Choroidal metastasis from adenoid cystic carcinoma of the lung

PURPOSE: We report a case of a choroidal metastasis from an adenoid cystic carcinoma of the lung.Interventional case report. DESIGN: A 40-year old man, 9 months' status postresection of a bronchial adenoid cystic carcinoma, was diagnosed by clinical evaluation and fine-needle aspiration biopsy and treated with palladium-103 ophthalmic plaque brachytherapy. RESULTS: This unusual patient with uveal metastasis from adenoid cystic carcinoma presented with decreased vision in the right eye and a diaphanous amelanotic choroidal tumor in the superotemporal macula. Ultrasound revealed a dome-shaped tumor that measured 4.0 mm in apical height and 11 x 10 mm in basal diameter. Fluorescein angiography revealed a double circulation and late intense subretinal fluorescence. Plaque brachytherapy provided local control and preservation of the eye. CONCLUSION: Bronchogenic adenoid cystic carcinoma can metastasize to the choroid.     

Treatment considerations for primary uveal melanoma with choroidal metastasis to the fellow eye

We report two cases of primary uveal melanoma with metastatic involvement of the contralateral eye. Two female patients presented with primary choroidal melanoma. In the first case, primary enucleation of the affected eye was performed. Two years later, systemic tumor spread with contralateral choroidal melanoma was detected. A decision for observation of the ocular metastasis was made. In the second case, systemic tumor spread was already evident at time of initial diagnosis of the ocular melanoma. Six months later, a choroidal metastasis was detected in the fellow eye. Again, observation was recommended. In conclusion, systemic spread of primary choroidal melanoma may include a choroidal metastasis to the contralateral eye. Observation of the second affected eye may be prescribed.     

Treatment Considerations for Primary Uveal Melanoma with Choroidal Metastasis to the Fellow Eye

We report two cases of primary uveal melanoma with metastatic involvement of the contralateral eye. Two female patients presented with primary choroidal melanoma. In the first case, primary enucleation of the affected eye was performed. Two years later, systemic tumor spread with contralateral choroidal melanoma was detected. A decision for observation of the ocular metastasis was made. In the second case, systemic tumor spread was already evident at time of initial diagnosis of the ocular melanoma. Six months later, a choroidal metastasis was detected in the fellow eye. Again, observation was recommended. In conclusion, systemic spread of primary choroidal melanoma may include a choroidal metastasis to the contralateral eye. Observation of the second affected eye may be prescribed.     

Natural development over 4 years of a macular small choroidal melanoma in a single-eyed patient

We report the case of a single-eyed patient with a small (2.2 mm thick with largest tumor diameter 7.6 mm) choroidal melanoma involving the entire macular surface with few functional signs. Visual acuity was 20/63. The patient was informed of the side effects and so was followed regularly at the oncology unit over 4 years. During this period, the tumor volume increased fourfold (the thickness reached 4.3 mm and the LTD 10.4 mm), with visual acuity decreasing to 20/250: proton beam therapy was therefore performed. The patient showed no metastasis more than 2 years after the treatment. This unusual case raises the question of small choroidal melanoma management, especially if the patient is single-eyed, in good general health, middle-aged and if the tumor is retrofoveal with just a few functional signs: when, why and who should be treated?     

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.     

Presumed choroidal metastasis of Merkel cell carcinoma

Merkel cell carcinoma is a rare skin tumor of neural crest origin and is part of the amine precursor uptake and decarboxylase system. It typically occurs on the face of elderly people. Distant metastasis is almost uniformly fatal. Choroidal metastasis, to our knowledge, has not been described. We report a patient with Merkel cell carcinoma who had a synchronous solid choroidal tumor and a biopsy-proven brain metastasis. Our 56-year-old patient presented with a rapidly growing, violaceous preauricular skin tumor. Computed tomography of the head disclosed incidental brain and choroidal tumors. Light and electron microscopy of biopsy specimens of both the skin and the brain lesions showed Merkel cell carcinoma. Ophthalmoscopy, fluorescein angiography, and A and B echography revealed a solid choroidal mass. The brain and skin tumors responded well to irradiation. A radioactive episcleral plaque was applied subsequently to the choroidal tumor. All tumors regressed, and the patient was doing well 28 months later. To our knowledge this is the first case of presumed choroidal metastasis of Merkel cell carcinoma.     

