To report a case of recurrent bilateral combined branch retinal vein occlusion (BRVO) and branch retinal artery occlusion (BRAO) with paracentral acute middle maculopathy (PAMM) as the first manifestation of lung adenocarcinoma. A 54-year-old male with a history of inferonasal BRVO in the left eye (LE), was referred to our department for blurred vision in the LE. On examination, best-corrected visual acuity was 20/20 in the right eye (RE) and 20/25 in the LE. Fundus examination showed tortuosity and dilatation of the inferotemporal branch vein, cotton-wool spots, retinal hemorrhages, and areas of retinal whitening in both eyes corresponding to a BRVO associated with BRAO and PAMM. A few months later, the patient complained of blurred vision in the RE. Examination revealed a superior temporal BRVO and BRAO. An exhaustive work-up was performed. Results showed a high level of antiphospholipid antibodies. Chest scan showed the presence of a pulmonary mass related to lung adenocarcinoma. The patient underwent a surgical removal of the lung tumoral mass and chemotherapy. The level of antiphospholipid antibodies was back to normal and no recurrence of ocular symptoms was noted after a follow-up of one year. The association between retinal vascular occlusions and systemic carcinomas is rare. Malignant tumors may induce a hypercoagulation state and an increased risk of thromboembolic complications including branch retinal vascular occlusions.

CLINICAL IMAGE Lung carcinoma mimicking breast cancer 1 Computed tomography identified an infiltrative mass in the right upper lobe (31 mm 74 mm), pleural effusion, as well as multiple bone metastases, multiple liver metastases, adrenal and renal lesions, and skeletal metastases.Mammography and breast ultrasound showed bilateral irregular, well -defined, hypoechogenic breast nodules (14-19 mm; Breast Imaging Reporting and Data System, 4c).Such lesions can mimic primary BC, including triple -negative phenotypes, which is why tissue diagnosis with immunohistochemistry is the golden standard. 4FIGURE 1A-1F shows the diagnostic imaging performed.Liver biopsy demonstrated adenocarcinoma-CK7+, TTF1+, HER2-, and Ki67 of approximately 42%-consistent with pulmonary origin.Breast biopsies in both cases showed adenocarcinoma metastatis immunoprofile: CK7+/TTF1+/ER-/ PR-/HER2-/GATA3-/GCDFP-/ mammaglobin-.The result supported lung origin rather than primary breast carcinoma.Microscopic images of histology samples are presented in FIGURE 1G and1H.Key features that can distinguish between metastatic and primary breast carcinoma include: absence of an in -situ component, multiplicity / bilaterality, and a lack of breast markers, such as ER/ PR/HER2/GATA3/GCDFP/mammaglobin, with positive lung markers (TTF -1).The treatment proposed by a multidisciplinary board included stereotactic radiotherapy for brain metastases, brachytherapy for ocular metastasis, and systemic therapy (chemotherapy or immunotherapy) pending molecular testing (programmed cell death ligand 1 and next generation sequencing).The patient remained clinically stable and was discharged with follow -up scheduled for oncology, ophthalmology, radiotherapy, and palliative care.The therapy consisted of paclitaxel, gemcitabine, and radiotherapy of the brain.The treatment followed current standards of care. 5etastatic breast disease originating from lung cancer is a rare clinical condition, even rarer

Choroidal metastasis resembling hemangioma on angiogram as initial manifestation of lung adenocarcinoma.

PAINFUL FINGERS AND TOES REVEAL A CASE OF NON-SMALL CELL LUNG CANCER

Iris metastasis as a first manifestation of lung adenocarcinoma

Purpose: To report a case of choroidal metastasis as the main presentation in a patient with lung carcinoma. Method: Case report. Results: A 69-year-old woman complained of blurred vision in her right eye for 2 months. The best-corrected visual acuity was counting finger in right eye. Fundoscopy demonstrated a large choroidal mass located inferiotemporally associated with exudative retinal detachment in her right eye. B-scan ultrasound revealed the tumor had a high internal reflectivity. Magnetic resonance imaging of the orbit showed an intraocular mass that was approximately 5 mm in thickness. After enucleation, pathologic study of the enucleated eye demonstrated a choroidal metastasis. Complete systemic survey disclosed that a primary lung adeno-carcinoma with bone and choroidal metastasis count for the ocular lesion. Conclusions: Choroidal metastasis can be the first clinical manifestation of lung adenocarcinoma. Ophthalmologists should be aware of systemic malignancy in choroidal metastasis and initiate a thorough systemic evaluation for early detection of life-threatening malignancies.

P118 Stroke as major paraneoplastic manifestation of lung adenocarcinoma: a clinical case

A Hard Palate Mass as the First Manifestation of Lung Adenocarcinoma

Anemia is common in patients with disseminated carcinoma and is usually due to bleeding, infection, or marrow suppression from chemotherapy or metastatic infiltration. However, microangiopathic hemolytic anemia is rarely seen in such patients. We report a case in which microangiopathic hemolytic anemia was the initial finding in lung adenocarcinoma.

Anemia is common in patients with disseminated carcinoma and is usually due to bleeding, infection, or marrow suppression from chemotherapy or metastatic infiltration. However, microangiopathic hemolytic anemia is rarely seen in such patients. We report a case in which microangiopathic hemolytic anemia was the initial finding in lung adenocarcinoma.