Choroidal metastasis from submandibular salivary gland adenoid cystic carcinoma.

A case of choroidal metastasis from an adenoid cystic carcinoma ofsubmandibular salivary gland is described. A 50-year-old woman with loss of vision in her left eye for 1 week was evaluated clinically, radiologically, and pathologically. A fundus image of the left eye showed an amelanotic, plateau-shaped choroidal mass measuring 17 x 12 X 4 mm with overlying exudative retinal detachment. A choroidal biopsy was consistent with metastatic adenoid cystic carcinoma from her submandibular salivary gland treated 5 years previously. She was treated with external beam radiotherapy but developed liver and lung metastases 3 months later and died within 1 month. All of the metastases demonstrated a basaloid histologic variant of adenoid cystic carcinoma that is known for its aggressive potential. Salivary gland carcinoma rarely metastasizes to the choroid; however, evaluation of patients with this carcinoma should include ophthalmic examination.     

Adult wilms' tumor metastatic to the choroid of the eye

BACKGROUND: Ocular manifestations of Wilms' tumor are rare, particularly in adults. We present the first reported case of a choroidal metastasis resulting from Wilms' tumor. DESIGN: Case report. PARTICIPANT: A 37-year-old white male with an adult-onset biopsy-proven Wilms' tumor with multiorgan metastatic disease. RESULTS: We report a unique case of uveal metastasis presumed from a Wilms' tumor. The patient's history included a primary Wilms' tumor with known disseminated metastasis, orbital pain, metamorphopsia, and decreased vision. Ophthalmoscopy revealed a unifocal choroidal tumor in the inferotemporal quadrant of the right eye. Ultrasonographic measurements of the tumor were 4.9 mm in apical height and 15 x 13 mm in basal diameter. Unusual ultrasound findings included echodense stromal opacities and retrobulbar edema. Fluorescein angiography revealed double circulation and late intratumoral fluorescence. CONCLUSIONS: This is the first reported case of a choroidal metastasis by a Wilms' tumor.     

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.     

Metástasis coroideas de un carcinoma adenoide quístico de glándula salival menor: caso clínico

Case report

A 61-year-old man with a lower lip minor salivary gland adenoid cystic carcinoma, suffered from a unilateral progressive visual acuity loss due to choroidal metastasis.

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.     

Transpupillary thermotherapy for choroidal metastases

INTRODUCTION: We report on a case with bilateral choroidal metastases derived from a renal cell carcinoma 13 years after nephrectomy. The treatment modality is discussed. METHODS: A male patient (58 years of age) presented with asymptomatic bilateral choroidal metastases deriving from renal cell carcinoma. The right kidney had been removed because of renal cell carcinoma 13 years before the appearance of the choroidal metastases. He had full visual acuity (20/20) and normal intraocular pressure in both eyes. Fundus examination showed a small tumor in the peripheral choroidea of his right eye and an intermediate-sized solid tumor in the periphery of his left eye. RESULTS: The tumor of the right eye was treated by TTT and the tumor of the left eye by (106)Ru plaque radiotherapy. The tumors showed total regression into flat chorioretinal atrophies in both eyes and no tumor could be found 13 moths after treatment maintaining full visual acuity (20/20). CONCLUSION: Asymptomatic ocular metastases can develop even many years after removal of the primary tumor. TTT and (106)Ru brachytherapy are useful treatment modalities in cases of small and intermediate-sized choroidal metastases.     

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.     

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 metastasis of a gingival squamous cell carcinoma

PURPOSE: To report a case of choroidal metastasis of a gingival squamous cell carcinoma. DESIGN: Interventional case report. METHODS: Review of the clinical history and pathologic findings. RESULTS: A 59-year-old woman with a history of right gingival squamous cell carcinoma presented with sudden dimness of vision in the left eye of 4 weeks duration. Fundus examination of the left eye revealed a yellowish elevated subretinal lesion involving the optic disk and macula. Fine-needle aspiration biopsy of the choroidal lesion, left eye, revealed metastatic squamous carcinoma cells. The patient was referred to a radiation oncologist for further management. CONCLUSION: Choroidal metastasis from gingival squamous cell carcinoma is rare, and it may develop from hematogeneous spread.     

