Preservation And Prolong Survival

Introduction: Choroidal metastases are infrequent in breast cancer, but if they present, they usually signify the disseminated disease and poor prognosis. The challenges in treating choroidal metastases are not only to prolong survival but also to preserve vision, improving the quality of life. Case Presentation: Our patient was firstly diagnosed with stage-three triple-negative breast cancer at the age of 32 years. She had surgery, adjuvant chemotherapy with anthracycline regime, as well as adjuvant radiotherapy. Her disease firstly recurred two years later with pleural effusion, but it was controlled with six cycles of docetaxel. She was in remission until ten years later when she presented with a worsening dry cough and progressive blurring of vision in both eyes. CT restaging showed multiple sub-centimeter bilateral lung nodules, singular pleural metastases, and multiple bone metastases. Choroidal metastases were also confirmed with the ophthalmological assessment which includes CT of the orbit. She received short-course palliative radiotherapy followed immediately by eribulin. Then, she started monthly bisphosphonates. She was able to read again four months after radiotherapy, and her vision remains normal to date. The latest PET scans showed no FDG avid disease in the lungs with pleural metastases significantly reduced in size. Bone metastases remain stable and asymptomatic. It has been nearly four years since the diagnosis of choroidal metastases. She is still on eribulin at an adjusted dose and interval. She remains asymptomatic from her bone, lung, and choroidal metastases. Conclusions: Short-course radiotherapy to the orbit, followed by continuous administration of eribulin, can lead to prolonged survival with a good quality of life in triple-negative breast cancer with choroidal metastases

Multimodal Imaging in Diagnosis of Choroidal Metastasis in Breast Carcinoma

Multimodal Imaging in Diagnosis of Choroidal Metastasis in Breast Carcinoma

Palliative radiation therapy for patients with orbital and ocular metastases.

Patients with cancer may develop metastases to the orbit causing distressing symptoms. External beam radiation therapy (RT) is an effective palliative treatment for patients with orbital and ocular metastases. The aim of treatment is to preserve vision and to reduce pain. Delivery of 30 to 40 Gy in 2 Fr fractions is a practice in many oncology centres. The aim of this study is to evaluate the outcome of shortcourse palliative radiotherapy in the management of orbital and ocular metastases. A retrospective study to review all patients with orbital metastases treated in 2016 to 2018 were performed. The primary outcomes were a change in visual acuity and tumor response. Secondary outcomes included toxicities of radiotherapy, symptomatic response and survival. Fifteen patients with 19 eyes were included. The most common presenting symptoms were decreased vision, periorbital swelling, and pain. The median follow-up period was 8 months. Visual acuity improved in 11 out of 13 (84.6%) of patients and remained stable in the remaining 2 patients. Partial and complete response (CR) of tumor was observed in 14 out of 15 (93.3%) of patients while one (6.6%) patient had stable disease. The overall response rate (ORR) was 100%. Two (13.3%) patients had grade 2 conjunctivitis. There were no grade 3-4 toxicities and no long-term toxicities observed. The median survival was 9.1 months from diagnosis of choroidal metastases. Short course palliative RT is effective and well tolerated in patients with orbital and ocular metastases. The current review showed that it effectively preserves vision and improves orbital symptoms with minimal radiation-induced toxicity. Short course radiotherapy will help to minimize the traveling time to the hospital and relieve the burden of a long treatment course in this palliative patient population.

Novel presentation of intraocular metastases in a patient with penile squamous cell carcinoma: a case report

