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.     

Late choroidal metastasis secondary to papillary thyroid carcinoma.

PURPOSE: To report a case of late choroidal metastasis from papillary thyroid carcinoma. METHODS: Interventional case report. A 43-year-old woman who had been treated for papillary thyroid carcinoma 30 years earlier presented for evaluation of vision loss in the left eye. Eight weeks before this presentation, an ophthalmologist had diagnosed a metastatic uveal mass in the left eye of the patient. The clinical record was retrospectively reviewed. Ocular sonography was performed to confirm the diagnosis of choroidal metastasis. RESULTS: The choroidal mass had the typical characteristics of a metastatic lesion. The patient was treated with a combination of brachytherapy and chemotherapy. CONCLUSION: Papillary thyroid carcinoma can metastasize to the choroid many years after the initial diagnosis.     

Subretinal neovascularization secondary to choroidal septic metastasis from acute bacterial endocarditis.

The clinical features of an infective embolic choroidopathy are described, from its early onset to late complications in a 45-year-old man with acute Staphylococcus aureus endocarditis of the aortic valve. Initial fundus examination revealed, in addition to fresh choroidal lesions, stigmata of a previous embolic episode secondary to endocarditis from Actinobacillus actinomycetemcomitans. The choroidal lesions were extremely asymmetrical, with a clear preference for localization in the left eye. Similar ocular findings were seen in a 78-year-old female with mitral valve prolapse and acute S. aureus endocarditis. In this case, however, choroidal involvement from septic emboli spread was bilateral and roughly symmetrical. Choroidal neovascular membranes arising in scars from choroidal septic emboli occurred in the macular area of the left eye of both patients, 10 months and 5 years after embolization, respectively.     

Photodynamic therapy for choroidal neovascularization secondary to choroidal nevus

PURPOSE: To describe a patient treated with photodynamic therapy for subfoveal choroidal neovascularization secondary to choroidal nevus. DESIGN: Interventional case report. METHODS: A 61-year-old woman presented with subfoveal choroidal neovascularization secondary to choroidal nevus and best-corrected visual acuity of 20/50. The choroidal neovascularization was treated with two verteporfin photodynamic therapy sessions, separated by 3 months. RESULTS: The choroidal neovascularization was occluded after two sessions. Best-corrected visual acuity improved to 20/25 and remained stable throughout an 18-month follow-up. CONCLUSION: Photodynamic therapy seems to be an effective treatment for subfoveal choroidal neovascularization secondary to choroidal nevus.     

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.     

Solitary metastasis of choroidal melanoma to the contralateral eyelid

A 60-year-old man developed a subcutaneous mass in the right lower eyelid 2 1/2 years after enucleation of the left eye for a mixed-cell-type choroidal melanoma. Excision of the subcutaneous eyelid mass revealed the tumor to be a malignant melanoma composed of spindle B cells similar to those in the intraocular tumor. The patient's systemic evaluation, including liver enzymes, has remained normal, with no signs of further metastasis and no evidence of another primary melanoma for 14 months of postexcision follow-up. The significance of the rare occurrence of isolated metastatic melanoma from the choroid of one eye to the eyelid of the other is discussed.     

Intraocular reticulum cell sarcoma: diagnosis by choroidal biopsy.

A patient with uveitis and retinal pigment epithelial detachments underwent an extensive medical examination and pars plana vitrectomy in an attempt to confirm the clinical diagnosis of reticulum cell sarcoma. None of these examinations revealed the presence of malignancy. Transscleral biopsy of subretinal lesions confirmed the histopathological diagnosis of reticulum cell sarcoma. The patient was begun on systemic chemotherapy and external beam radiation to the eye and orbit, with resultant preservation of the eye, vision, and probable extension of life because of early detection of reticulum cell sarcoma by choroidal biopsy. This technique may be advantageous in the diagnosis cases of eyes with clinical evidence of reticulum cell sarcoma, no systemic signs of malignancy, and negative vitreous biopsies.     

