Incidence and clinical characteristics of symptomatic choroidal metastasis from breast cancer

PURPOSE: To determine the clinical incidence and characteristics of symptomatic choroidal metastasis (CM) in breast cancer. METHODS: Forty-six consecutive patients with CM from breast cancer were retrospectively reviewed in respect of ocular findings, medical history and systemic disease. Clinical incidence of CM was determined and compared with the incidence predicted from prevalence data obtained in ocular screening studies. RESULTS: Choroidal metastasis occurred with a median interval of 42.4 months after diagnosis of breast cancer and was predominantly unilateral (63% patients) and solitary (57% affected eyes). A total of 32% of patients had no history of metastatic tumour disease, but systemic screening with CT and scintigraphy revealed metastatic disease in 100% of patients. A median number of three other organs were affected by metastasis. Median survival from diagnosis of CM was 13.1 months. The mean number of local patients diagnosed with CM was 2.9 per year, which was one order of magnitude less than predicted from clinical screening studies. CONCLUSIONS: Choroidal metastasis occurs in advanced metastatic breast cancer, indicating a grave vital prognosis. In a minority of patients (32%) it is the first sign of metastatic disease. The clinical incidence of CM is far smaller than predicted from prevalence data obtained from ocular screening studies.     

Frequency of asymptomatic choroidal metastasis in patients with disseminated breast cancer: results of a prospective screening programme

AIM—To determine the frequency of visually asymptomatic choroidal metastasis in patients with disseminated breast cancer and its dependence on the incidence of metastasis by number and site of other organ metastases.
METHODS—From January 1995 until April 1997 120 patients irradiated for disseminated breast cancer underwent ophthalmological screening for choroidal metastasis. No patient was symptomatic for ocular disease. 68 out of 120 patients were found to have metastases in one organ and 52 patients had metastases in more than one organ. 80% of the patients had bone metastases, 25% lung metastases, 22% liver metastases, 15% brain metastases, and 22% had metastases in other organs.
RESULTS—Six patients (5%) were found to have asymptomatic choroidal metastases. Five patients had unilateral and one patient bilateral metastases. 52 patients with more than one involved organ had a significantly higher risk for asymptomatic choroidal metastasis (6/52, 11%) than 68 patients with metastases in only one organ (0/68) (p=0.006). In univariate analysis a significantly higher risk was seen for patients with lung metastases (14% choroidal metastases versus 2% in patients without lung metastases, p=0.03) and for patients with brain metastases (17% choroidal metastases versus 3% in those without brain metastases, p=0.04).
CONCLUSION—In disseminated breast cancer the incidence of asymptomatic choroidal metastases was 5% and increased to 11% when more than one organ was involved in metastatic spread. Risk factors for choroidal metastases were dissemination of disease in more than one organ and the presence of lung and brain metastases.

Keywords: choroidal metastasis; breast cancer; screening programme     

Regression of choroidal metastasis from breast carcinoma following Letrozole therapy

Metastasis to the choroid from primary tumours elsewhere in the body is not an infrequent occurrence. Management of such metastasis may involve modalities such as radiotherapy, chemotherapy, photocoagulation and surgical resection. The role of hormonal therapy is poorly defined in the management of these tumours. Herein regression of choroidal metastasis from primary breast carcinoma following antihormonal therapy with the antioestrogen drug Letrozole is reported.     

脉络膜转移癌的最新研究进展

脉络膜转移癌是眼部最常见的恶性肿瘤之一。其症状表现为眼部疼痛、视力下降等,从而降低了患者的生活质量。早期发现和早期治疗可改善患者视力,延长患者寿命,意义重大。因此,脉络膜转移癌的治疗方式迅速发展。靶向药物和基因治疗的玻璃体腔注射是研究的热点。本文主要叙述了目前脉络膜转移癌的病因、发展、诊断和治疗方法。     

Bilateral choroidal metastasis from carcinoma of the submandibular gland

Metastatic tumor is the most common uveal malignancy. However, choroidal metastasis from a salivary gland neoplasm is extremely rare. We report a case of bilateral, multifocal choroidal metastasis from carcinoma of the submandibular gland.     