BackgroundThe choroid is the most common site for intraocular tumor metastasis because of its abundant vascular supply. However, choroidal metastasis in penile cancer is highly unusual. Here, we report the first case of diagnosis of choroidal metastasis at presentation in a patient with penile squamous cell carcinoma.Case presentationA 43-year-old Asian man with a 3-year history of penile cancer presented with metastasis in the right intraocular sites. Magnetic resonance imaging showed hyperintensity in the T1-weighted images and hypointensity in the T2-weighted images of the right eye. After enucleation of his right eye, histopathological analysis led to a diagnosis of metastatic, moderately differentiated penile squamous cell carcinoma.ConclusionsPenile cancer typically occurs as penile squamous cell carcinoma, and its most common metastatic sites are the inguinal lymph nodes. Hemorrhagic transfer of tumor cells is extremely rare, especially to intraocular sites. Intraocular metastatic tumors have a unique presentation on imaging, as observed on magnetic resonance imaging and histopathological analysis. This novel finding of intraocular metastasis in penile squamous cell carcinoma is of great significance to optic surgeons and oncologists as it has new implications in the diagnosis of and timely intervention for penile cancer metastasis.

Retrospective descriptive study on diagnosed patients of choroidal metastases

AbstractPurposeThe most frequent intraocular tumour are metastatic carcinomas. Although it is a rare entity, choroidal involvement is considered the most frequent intraocular malignancy due in part to its abundant vascularization. Although they are often the first manifestation of the tumour, they usually appear late in the course of a tumour disease and are associated with poor prognosis. The most frequent primary origin in the case of women is the breast and in the male the lung. Blurred vision or visual loss is the most common form of presentation. The therapeutic options include systemic treatments and local therapies such as radiotherapy or surgery among others.MethodsRetrospective descriptive study conducted in our centre from May 2009 to May 2019 on patients diagnosed with choroidal metastases. We analysed the primary tumour origin, clinic at the beginning, initial presentation of neoplastic disease, therapeutic attitude and median survival.ResultsOf the 10 patients studied there were four males (40%) and six females (60%). The average age was 63.6 years. The initial presentation clinic was headache in four patients (40%), exophthalmos in two (20%), visual field reduction in one (1%), blurred vision in one (10%), retinal detachment in one (10%) and seizure in one (10%). As a primary source, pulmonary neoplasia was identified in four patients (40%) (two adenocarcinomas, one squamous and one small cell carcinoma), breast cancer in three patients (30%), adenocarcinoma of the pancreas in one patient (10%), papillary carcinoma of thyroid in one (10%) and high‐grade undifferentiated carcinoma in one (10%). Regarding the treatment received, six patients were candidates for palliative chemotherapy, one for radioactive iodine, one patient could not receive any type of treatment for death and two were candidates for local therapy by exantheration.ConclusionsThe results obtained in our sample are concordant with those found in the literature, obtaining a median survival of 10 months after the diagnosis of choroidal metastases. Choroidal metastases are a rare entity and generally associated with poor survival. The most commonly identified primary origins are carcinomas of the lung and breast. In a significant percentage of cases, choroidal metastases are the initial presentation of an unknown systemic neoplasm.

Bilateral Choroidal Metastases as Initial Presentation of Widespread Follicular Thyroid Cancer

Follicular thyroid cancer (FTC) is the second most common malignancy of the thyroid gland and comprise 10-15% of all thyroid tumors; the usual mode of spread is via hematogenous dissemination with the most common sites of metastases being the lungs and bones.4 A case is presented to demonstrate the unusual presentation of follicular thyroid cancer as bilateral choroidal metastases. Although exceptional, a diagnosis of choroidal metastases should be considered in any decline in visual acuity in patients with thyroid cancer.

Clinical outcomes of hypofractionated radiation therapy for choroidal metastases: Symptom palliation, tumor control, and survival