Plaque radiotherapy for selected orbital malignancies: preliminary observations: the 2002 Montgomery Lecture,part 2

PURPOSE: To describe the principles and preliminary results of plaque brachytherapy for selected orbital malignancies. METHODS: A custom-designed Iodine-125 plaque, designed to deliver a target dose of 50 Gray, was placed surgically in the region from which an orbital malignancy was partially resected. The mean dose to the target area was 50 Gray. The initial and follow-up patient data were reviewed. RESULTS: Of the 8 patients, the diagnosis was adenoid cystic carcinoma of the lacrimal gland (4 cases), orbital invasion by basal cell carcinoma (2), orbital extension of conjunctival melanoma (1), and metastatic carcinoma (1). Of the 4 with adenoid cystic carcinoma, there was microscopic residual tumor after excision and orbital exenteration was considered. Three have tumor control with follow-up of 1, 3, and 6 years. One patient required exenteration for recurrence separate from the field of brachytherapy and is free of tumor after 10 years. All 4 patients are alive and well with tumor control. Of the 2 patients with orbital extension of basal cell carcinoma, tumor control without recurrence has been achieved in both after 2 years. The patient with orbital metastasis responded to plaque radiotherapy, with no orbital recurrence, but died of systemic metastasis. The patient with orbital melanoma had local orbital recurrence separate from the area of irradiation and is currently being treated for systemic metastasis. CONCLUSIONS: Based on preliminary observations, plaque radiotherapy appears to be a reasonable alternative to exenteration and external irradiation for selected orbital malignancies.     

Primary cutaneous adenoid cystic carcinoma of the eyelid

PURPOSE: To report a case of primary cutaneous adenoid cystic carcinoma involving the eyelid. METHODS: We examined a 70-year-old woman with an 18-month history of a gradually enlarging, blue-colored mass in the medial third of the right upper eyelid. Excisional biopsy and additional resection of the medially infiltrated margin resulted in tumor-free edges. Superior cervical and orbital evaluations were performed. RESULTS: Histopathologic evaluation revealed a primary cutaneous adenoid cystic carcinoma. No gland pathology was documented. No tumor recurrence has been noted. CONCLUSION: Primary cutaneous adenoid cystic carcinoma, an uncommon tumor of the skin, should be added to the differential diagnosis of eyelid tumors.     

Bilateral breast metastases from choroidal melanoma

PURPOSE: To report an unusual case of solitary sequential bilateral breast metastases from choroidal melanoma. METHOD: Case report. RESULTS: A 48-year-old woman with a large choroidal melanoma in the left eye was treated with Iodine-125 brachytherapy and responded satisfactorily with decrease in tumor thickness. Thirty-seven months after treatment, she developed a solitary, circumscribed melanoma metastasis to the right breast, and 54 months after treatment, a similar metastasis was detected in her left breast. Both breast tumors were managed with lumpectomy. Systemic examination including magnetic resonance imaging of abdomen, chest, and head have been performed regularly and have been normal. At 61 months after treatment, the patient has no clinical evidence of metastatic disease elsewhere. CONCLUSIONS: Uveal melanoma rarely metastasizes to breast tissue. A breast nodule in a patient with a history of uveal melanoma is most likely a primary breast tumor but may rarely represent a metastasis from uveal melanoma.     