应用新的B超检查参数测量随访脉络膜转移癌的变化

目的:报道应用新的B超检查参数(最大交叉截面积)测量评估随访患者的脉络膜转移肿瘤的大小.方法:报告1例脉络膜转移癌患者,在随访中应用B超测量其肿瘤的高、基底和最大交叉截面积.结果:一位62岁华人老年妇女,已知为肺非小细胞癌患者,表现为右眼无痛性视物模糊.被诊为双眼脉络膜转移癌(右眼进展期,左眼初期),双眼视力良好.首次化疗后右眼肿瘤明显减小,但最后一轮化疗结束后6wk即出现增长.患者又进行了放疗和另一轮的化疗后右眼肿瘤大小没有变化.左眼肿瘤大小在随后的2a内没有变化.双眼维持着最佳矫正视力(右6/9,左6/6).对右眼肿瘤的大小进行了连续B超测量评估.结论:超声检测在随访中是可重复的,并与右眼肿瘤临床表现相符.我们建议在治疗阶段应用B超对脉络膜肿瘤的大小进展或转归进行定量评估.     

脉络膜转移癌的眼底表现

目的探讨脉络膜转移癌眼底表现的特点及原发癌的病理分型和预后。方法应用回顾性系列病例研究方法。分析16例20眼脉络膜转移癌患者的临床资料。眼部检查包括视力、眼前节、散瞳眼底、B型超声、彩色眼底照相和荧光素眼底血管造影（FFA）检查。全身检查包括肿瘤标记物筛查,支气管活检,头部、胸部和腹部影像学检查及全身骨扫描等。结果 16例患者中男6例,女10例;年龄31～72岁,平均年龄50.9岁;随诊1～60个月,平均12.6个月。双眼患者4例;单眼患者12例,其中右眼8例,左眼4例。首诊于眼科者9例,其中8例原发癌为肺癌,1例乳腺癌为原发癌。初诊视力：光感者2眼,手动/眼前～0.1者4眼,0.2～0.5者6眼,0.6～1.0者5眼,〉1.0者3眼。裂隙灯显微镜检查：15眼眼前节正常,5眼有继发性青光眼。散瞳眼底检查：19眼可见视网膜下黄白色、扁平隆起的实性肿物,12眼伴有不同程度的渗出性视网膜脱离。B型超声检查结果显示,20眼均为脉络膜实性占位性病变。FFA可见早期脉络膜肿物遮挡背景荧光,晚期可见融合成斑驳样的高荧光。原发癌为肺癌者10例,乳腺癌者4例,直肠腺癌者1例,子宫颈鳞癌者1例。结论脉络膜转移癌眼底表现的特点是视网膜下实性肿物,常伴有渗出性视网膜脱离,可继发青光眼。原发癌病理分型以肺腺癌为主,乳腺癌次之。     

Bilateral choroidal metastasis from carcinoma ex pleomorphic adenoma of the parotid gland

The histological, clinical and angiographic findings are reported of a 34-year-old man with bilateral visual loss who had left parotidectomy with subsequent radiotherapy due to carcinoma ex pleomorphic adenoma of the parotid gland 1 year before. Funduscopy disclosed choroidal masses with surrounding serous retinal detachment in both posterior poles. At the time of ocular diagnosis, lung, pleura and pharynx metastases had recently been revealed. Because of the extent of disease and its poor prognosis, no treatment was offered. Although parotid gland carcinoma usually spreads via lymphatics, choroidal involvement may rarely occur due to haematogenous dissemination.     

