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.

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 year old female patient presented with central metamorphosia in the right eye. Undoscopy showed a solitary pale raised lesion in the central right macula about 6disc 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 × 2.6cm lesion in the tail of the pancreas. A CT guided liver biopsywas 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 thesignificance 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 imagingstudies in cases where a solid choroidal lesion of unknown origin is identified.