Spontaneous regression of choroidal metastasis from renal cell carcinoma

PURPOSE: To describe a patient with choroidal metastasis from renal cell carcinoma that spontaneously regressed after nephrectomy. DESIGN: Interventional case report. METHOD: A 48-year-old Hispanic woman presented with reduced vision in the left eye attributable to an elevated choroidal lesion and associated exudative retinal detachment. Oncology workup revealed a left kidney renal cell carcinoma with pulmonary metastases. The patient underwent primary nephrectomy, without specific treatment of choroidal or pulmonary metastases. RESULTS: The metastatic choroidal lesion regressed and the retinal detachment completely resolved, as evidenced by fundus photographs and ultrasonography. CONCLUSIONS: Choroidal metastasis from renal cell carcinoma may spontaneously regress after removal of the primary tumor.     

A rapidly growing choroidal melanoma

PURPOSE: We describe a rapidly growing choroidal melanoma that failed to respond to consecutive globe-sparing treatments in an individual with ocular melanocytosis. DESIGN: Interventional case report. METHODS: A 53-year-old man with right ocular melanocytosis, decreased vision in the right eye, and right eye pain was referred for suspected choroidal melanoma. The lesion, which measured 2.4 mm x 6.6 mm x 6.0 mm, was treated with transpupillary thermotherapy on two occasions and with iodine-125 (I-125) plaque brachytherapy, both of which failed. Enucleation allowed histologic analysis. RESULTS: At enucleation, the choroidal melanoma in the right eye measured 13.6 mm x 16.5 mm x 16.9 mm, which demonstrated the most rapid growth and doubling time reported in a tumor of this type thus far. Pathologic analysis classified the tumor as a mixed-cell type. CONCLUSION: This case reiterates the association between ocular melanocytosis and choroidal melanoma, provides additional evidence that rapid growth and doubling time may be associated with transpupillary thermotherapy and I-125 plaque failure, and highlights the need to follow those tumors closely.     

Choroidal melanoma metastatic to the contralateral choroid

PURPOSE: To report metastasis of choroidal melanoma to the contralateral choroid. METHODS: Interventional case report. In a 49-year-old Caucasian female, a primary choroidal melanoma, left eye, was diagnosed and treated with Ruthenium-106 plaque radiotherapy. The choroidal melanoma showed excellent regression with flattening of the mass and adjacent chorioretinal atrophy. RESULTS: Fifteen years after brachytherapy for choroidal melanoma, left eye, the patient developed a metastatic melanoma to the contralateral choroid as the first sign of metastasis. No history of oculo(dermal) melanocytosis or cutaneous melanoma existed. Systemic evaluation disclosed multiple metastases confined to the liver. CONCLUSION: Metastasis to the contralateral choroid can be the first sign of metastasis from choroidal melanoma.     

Choroidal melanoma complicated with central retinal vein occlusion

BACKGROUND: Various complications for choroidal melanoma have been reported. However, there are no reports on choroidal melanoma complicated with central retinal vein occlusion. CASE REPORT: A 37-year-old male showed an elevated yellowish white tumor of about 8 discs in diameter, and involving the optic disc in the left eye. Serous retinal detachment and subretinal exudate were noted around the tumor. Central retinal vein occlusion occurred concurrently. Fluorescein angiography revealed blocks due to hemorrhage and fluorescence leakage from the retinal vein. Dilation of retinal capillary vessels and marked leakage of fluorescence from the retinal vein and capillary vessels were found in the tumorous region. In the late stage, the entire tumor presented hyper-fluorescence. On indocyanine green angiography, the tumor on the whole presented hypo-fluorescence from the early to late stage, and an insular hyper-fluorescence suggestive of the presence of intratumor vessels with leakage of fluorescence was seen inside. Ultrasonography revealed choroidal excavation. General examination showed no abnormality. On the basis of these findings the patient was diagnosed with choroidal melanoma. CONCLUSION: We report a case of choroidal melanoma, which was complicated with central retinal vein occlusion by mechanical compression and invasion of the optic disc from the first medical examination.     

Choroidal metastasis as the initial manifestation of a pigmented neuroendocrine tumor

We report the case of a 77-year-old woman in whom choroidal metastasis was the initial manifestation of a primary neoplasm presumed to be a pigmented pulmonary carcinoid tumor. The tumor initially was misdiagnosed cytologically and pathologically as a choroidal melanoma because it contained intrinsic melanin pigment. Positive immunoreactivity for cytokeratin, synaptophysin, chromogranin, and calcitonin and the presence of dense-core neurosecretory vesicles disclosed by electron microscopy established that the metastasis was a neuroendocrine tumor. Findings from systemic evaluation suggested that the primary tumor was located in the lung. The patient subsequently developed an intradural paraspinal metastasis, which also contained melanin pigment. The latter observation confirmed that the melanin in the uveal metastasis was intrinsic and did not represent secondary phagocytosis by tumor cells. Metastases from pigmented tumors of nonmelanocytic derivation are exceedingly rare but present a major diagnostic challenge to ocular pathologists and cytopathologists if the diagnosis is not suspected. Confirmatory immunohistochemical analysis should be obtained when a pigmented choroidal tumor thought to be a melanoma has atypical features. Arch Ophthalmol. 2000;118:841-845     

