Red lesions of the iris, choroid, and skin secondary to metastatic carcinoma of the thyroid: a review

An 83-year-old man was seen with a history of bilateral progressive loss of vision of 1 month's duration. On examination, there was a reddish, nodular lesion adjacent to the right side of the nose. Slit-lamp examination revealed a reddish iris mass in the left eye. Ophthalmoscopic examination revealed two orange choroidal lesions in the right eye and a large subretinal hemorrhage in the posterior pole with a central reddish vascular lesion in the left eye. An excisional biopsy of the skin lesion was performed. A diagnosis of metastatic follicular thyroid carcinoma was made according to the histopathologic findings and immunohistochemistry. The patient had no known history of thyroid malignancy and a metastatic survey revealed widespread metastasis. The patient had a total thyroidectomy followed by two series of radioactive iodine ablation. The iris lesion completely resolved and the choroidal lesions in the right eye showed partial regression during the follow-up period. Ocular and skin metastasis secondary to thyroid carcinoma is uncommon. In a review of English literature we found reports of 12 clinically well-documented cases of choroidal metastasis and two cases of iris metastasis. Our case and review of the previous cases reveal that reddish/orange color is a commonly observed feature of the uveal metastasis of thyroid carcinoma. Although ocular and skin metastases from thyroid carcinoma are rare, this possibility should be considered in the differential diagnosis of reddish-colored iris and choroidal masses as well as reddish nodular lesions of the scalp, face, and neck.     

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.     

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.     

Metastasis of medullar thyroid carcinoma (case report)

We report the case of a 38 year-old man treated for medullar thyroid carcinoma in 1990. Nine years later, this patient developed metastases in the parotid, cervical nodes and bones, with a choroidal metastasis in the left eye one year later. Polychemotherapy was performed without good outcome.     

Presumed eccrine carcinoma metastatic to the choroid

The purpose of this article is to describe a patient with presumed choroidal metastasis from an eccrine adenocarcinoma of the scalp. A 45-year-old Caucasian woman presented with decreased visual acuity. Ophthalmologic examination was unremarkable. Her past medical history was significant for eccrine carcinoma of the scalp. The patient developed bilateral cervical lymph node metastases, and received chemotherapy and radiotherapy. She had recurrence of the scalp lesion and developed bone metastasis. The patient was again referred to an ophthalmologist owing to reduced visual acuity. Multiple choroidal metastases were detected in right eye, and one metastatic lesion in left eye. The patient passed away 2 months after choroidal metastases. This is the first report of choroidal metastases from an eccrine carcinoma. This is a rare aggressive neoplasm with poor outcome in most cases of metastatic disease, and in this case report, uveal metastasis was indicative of poor prognosis.     

Metástasis coroidea como primera manifestación de carcinoma papilar de tiroides: a propósito de un caso

The case is presented of 78 year-old who consulted due to decreased visual acuity in right eye for several months. Indirect ophthalmoscopy revealed an orange-yellow coloured choroidal mass at the posterior pole, without retinal detachment. Computed tomography showed a thyroid mass in the isthmus, as well as multiple pulmonary nodules and metastatic foci. The findings of transbronchial lung biopsy were compatible with metastatic dissemination. Fine-needle aspiration biopsy of thyroid nodule was diagnostic for a with columnar cell variant of papillary thyroid cancer. Positron emission tomography confirmed papillary thyroid carcinoma. The patient underwent total thyroidectomy and radioactive iodine therapy.     

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.     

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.     

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.     

Simultaneous eyelid and choroidal metastases 36 years after diagnosis of medullary thyroid carcinoma

A 56-year-old man had a 6-month history of a progressively enlarging mass of his right upper eyelid. Thirty-six years previously he had undergone thyroidectomy for medullary thyroid carcinoma in the absence of family history. Supraclavicular lymph node metastases were discovered 3 years after initial diagnosis, pulmonary metastasis 26 years later, and cervical lymph node metastases 35 years later. Ocular examination revealed a pedunculated, amelanotic, highly vascularized metastasis involving the right upper eyelid and palpebral conjunctiva. Ophthalmoscopy revealed 2 amelanotic, dome-shaped choroidal metastases in the right eye and 3 similar tumors in the left eye. Medullary thyroid carcinoma not associated with the multiple endocrine neoplasia syndromes can metastasize to the ocular region and metastases can occur decades after the original diagnosis.     

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.     

Transpupillary Thermotherapy in the Treatment of Choroidal Metastasis from Breast Carcinoma

BACKGROUND: Most patients who develop metastatic carcinoma to the choroid are managed by local radiation or chemotherapy. Since transpupillary thermotherapy (TTT) is currently gaining attention as an optional treatment for choroidal melanomas and hemangiomas, we sought to determine whether TTT is suitable for treatment of solitary choroidal metastasis at the posterior pole. METHOD: We report on a patient with decreased vision due to a serous macular detachment in a eye with a solitary choroidal metastasis from breast carcinoma, who was managed by TTT. RESULTS: After two months of follow up, total re-absorption of the serous macular detachment was achieved and the patient recovered full visual acuity in the treated eye. The choroidal mass became atrophic and hyperpigmentation of the retinal pigment epithelium and retinal folds in the macular region were observed. After six months of TTT, the ocular picture remained unchanged. CONCLUSION: TTT can be considered an acceptable therapeutic option for solitary choroidal metastasis associated with serous retinal detachment.     