PurposeExternal beam radiation therapy (RT) is an effective palliative treatment for patients with choroidal metastases and is aimed at preserving vision and obtaining local tumor control. Delivery of 30 to 40 Gy in 2-Gy daily fractions is a standard approach at many centers. This study reports the outcomes of a hypofractionated schedule of 20 Gy in 5 fractions in this palliative setting. Methods and materialsWe conducted a retrospective review of patients who were treated with RT (20 Gy in 5 fractions) for choroidal metastases between January 1999 and November 2012. The primary outcome measures were change in visual acuity and tumor response. Secondary outcomes included toxicities of RT, tumor control, and overall survival (OS) from diagnosis of choroidal metastases. Univariate and multivariable Cox regression modeling was used to investigate the predictors for OS. ResultsFifty-five patients with 71 affected eyes were included. Decreased vision was the presenting symptom in 43 eyes (61%). Visual acuity improved from a median of 20/70 at baseline to 20/40 at last follow-up and remained stable or improved in 56 eyes (80%). Tumor regression was observed in 64 eyes (91%) with complete response in 47 eyes (67%). Local progression occurred in 4 eyes (6%). The median survival after diagnosis of choroidal metastases was 13 months. No acute complications were observed in 49 patients (89%). Mild acute toxicities included transitory dryness in 5 patients and episcleritis in 1 patient. Cataracts, retinopathy, optic neuropathy, pigmentary maculopathy, and neovascular glaucoma developed in 4 eyes (6%), 1 eye, 7 eyes (10%), 5 eyes (7%), and 1 eye, respectively. No variables were statistically significantly associated with OS. ConclusionsA short fractionation schedule of 20 Gy in 5 fractions is a well-tolerated treatment that effectively preserves vision and gains local tumor control for many patients with choroidal metastases. This hypofractionated approach would help reduce the burden of a longer treatment course in this palliative patient population.

Outcomes of hypofractionated palliative radiotherapy for choroidal metastases.

194 Background: External beam radiotherapy (RT) is an effective palliative treatment for choroidal metastases aimed at preserving vision and obtaining local tumor control. Delivery of 30-40 Gy in 2 Gy daily fractions is a standard approach in many centers. At our center, a shorter, more convenient schedule of 20 Gy in 5 fractions has been used in this palliative setting. This study reports the efficacy and toxicity of this hypofractionated RT approach. Methods: We conducted a retrospective review of patients treated in the Ocular Oncology clinic at Princess Margaret Cancer Center who received RT (20 Gy in 5 fractions) for choroidal metastases between January 1, 1999 and November 30, 2012. Primary outcome measures were change in visual acuity and tumor response. Secondary outcomes included toxicities of RT, tumor control, and overall survival from the date of choroidal metastases diagnosis. Results: A total of 55 patients with 71 involved eyes were included. Decreased vision was the presenting symptom in 43 eyes (61%). Visual acuity improved from a median of 20/70 to 20/40 between baseline assessment and last follow-up, and remained stable or improved in 56 eyes (80%). On ultrasound, tumor regression was observed in 64 eyes (91%) with complete response in 47 eyes (67%). Metastases progressed in 4 eyes (6%) despite RT with 1 eye requiring enucleation. Median survival after diagnosis of choroidal metastases was 13 months with estimated overall survival at 1, 2, and 3 years to be 50% (36-62), 23% (12-35), and 8% (3-18), respectively. Forty-nine patients (89%) did not experience any acute complications. Mild acute toxicities included transitory dryness in 5 patients and episcleritis in 1 patient. Cataracts developed in 4 eyes (6%), retinopathy in 1 eye, optic neuropathy in 7 eyes (10%), pigmentary maculopathy in 5 eyes (7%), and neovascular glaucoma in 1 eye. Conclusions: A short fractionation schedule of 20 Gy in 5 fractions is a well-tolerated treatment that effectively preserves vision and gains local tumor control for many patients with choroidal metastases. This hypofractionated approach would help reduce the burden of a longer treatment course in this palliative patient population.

Choroidal metastasis as the presenting feature of a non-small cell lung carcinoma with no apparent primary lesion identified by X-ray: A case report.