Long-term progression in a case of transvitreal endoresection of a posterior choroidal malignant melanoma

BACKGROUND: In Japan, there are few reports of the prognosis of the endoresection of malignant choroidal melanoma. We previously reported this case of transvitreal endoresection of a posterior choroidal malignant melanoma. The tumor recurred and enucleation was carried out. Here we report the subsequent long-term clinical course. CASE: A choroidal tumor temporal to the macula was noted in the right eye of a 47-year-old male patient. The tumor size increased within the 1 year of observation and was suspected to be a malignant choroidal melanoma. Since the patient strongly wished to preserve his eyeball, he underwent infrared diode laser photocoagulation, resulting in further progress of the tumor. Three months later a transvitreal piecemeal endoresection was carried out. Four years after endoresection, the tumor recurred, and then the eyeball was enucleated. A pathological examination identified a spindle-cell type malignant melanoma located in the posterior part of the eyeball. No invasion was observed within the sclera or optic nerve. Neither local recurrence nor metastasis has been observed for 5 years after the enucleation. CONCLUSION: In this case, in spite of our utmost efforts, the eyeball could not be preserved. This case can provide useful information for considering endoresection as a management tool for choroidal melanoma.     

Orbital apex syndrome and choroidal metastasis resulting from ovarian carcinoma

Central nervous system involvement from ovarian cancer is rare, and ovarian cancer-related orbital apex syndrome does not appear to have been previously reported. Only a few cases of choroidal metastases from primary ovarian origin have been reported in the literature. We describe what we believe to be the first case of ovarian cancer with the presentation of orbital apex syndrome and choroidal metastasis as a part of the manifestations. Progressively blurring vision and subsequent ophthalmoplegia of the left eye developed in a 37-year-old woman. Funduscopic examination revealed mild disc edema with flame-shaped hemorrhage and a one disc-sized choroidal mass. Cranial magnetic resonance imaging indicated an ill-defined lesion at the left superior orbital fissure with bony erosion. Systemic evaluation demonstrated an ovarian tumor with multiple organ metastases. Although the ophthalmoplegia cleared completely subsequent to chemotherapy and irradiation, visual acuity still remained the same, with no light-perception. The patient died seven months following the initial diagnosis.     

Choroidal melanoma complicated by central retinal vein occlusion

BackgroundVarious complications for choroidal melanoma have been reported. However, there are no reports on choroidal melanoma complicated by central retinal vein occlusion.Case reportA 37-year-old male showed an elevated yellowish white tumor of about 8 discs in diameter, and involving the optic disc in the left eye. Serous retinal detachment and subretinal exudate were noted around the tumor. Central retinal vein occlusion occurred concurrently. Fluorescein angiography revealed blocks due to hemorrhage and fluorescein leakage from the retinal vein. Dilation of retinal capillary vessels and marked leakage of fluorescein from the retinal vein and capillary vessels were found in the tumorous region. In the late stage, the entire tumor presented hyperfluorescence. On indocyanine green angiography, the tumor on the whole presented hypofluorescence from the early to late stage, and an insular hyperfluorescence suggestive of the presence of intratumor vessels with leakage of fluorescein was seen inside. Ultrasonography revealed choroidal excavation. General examination showed no abnormality. On the basis of these findings the patient was diagnosed with choroidal melanoma.ConclusionWe report a case of choroidal melanoma, which was complicated by central retinal vein occlusion caused by mechanical compression and invasion of the optic disc. These findings were not reported in the first medical examination. We must be careful in our diagnosis in such cases.     

Hemorrhagic complication in an unsuspected macular choroidal melanoma

PURPOSE: To report a rare presentation of a hemorrhagic complication in a patient with unsuspected macular choroidal melanoma. DESIGN: Interventional case report. METHODS: A 32-year-old Chinese woman presented with disturbance of her left central vision. A hemorrhagic mass at the macula was noticed that was evacuated by submacular surgery. RESULTS: The mass expanded rapidly into a mushroom configuration after surgery. Fine-needle aspiration confirmed the diagnosis of malignant choroidal melanoma, and enucleation followed. Histology demonstrated moderately large epithelioid tumor cells with prominent nucleoli. The sclera was intact, and the optic nerve was not involved. The patient has been followed for 5 years without signs of local recurrence or metastasis. CONCLUSION: We should be alert for atypical presentations of choroidal melanoma. Unnecessary or inadvertent surgical intervention may induce tumor growth and subsequent local spread or metastasis.     