Successful treatment of a large choroidal abscess in an immunocompetent child

BACKGROUND: We report the case of a systemically well 4-year-old Aboriginal boy who developed a choroidal abscess after being poked in the left eye with a blunt object. CASE REPORT: This boy presented with redness and reduced vision in the left eye after a blunt object was poked into his eye by his sibling. He was noted to have a choroidal mass which finally manifested as a choroidal abscess. RESULTS: His initial visual acuity was 6/60, and dilated fundus examination demonstrated a localised solid-appearing choroidal elevation involving the posterior pole, including the macula. An ultrasound of the eye revealed a choroidal haematoma with an atypical appearance, whose height was 8 mm with a base of 12 mm x 10 mm. The lesion failed to resolve, and eventually resulted in orbital cellulitis that did not respond to intravenous and topical antibiotic treatment. He then went on to achieve complete visual recovery after successful management by transcleral incision, drainage and systemic antibiotic therapy. CONCLUSION: Choroidal abscess has been described in patients who are debilitated, immunocompromised or suffer with systemic disease such as cystic fibrosis or endocarditis. This case represents a unique report of staphylococcal choroidal abscess in a healthy child that completely resolved after transcleral drainage and systemic antibiotics.     

Choroidal metastasis from medullary thyroid carcinoma in multiple endocrine neoplasia

PURPOSE: To report choroidal metastasis from medullary thyroid carcinoma in a patient with multiple endocrine neoplasia (MEN) type 2b.DESIGN: Interventional case report.METHODS: Medullary thyroid carcinoma developed in a 20-year-old woman and led to the diagnosis of MEN 2b. She had mucosal neuromas on the lips and tongue and prominent corneal nerves in both eyes. Right choroidal metastasis developed when she was 36 years of age.RESULTS: The eye was treated with irradiation, but 9 months later the patient died of widespread metastases.CONCLUSIONS: In patients with MEN type 2b, choroidal metastasis can develop from medullary thyroid carcinoma. Although fundus abnormalities typically do not occur with MEN 2b, choroidal metastasis from medullary thyroid carcinoma is a potential fundus finding.     

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.     

Dedifferentiated adenoid cystic carcinoma of the lacrimal gland

A rare variant of adenoid cystic carcinoma is the dedifferentiated sarcomatoid form, which has previously been reported in the hard and soft palate, maxillary sinus, submandibular glands, and nasal cavity. The authors report the first case of a dedifferentiated sarcomatoid adenoid cystic carcinoma occurring in the lacrimal gland, that of a 52-year-old man. The patient presented with a 4-month history of diplopia, decreased vision, and right upper eyelid swelling. Radiographic imaging showed a soft tissue mass in the extraconal compartment superolateral to the right eye. The patient subsequently underwent surgical debulking. Histologic examination of the tissue revealed classic cribiform adenoid cystic carcinoma and a sarcomatous component consisting of malignant spindle cells and fusiform cells arranged in whorls. Dedifferentiation is a well-established phenomenon in salivary gland tumors that is associated with aggressive behavior and poor prognosis; however, the exact nature of such dedifferentiated neoplasms remains unclear.     

Diagnosis of Choroidal Melanoma in Dense Asteroid Hyalosis

Purpose: To demonstrate the utility of Optos ultra-wide field imaging in the diagnosis and management of choroidal melanoma in the setting of asteroid hyalosis. Design: Observational case report. Method: A 52-year-old female was referred for evaluation of floaters, photopsias, and blurry vision in the right eye. Clinical examination revealed dense asteroid hyalosis obscuring the fundus, and a limited view of a pigmented choroidal lesion in the nasal periphery. Optos ultra-wide field fluorescein angiography and ultrasonography facilitated the diagnosis of a choroidal melanoma. Results: The patient underwent Iodine-125 brachytherapy for local tumor control and excellent tumor response was confirmed with serial follow-up Optos imaging and ultrasonography. Conclusion: Ultra-wide field fundus fluorescein angiography facilitated the diagnosis of a choroidal melanoma, which was obscured by dense asteroid hyalosis, allowing for local tumor control with brachytherapy. Optos wide-field imaging may be a valuable tool for detecting potentially life-threatening lesions in the setting of asteroid hyalosis.     

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.     

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.