Incidence and clinical patterns of polypoidal choroidal vasculopathy in Korean patients

Purpose To determine the incidence, demographic features, and clinical characteristics of polypoidal choroidal vasculopathy (PCV) in Korean patients. Methods A retrospective review was undertaken of 392 eyes of 321 symptomatic patients suspected of having exudative age-related macular degeneration (AMD) after their first visit to a tertiary hospital between February 2002 and May 2006. All patients underwent a complete ophthalmic examination, including fluorescein and indocyanine green angiography (ICGA). Results Of the 321 patients (392 eyes), 79 (98 eyes, 24.6%) were diagnosed with PCV. The mean PCV patient age was 64.6 ± 7.6 years. PCV was more common in men (78.5%), and was usually unilateral (75.9%). In terms of PCV clinical manifestation, 52% of patients showed an exudative pattern, 34.7%, a hemorrhagic pattern, and 13.3%, an extensive hemorrhagic pattern. The mean visual acuity at presentation was 0.231 ± 0.256. Classification was based on ICGA findings; 52% of patients showed relatively large aneurismal dilations, 25.5% showed atypical vessel deformations, and 22.5% showed dense clusters of numerous small hyperfluorescent dots. Conclusions The incidence of PCV in Korean exudative AMD patients was relatively high compared with that in other ethnic groups. As in other Asian patient populations, PCV occurred more commonly in men and was predominantly unilateral.     

脉络膜转移癌临床特征的分析

目的 研究脉络膜转移癌的临床特征,以便早期诊断及与其他脉络膜肿瘤进行鉴别诊断.方法 本研究为回顾性系列病例研究.通过病历,收集患者视力检查、裂隙灯显微镜眼前节检查、问接检眼镜眼底检查、荧光素眼底血管造影(FFA)、吲哚氰绿血管造影(ICGA)、相干光断层扫描(OCT)及A超和B超扫描、磁共振(URI)以及胸部CT检查等资料.结果 共5例(9只眼)脉络膜转移癌,单眼1例,双眼4例.男性1例,女性4例;年龄31～56岁,中位数年龄45岁.症状:视力减退4例,视物变形1例.眼部检查:视力≤0.05且<0.3者4只眼;≤0.3且<0.7者2只眼;≥0.7者3只眼.原发癌来自肺癌者3例,乳腺癌1例,胃癌1例.肿瘤转移至眼的时间:2例为眼科首诊发现,3例分别为1年半、4年及5年.眼底特征:脉络膜转移癌表现为黄白色扁平形隆起者比球形隆起更多见,或伴斑驳样色素沉着及视网膜下液体或视网膜脱离.转移癌位于黄斑部和近视乳头者共6只眼,黄斑和赤道部之间3只眼.孤立转移灶5只眼,多个转移灶4只眼.FFA表现为瘤体呈现斑驳样强荧光,晚期有荧光素渗漏.ICGA表现为遮蔽荧光和弱荧光.A超扫描显示转移灶呈现中等不规则内反射.B超扫描显示扁平实质性隆起.眼部MRI显示肿瘤处表现为中等短T1W和短T2W信号.血清肿瘤标志物增高:3例癌抗原分别为16.28 μg/L、4.95μ/L、癌抗原125增高为160.50 kU/L.结论 脉络膜是最常发生转移癌的部位.脉络膜转移癌可发生在原发癌诊断之前,当患者眼底有黄白色扁平形隆起病灶时,尤其是双眼有病灶者,眼A、B超扫描、胸部CT及癌抗原检查以排除来自肺和乳腺的原发癌是很重要的.     

以脉络膜转移为首发的胰尾粘液腺癌

目的:报告1例胰尾粘液腺癌表现为孤立性脉络膜转移瘤.方法:一位57岁女患者主诉右眼中心视物变形.检眼镜检查见1个位于右眼黄斑中心、长约6 PD的孤立性淡色隆起病灶.她没有特殊的既往眼科和全身病史.A/B超声检查证实在后极部黄斑内有一个实性病灶,荧光素血管造影发现中心病灶无渗漏区.结果:根据病史和临床发现,请求了FBC、血沉、LFT、胸部X线和腹部CT等检查.胸部X线发现在双肺野有多发性模糊的病灶,提示为转移性肺结节.CT发现肝内多发性结节和在胰尾的一个3.5 cm×2.6 cm病灶.进行了CT引导下的肝活检,证实为中度分化的转移性粘液腺癌.此后血液分析证实CA19-9升高.肿瘤原发部位证实为胰尾,并决定进行姑息治疗.结论:初发临床体征为孤立性脉络膜病灶经证实为胰尾癌的报告鲜见.这一病例提示,在发现未知来源实性脉络膜病灶的病例,进行详细的腹部影像学检查是重要的.     