Photodynamic therapy for choroidal metastasis from carcinoid tumor

PURPOSE: To determine the efficacy of photodynamic therapy for the treatment of a choroidal metastasis unresponsive to chemotherapy and radiation therapy. DESIGN: Interventional case report. METHODS: Photodynamic therapy with verteporfin was performed. Visual acuity, local tumor control, and complications were assessed. RESULTS: A 72-year-old woman was diagnosed with bilateral, biopsy-proven choroidal metastasis from a pulmonary carcinoid tumor that was resistant to chemotherapy and radiotherapy. The tumor in the left eye caused a retinal detachment and vision loss to light perception. The smaller lesion in the right eye progressively enlarged toward the fovea despite therapy and was treated with photodynamic therapy with verteporfin. Within 2 months, the exudative detachment resolved, the visual acuity returned to baseline, and the tumor volume decreased by 50%. CONCLUSION: Photodynamic therapy may be an effective treatment option for selected patients with choroidal metastasis.     

Clinical Course of a Presumed Metastatic Uveal Melanoma to the Contralateral Choroid

Abstract

We present the ultrasound and optic coherence tomography follow-up of a presumed choroidal metastasis from a contralateral melanoma. A 53-year-old male was diagnosed with uveal melanoma with extraescleral extension in his left eye. A year later, the fundus examination revealed a flat, gray-green, pigmented choroidal lesion in the right eye. The ultrasonography showed a mass, almost flat, and all these findings were compatible with a choroidal melanocytic lesion with risk factors for growth. One month later, melanocytic skin lesions appeared on the scalp, as well as small tumors. Three months later, an ultrasonography on B scan showed a growth of the tumor size. The patient developed a progressive deterioration and died. Three possibilities can explain the occurrence of a choroidal pigmented tumor in the contralateral eye: first, bilateral primary choroidal melanomas; second, both choroidal tumors are metastatic in origin from an unknown primary melanoma; and third, the contralateral tumor is a metastatic tumor from the primary choroidal melanoma.     

Systemic chemotherapy and tamoxifen induced regression of choroidal metastasis from a breast carcinoma in a male

We report a case of a 55-year-old male patient with breast carcinoma, who developed choroidal metastasis. The patient had undergone mastectomy for carcinoma of right breast, five years ago. The patient was advised close follow-up for the left eye, as he was already on tamoxifen therapy (started a month ago) for spinal metastasis. On last follow-up, a year later, the choroidal lesion had completely scarred, with no recurrences. Systemic hormonal therapy like tamoxifen given for the breast primary and other systemic metastases may cause regression of the choroidal metastasis, thereby avoiding ocular radiotherapy. Medline search revealed only one published case of regression of choroidal metastasis from a male breast primary, on tamoxifen therapy.     

Ocular metastasis demonstrated a carcinoma of the thyroid gland (author's transl)]

Report of a case of choroidal metastasis. Enucleation was performed because of the clinical aspect of a primitive tumor. Histopathologic stains revealed a vesicular adenocarcinoma, may be of the thyroid gland. Total thyroidectomy was performed and demonstrated a vesicular microcancer (1/10e mm diameter).     

Calcification in choroidal melanoma after transpupillary thermotherapy

PURPOSE: To report the response of calcification in choroidal melanoma after transpupillary thermotherapy. METHODS: Interventional case report. A 66-year-old male with a posterior uveal melanoma measuring 10 x 8 x 4.4 mm underwent infrared diode laser transpupillary thermotherapy three times, each 12 weeks apart. For each treatment, a 3-mm spot size of 1-minute duration was used, and the power setting varied between 450 mW and 500 mW. RESULTS: Two months after the last transpupillary thermotherapy session, A- and B-mode echographic patterns strongly suggestive of intratumor calcification were observed. The tumor regressed to 2.8 mm in thickness, but calcification persisted. Local recurrence or distant metastasis was not detected during a follow-up of 14 months. CONCLUSION: Clinically detectable calcification is extremely rare in choroidal melanomas. Tumor regression with slowly progressive calcification may occur after transpupillary thermotherapy.