The most common type of intraocular tumor in adults is the metastatic variety, with the choroid as the typical site of involvement. The case of a patient with non-small cell lung cancer, who presented with choroidal metastasis, is described in the current report. In addition, the limitation of using a chest X-ray to identify a large primary lung lesion is highlighted. A 71-year-old female that presented with a choroidal mass lesion is described in the current report. A chest X-ray was conducted and was considered to be normal following detailed investigation, however, a computed tomography (CT) scan of the thorax revealed a large lobulated mass in the right upper lobe. On further histopathological analysis, the patient was diagnosed with a non-small cell lung carcinoma. Thus, when a large choroidal lesion and overlying exudative retinal detachment is observed, a diagnosis of choroidal metastasis should be considered. X-ray images may appear to be normal even in the presence of a large pulmonary lesion. Therefore, in cases where there may be a metastatic lesion, a CT scan is proposed as the optimal diagnostic imaging technique.

Bilateral Choroidal Metastases from Primary Esophageal Melanoma

The purpose of this case report is to report a rare, bilateral, choroidal metastases from a primary esophageal melanoma. A 44-year-old white female presented to the ocular oncology clinic in February 2010 on urgent referral from her ophthalmologist for evaluation of an elevated mass in each eye. The patient presented with best-corrected visual acuities of 20/25 in both eyes. Fundus examination displayed creamy white choroidal infiltrates located in the superior temporal arcade of the right eye and temporally in the left eye. The patient was diagnosed with bilateral choroidal metastatic melanoma from known primary esophageal melanoma. External beam radiation therapy was administered and complete resolution of the lesions occurred. Final visual outcome was 20/20 in both eyes. Nine months after diagnosis of choroidal metastases, the patient died from complications related to the extensive systemic metastatic involvement. Choroidal metastases are the most common intraocular malignancy. However, metastatic melanoma is a rare finding and has only been reported from cutaneous and primary choroidal melanoma. Therefore, to the best of the authors' knowledge, this is the first reported case of bilateral choroidal metastasis from a primary esophageal malignant melanoma.

SD-OCT Patterns of the Different Stages of Choroidal Metastases

A diagnosis of choroidal metastasis is based on the patient's clinical history, the tumor's ophthalmoscopic appearance, and instrumental imaging results such as ultrasonography, fluorescein angiography, fundus autofluorescence, indocyanine green angiography, and optical coherence tomography. Spectral-domain optical coherence tomography (SD-OCT) has provided additional useful information for clinical diagnosis: a pattern of hyperintense irregular spots in the context of the photoreceptor layer and in the retinal pigment epithelium, subretinal fluid, and marked irregularity of the retinal pigment epithelium with thickening and gross undulation. The authors describe a case of bilateral choroidal metastasis presenting peculiar SD-OCT features acquired at different stages. They emphasize the central role of SD-OCT among instrumental imaging procedures and for final successful diagnosis.

Bilateral Choroidal Metastases as Presentation of Dissemination of Cutaneous Malignant Melanoma

Case Report. A 47-year-old man presented with blurred vision in the right eye. Ophthalmoscopic examination showed several placoid, pigmented lesions in the posterior pole and midperiphery of the retina of both eyes. Results. Patient referred a cutaneous malignant melanoma on the back skin removed 6 years ago. A systemic workup revealed multiple metastases in liver and spleen. After an exhaustive study we concluded that it was a dissemination of a cutaneous malignant melanoma with bilateral choroidal metastases, liver and spleen metastases. The patient obtained clinical ocular improvement after palliative chemotherapy, although he died in the following months. Pathological examination of the lesions confirmed the diagnosis of choroidal metastases from a malignant cutaneous melanoma. Conclusions. Monitoring patients who have had cutaneous malignant melanoma is very important, since melanoma metastases may occur even many years after the diagnosis of the primary tumor. Choroidal metastases from cutaneous melanoma are uncommon but we should be aware because their appearance worsens prognosis.