Intravitreal bevacizumab in the management of choroidal neovascular membrane secondary to choroidal osteoma

PURPOSE. To describe a patient with choroidal neovascular membrane (CNVM) secondary to choroidal osteoma treated successfully with intravitreal bevacizumab. METHODS. Case report. A 25-year-old healthy woman presented with complaints of sudden painless decrease in vision in the left eye (OS) of 1 month duration. On examination, visual acuity was 20/20 in the right eye (OD) and counting fingers at 1.5 meters OS. Slit lamp examination was unremarkable. Fundus examination OD was normal; OS demonstrated a flat, opaque, yellowish parapapillary choroidal lesion with adjacent subfoveal grayish membrane associated with minimal subretinal fluid suggestive of a CNVM. B-scan ultrasonography revealed findings consistent with a choroidal osteoma. Fundus fluorescein angiography (FFA) of the left eye revealed a relatively well-defined area of hyperfluorescence that increased in size and intensity in the later phases suggestive of active subfoveal CNVM. Optical coherence tomography (OCT) confirmed the subfoveal CNVM with altered foveal contour and distortion of foveal architecture. A diagnosis of subfoveal CNVM associated with choroidal osteoma was made. The patient was treated with intravitreal bevacizumab 1.25 mg in 0.05 mL OS and repeated 6 weeks later. RESULTS. At the 4-month visit, vision OS improved to 20/125. The FFA and OCT revealed a resolved CNVM. CONCLUSIONS. Intravitreal bevacizumab may be an effective alternative in the management of CNVM secondary to choroidal osteoma. Larger series of such cases need to be studied to further validate our findings.     

Use of intravitreal bevacizumab for the treatment of choroidal neovascularization secondary to choroidal rupture

Case reportA 28 year-old male attended our Emergency Department with a traumatic choroidal rupture and macular haemorrhage. After pneumatic displacement of the haemorrhage with C₃F₈ and tissue plasminogen activator, the haemorrhage was reabsorbed and visual acuity (VA) improved. Three months later the patient presented with decreased VA and a juxtafoveal choroidal neovascularisation (CNV) that was treated with intravitreal bevacizumab. One year after a single bevacizumab injection the CNV remained inactive, with a final VA of 0.5.DiscussionIntravitreal bevacizumab injection is a new and effective treatment for traumatic CNV. In our patient, in contrast to other aetiologies, the CNV needed no more than one Avastin^® injection to be inactivated, after one year of follow-up.     

Clinical characteristics of choroidal metastasis

ZusammenfassungHintergrund Die Aderhautmetastase ist der häufigste maligne intraokulare Tumor. Ziel dieser Untersuchung ist die Charakterisierung des klinischen Erscheinungsbildes, der zugrunde liegenden Tumorerkrankung sowie des differenzialdiagnostischen Vorgehens bei Aderhautmetastasierung (AM).Patienten und Methode Es wurden 71 konsekutive Patienten mit AM ausgewertet. Besondere Beachtung fanden die okulären Symptome, das ophthalmoskopische und sonographische Erscheinungsbild der AM sowie die Charakterisierung der zugrunde liegenden Tumorerkrankung. Bei allen Patienten erfolgte ein vollständiges Screening (CT Kopf, Thorax und Abdomen; Knochenszintigraphie) zur Primärtumorsuche bzw. bei bereits bekanntem Primärtumor zur Suche nach weiteren Organmetastasen.Ergebnisse Eine symptomatische AM zeigten 95% der Patienten, bei 5% handelte es sich um einen Zufallsbefund. Bei 60% der Patienten bestand eine solitäre AM, bei 40% multiple AM (2–14). Bei Erstvorstellung war bei 18% der Patienten (n=13) keine Tumorerkrankung bekannt. Bei 12 dieser Patienten konnte ein Bronchialkarzinom diagnostiziert werden. Insgesamt bestand bei 53% der Patienten ein Mammakarzinom, bei 26% ein Bronchialkarzinom, bei je 3% ein Nieren- oder Darmkarzinom, ein Aderhautmelanom oder ein kutanes Melanom, sowie bei einzelnen Patienten ein Zervix-, Ovarial-, Thymus- oder Prostatakarzinom sowie in einem Fall ein unbekannter Primärtumor. Weitere Fernmetastasen zeigten 96% der Patienten. Beim Bronchialkarzinom trat die AM im Mittel 9 Monate, beim Mammakarzinom 68 Monate nach Diagnose der Tumorerkrankung auf. Bei 58% der Patienten mit Bronchialkarzinom war die AM die Erstmanifestation der Grunderkrankung, beim Mammakarzinom bei 28% das erste Zeichen der Metastasierung.Schlussfolgerung Aderhautmetastasen finden sich fast nur bei einer generalisierten Tumorerkrankung. Beim Mammakarzinom treten sie typischerweise Jahre nach Diagnose auf und können das erste Zeichen einer Generalisierung sein. Beim Bronchialkarzinom kann die Aderhautmetastase das erste klinische Zeichen der Erkrankung sein.Teile des Beitrags wurden auf der 98. Tagung der Deutschen Opthalmologischen Gesellschaft präsentiert.     

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。