Choroidal metastases and choroidal melanomas: comparison of ultrasonographic findings

AIMS—The purpose of the study was to analyse, whether the shape and the height to base ratio in B-scan ultrasonography are appropriate to differentiate choroidal melanomas from metastases.
METHODS—Between 1991 and 1996 16 eyes of 16 patients with choroidal metastases from breast carcinomas and 66 eyes of 66 patients with choroidal melanomas were evaluated ultrasonographically. The diagnosis of choroidal melanoma has been confirmed histologically in all eyes. Irradiated tumours were excluded from the study. Fisher's exact test and χ² test were used for statistical analysis.
RESULTS—Choroidal metastases demonstrated a significantly lower height to base ratio in B-scan (mean 0.18, SD 0.08) than melanomas (mean 0.6 (0.16); p < 0.001). A polygonal tumour surface was significantly more frequent in metastases (13 out of 16 metastases and in six out of 66 melanomas, p < 0.001). A choroidal excavation could be demonstrated in 38 melanomas and in no metastatic tumour (p < 0.001). The reflectivity was significantly higher in metastases than in melanomas.
CONCLUSION—The combined use of height to base ratio and reflectivity enables a highly significant discrimination between choroidal melanomas and metastases from the breast, thus probably constituting appropriate variables for the clinical differentiation.

Keywords: choroidal melanoma; choroidal metastasis; ultrasonography     

Mucinous adenocarcinoma of the tail of the pancreas presenting with a choroidal metastasis

AIM: To report a case of mucinous adenocarcinoma of the tail of the pancreas presenting with a solitary choroidal metastasis. ·METHODS: A 57 years old female patient presented with central metamorphosia in the right eye. Fundoscopy showed a solitary pale raised lesion in the central right macula about 6 disc diameters in length. Her past ocular and medical history was unremarkable. A B-scan confirmed a raised solid lesion in the posterior pole within the macula while fluorescein angiography revealed a central lesion with no areas of leakage. ·RESULTS: In view of the history and the clinical findings a FBC, ESR, LFT, Chest X-ray, and abdominal CT were requested .The chest X-ray revealed multiple opaque lesions in both lung fields suggestive of metastatic pulmonary nodules. The CT revealed multiple nodules in the liver and a 3.5cm x 2.6cmlesion in the tail of the pancreas. A CT guided liver biopsy was performed and it revealed moderately differentiated metastatic mucinous adenocarcinoma. Subsequent blood analysis revealed an elevated CA19-9. The primary tumour site was identified as the tail of the pancreas and was decided to instigate palliative treatment. ·CONCLUSION: There are few reports that demonstrate the significance of a solitary choroidal lesion as the initial clinical sign of cancer of the tail of the pancreas. This case highlights the importance of performing detailed abdominal imaging studies in cases where a solid choroidal lesion of unknown origin is identified.     

脉络膜转移癌荧光素及吲哚青绿血管造影的影像分析

目的了解脉络膜转移癌共焦激光扫描检眼镜同步荧光素眼底血管造影（FFA）、吲哚青绿血管造影（ICGA）影像特点,为该疾病的准确诊断提供依据。设计回顾性病例系列。研究对象明确原发灶的脉络膜转移癌患者12例（17眼）。方法经临床诊断、有明确原发恶性肿瘤病灶的患者12例（17眼）,散大瞳孔后拍摄彩色眼底像,用海德堡共焦激光扫描检眼镜进行FFA及ICGA同步造影,观察两种影像学检查的异同。主要指标FFA及ICGA各期瘤体荧光表现及差异。结果FFA早期16眼瘤体呈低荧光。ICGA早期17眼瘤体均为低荧光,且低荧光范围略大于FFA;11眼在瘤体边缘见异常脉络膜血管。FFA静脉期显示瘤体表面视网膜血管迂曲、毛细血管扩张及微血管瘤;中晚期渗漏明显,肿瘤边界模糊,色素斑块及出血表现为荧光遮蔽。ICGA中晚期,13眼瘤体边缘见斑驳淡荧光,4眼淡荧光位于瘤体中央,晚期瘤体轮廓较FFA清晰。对于1眼瘤体扁平、面积较小的病灶,ICGA可清晰显示,而FFA表现不典型。结论ICGA对确定肿瘤特别是小而扁平的瘤体的轮廓及脉络膜血管异常有优越性,FFA可显示肿瘤导致的视网膜血管及色素上皮改变。二者结合,有助于脉络膜转移癌的诊断。     