Choroidal Metastasis of Adenocarcinoma of the Lung Presenting as Pigmented Choroidal Tumor

Our case represents a unique occurrence of pigmented choroidal tumor that clinically appeared as choroidal melanoma and was treated accordingly. At the same time, while evaluating the patient for systemic metastases of uveal melanoma, she was diagnosed as having lung carcinoma. Events that led to the enucleation of the eye enabled a histological diagnosis: pulmonary adenocarcinoma. In our case, it happened that a very rare pigmented choroidal metastatic tumor was the presenting sign of a pulmonary adenocarcinoma.Key Words: Choroidal metastasis, Pulmonary adenocarcinoma, Pigmented choroidal tumor     

Cryo- and photocoagulation for choroidal metastases of a thyroid carcinoma (author's transl)

A 47-year-old patient underwent surgery in 1972 for a metastasising medullary thyroid carcinoma. 4 years later he developed choroidal metastases in the left eye and then, after another 3 months, multiple small metastases appeared in the right eye. The metastases were cryo- and photocoagulated because medullary thyroid carcinoma do not respond to radiation or chemotherapy. Although the single very large metastasis in the left eye was scarcely affected, the multiple metastases in the right eye were destroyed. As a result the patient has retained useful vision in this eye for the past three years.     

甲状腺髓样癌转移至虹膜角膜角1例

目的:报告甲状腺髓样癌在虹膜角膜角转移的病例1例。方法:患者,女,28岁,患有单一的甲状腺髓样癌伴左眼虹膜角膜角包块。随后几个月对其视网膜的随访显示其视网膜也有一些浸润病灶。结果:用激光照射姑息切除脉络膜及房角病灶后,没有发现有复发迹象和任何新病灶出现。结论:据我们所知,这是文献中第一次报告甲状腺髓样癌在虹膜角膜角的转移。     

Metastatic renal cell carcinoma to the palpebral lobe of the lacrimal gland

PURPOSE: To describe a clinicopathologic correlation of a metastatic renal cell carcinoma to lacrimal gland. METHODS: Case report. RESULTS: A 59-year-old man with a history of renal cell carcinoma had a hemorrhagic mass involving the palpebral lobe of the right lacrimal gland. Fundus examination disclosed two lesions with typical features of choroidal metastasis. The lacrimal gland mass was excised, and histopathologic examination revealed metastatic renal cell carcinoma. The patient was treated for systemic metastasis but required no further ocular treatment. CONCLUSIONS: Renal cell carcinoma can metastasize to the lacrimal gland, where it may appear as a hemorrhagic mass.     

Ciliary body metastasis as the first sign of small-cell bronchial carcinoma

BACKGROUND: About 3-10% of patients suffering from metastatic disease develop metastatic choroidal tumors. In this case report ocular symptoms were the first sign of a systemic malignancy. CASE REPORT: A 65-year old man complained of an increasing painful redness of his left eye. He showed a white mass with 10 mm in thickness in the temporal chamber angle with "pseudohypopyon" and secondary glaucoma. Because of increasing pain the eye was removed. Histologic examination showed a small cell carcinoma of the ciliary body with high malignancy, which most probably has to be seen as a metastasis of a carcinoma of the lung, which was detected by internal examination concurrently. In addition, a metastasis in the adrenal gland was found. ACE polychemotherapy was performed, but 4 months later the patient died of metastatic disease with break down of the kidneys. DISCUSSION: Based on literature data patients with systemic malignancy present themselves to a physician primarily because of ocular symptoms in 12-31%. In these cases differentiation of an uveal metastasis from a primary amelanotic melanoma can be difficult. The search for primary tumors has to be started in due time.     

Regression of a choroidal metastasis from prostate adenocarcinoma after hormonal therapy

CASE REPORT: We report a case of a patient diagnosed with prostatic adenocarcinoma with multiple bone metastases and a choroidal metastasis in his left eye. Hormonal therapy with an anti-androgen and a LH-RH agonist was followed by regression of the choroidal mass over a period of 2 months. No metastatic recurrence has been demonstrated after a follow-up period of 14 months. DISCUSSION: Complete resolution of choroidal metastases of prostatic adenocarcinoma with hormonal therapy is exceptional, but the effect of this treatment on such metastases should be observed before recommending radiation therapy.     

Papillary carcinoma thyroid presenting as a choroidal metastasis. Report of a case and brief review of literature

A patient of papillary thyroid carcinoma, who initially presented with a choroidal metastasis and secondary intractable glaucoma is reported. The orange-coloured tumour posed a diagnostic difficulty, until histopathology of the enucleated eye confirmed the metastasis from the thyroid. The initial presentation of distant metastasis in patients with thyroid cancer is rare.