Métastase choroïdienne d’un carcinome vésiculaire thyroïdien : un cas rare

Choroidal metastases are, with melanoma, the most frequent malignant eye neoplasms. Breast carcinoma for women and lung carcinoma for men most commonly metastasize to the eye. We report a rare case of choroidal metastasis from follicular thyroid carcinoma. A 75-year-old man, with metastatic follicular thyroid carcinoma, presented a decline in visual acuity of the left eye lasting one month. The best corrected visual acuity was 3/10 in his left eye. Biomicroscopic examination of the anterior segment did not reveal anything abnormal. Funduscopic examination showed an amelanotic choroidal mass located at the posterior pole with serous retinal detachment. Tomoscintigraphy with computed tomography confirmed the thyroid origin by uptake of radioiodine in the choroidal mass. External radiotherapy was then proposed. Although it is exceptional, diagnosis of choroidal metastases should be considered in any decline in visual acuity in patients with thyroid cancer. The treatment is difficult because metastases from thyroid cancer are very poorly sensitive to radiotherapy and chemotherapy.

Is a Diagnostic CT of the Brain Indicated in Patients with Choroidal Metastases Before Radiotherapy?

There is no evidence in the literature about the incidence of synchronous brain metastases in patients with choroidal metastases. This is of major importance, because the radiation fields of choroidal metastases and, later on, brain metastases, if treated consecutively, are partly overlapping, thus potentially increasing the rate of late side effects such as brain necrosis. The goal of this study was to determine the frequency of synchronous brain metastases. 50 patients with choroidal metastases were enrolled into a study of the "Arbeitsgemeinschaft Radiologische Onkologie" of the German Cancer Society (ARO 95-08) with standardized 40 Gy radiotherapy, 2 Gy single dose. All patients were staged before treatment with a computed tomography of the brain (CCT). No patient showed clinical signs of brain metastases. 13 out of 50 patients (26%) had brain metastases in the CCT leading to radiotherapy of the brain and choroidal metastases in one volume. A CCT is indicated at the diagnosis of choroidal metastases for screening of synchronous brain metastases. The incidence is about 25%, and the diagnosis of brain metastases results in a different target volume: the whole brain including the posterior parts of the eyes compared to the posterior parts of the eyes alone. Therefore, the risk of late side effects could be reduced compared with an additional later radiotherapy of the whole brain with partly overlapping fields.

Peripheral choroidal neovascularization.

Peripheral choroidal neovascularization can result in an elevated subretinal lesion which can simulate a choroidal tumor. We reviewed 8 eyes with 11 peripheral areas of subretinal fluid and exudate which were subsequently determined to be secondary to peripheral choroidal neovascularization. Previous reports of peripheral choroidal neovascularization have emphasized the hemorrhagic nature of these lesions which can simulate a choroidal melanoma. In contrast, turbid subretinal fluid and exudate characterized the majority of peripheral lesions in this series and the majority of these patients were referred with a diagnosis of choroidal metastasis. Clinical examination with fluorescein angiography and echography can effectively distinguish these areas of peripheral choroidal neovascularization from choroidal metastasis.

Clinical Features and Treatment of Seven Patients With Carcinoid Tumor Metastatic to the Eye and Orbit

To understand better the clinical features, treatment, and outcome of patients with carcinoid tumors metastatic to the eye and orbit. We studied seven patients with carcinoid tumors metastatic to the eye and orbit who were initially examined at the Mayo Clinic between 1974 and 1992. Carcinoid tumors metastasized to the choroid of six eyes of four patients and unilaterally to the orbit in three additional patients. Decreased vision was the most frequent initial symptom with choroidal metastases. Choroidal metastases were treated with brachytherapy only, with brachytherapy and chemotherapy, with external beam irradiation and chemotherapy, or with chemotherapy only. The duration of follow-up of these four patients ranged from seven to eight years after the diagnosis of choroidal metastases. Two of the four patients died from tumor complications 7 1/2 and seven years after the diagnosis of choroidal metastases. Proptosis and limitation of ocular motility were the most common initial signs with orbital metastases. Orbital metastases were treated with external beam irradiation and chemotherapy, with chemotherapy only, or with external beam irradiation only. Duration of follow-up of these three patients ranged from one-half to two years after the diagnosis of orbital metastases. All three patients died from tumor complications during the follow-up period. Because of the relatively good prospects for long-term survival in patients with carcinoid tumors metastatic to the choroid, early detection and treatment of the metastases are important.