Unsual ocular metastasis from breast cancer

Herein a clinical case of an unusual metastasis from breast cancer to the retina and vitreous confirmed by diagnostic vitrectomy is described. Further investigation also demonstrated the central nervous system metastasis.     

Verteporfin therapy for subfoveal choroidal neovascularization in age-related macular degeneration: From clinical trials to clinical practice

People with choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) are at high risk of central vision loss. Until verteporfin therapy became available, there was no safe and effective treatment for a large majority of these people. The phase III clinical trials of verteporfin therapy showed that treatment could safely reduce the risk of vision loss in the majority of patients presenting with either predominantly classic CNV or with occult with no classic CNV, and in selected patients with minimally classic CNV. The decision to treat patients with subfoveal CNV due to AMD using verteporfin therapy, requires an understanding of the outcomes of these clinical trials and of published guidelines. This review presents the key findings of the trials and outlines the factors that should be considered in clinical practice when deciding whether verteporfin therapy is indicated.     

加强对脉络膜新生血管的分类及临床意义的认识

脉络膜新生血管可按病因、与视网膜色素上皮的位置关系、距离黄斑无血管区中心的位置、荧光素眼底血管造影及吲哚氰绿血管造影进行分类。此外还存在脉络膜新生血管的特殊形式。不同的分类具有不同的临床意义。掌握脉络膜新生血管的分类对病变的评价及指导治疗有重要价值。     

Choroidal mass as the presenting sign of small cell lung carcinoma

CASE REPORT: To report the case of a 58-year-old man with blurred vision and metamorphopsia who had an amelanotic choroidal mass in the right eye as the presenting sign of a small cell lung carcinoma. Systemic screening failed to reveal a tumor elsewhere, and the lesion was initially treated as a primary ocular tumor. Discovery of the primary site was made 10 months after the ocular diagnosis, and the patient was then treated with systemic chemotherapy and local radiation therapy. COMMENTS: The ophthalmologist has a crucial role not only in the management of ocular metastases but also in the diagnosis of the primary nonocular malignancies that present as a choroidal mass. The possibility of ocular metastases in patients with choroidal masses should always be considered whether or not there is a diagnosis of cancer elsewhere.     

脉络膜破裂荧光血管造影分析

目的　为了研究眼底荧光血管造影在脉络膜破裂诊断中的应用价值。方法　用Ｎｉｋｏｎ 眼底照相机对１２ 例脉络膜破裂患者进行荧光血管造影检查,并进行详细分析。结果　１２ 例患者中９ 例板层脉络膜破裂,２ 例全层破裂,１ 例单纯色素上皮层破裂。结论　荧光血管造影能显示脉络膜破裂的大小、形状、数目、受损层次,并能以此判断预后。     

The management of small choroidal melanomas

There are a number of unresolved questions regarding small choroidal melanomas. At what stage in the natural history of these tumors do they develop the capacity to metastasize? What are the effects of various therapeutic modalities on the incidence of metastatic disease? Clinicopathologic studies suggest that patients with small choroidal melanomas (less than 10 mm in diameter and 3 mm in height) have an excellent prognosis. In patients with small choroidal melanomas with clear ocular media and no clinical retinal detachment, it is reasonable to do serial examinations without therapeutic intervention until growth is documented. In patients with small choroidal melanomas in which growth is documented, enucleation or alternate modes of therapy, including photocoagulation or radiation, are reasonable methods of treatment. Only by conducting prospective studies can we obtain a better understanding of the natural history of choroidal melanomas, determine at what stage these small lesions develop a metastatic potential, and evaluate the relative efficacy of various treatment modalities in preventing the development of metastatic disease.