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Solitary Choroidal Metastasis as the First Sign of Metastatic Lung Carcinoid

Solitary Choroidal Metastasis as the First Sign of Metastatic Lung Carcinoid A 65-YEAR-OLD white man had a progressive loss of visual field in the superotemporal quadrant of his right eye. He had laser photocoagulation of a juxtafoveal choroidal neovascularization in his right eye 18 months ago and had a macular scar in his left eye due to exudative age-related maculopathy for 3 years. Visual acuity was 16/20 OD and 20/400 OS. On ophthalmic examination, his right eye showed a highly elevated, orange choroidal mass resembling choroidal melanoma in the inferonasal quadrant (Figure 1). The tumor demonstrated lower signal intensities on magnetic resonance imaging by T1compared with the signals expected for choroidal melanoma (Figure 2 and Figure 3). The lesion was not present 18 months earlier during laser photocoagulation. Thus, rapid tumor growth was assumed and metastasis was suspected. Computed tomography of the lung revealed a peripheral bronchial carcinoma (Figure 4), classified as a carcinoid by bronchoscopic biopsy. After a total dose of 40 Gy of ocular external beam irradiation and chemotherapy (3 courses of etoposide [VePesid, Bristol-Meyers Oncology Division, Bristol-Meyers Squibb Co, Princeton, NJ] and cisplatin [Platinol, Bristol-Meyers Oncology Division]), the metastasis completely regressed without deterioration of visual acuity (Figure 5). The patient demonstrated no recurrence in the eye, but developed brain metastasis after 6 months of follow-up. Figure 1. View LargeDownload Fundus photograph of the right eye taken at first presentation, showing a highly elevated, orange choroidal mass in the inferonasal quadrant and a macular scar after laser coagulation of a juxtafoveal choroidal neovascularization 18 months before. Figure 2. View LargeDownload Magnetic resonance images using a high-resolution surface coil showed a large space-occupying lesion in the inferonasal quadrant of the right eye. On the plain T1-weighted image, the lesion was slightly hyperintense to vitreous and showed a relatively low signal intensity compared with uveal melanoma. Figure 3. View LargeDownload On T2-weighted images, the lesion was indistinguishable from uveal melanoma. Ghosting artifacts on the T2-weighted image are due to the requirement of full-gradient strength for high-resolution images. Note the different orientation of Figure 3 compared with Figure 2. Figure 4. View LargeDownload Computed tomographic scan of the lung showing a bronchogenic carcinoid in the periphery of the right middle lobe. Figure 5. View LargeDownload Ten weeks after external beam irradiation and chemotherapy, the choroidal metastasis showed complete regression. Visual acuity was still 16/20 OD. Comment Carcinoid tumors are a rare source of choroidal metastasis.1 Though carcinoid tumors are 3 times more common in the intestine than in the lung,2 choroidal metastasis from this tumor most commonly originates from bronchogenic primary tumors.1,3,4 Choroidal metastasis from carcinoid tumors shows a distinctive orange color.1 Metastasis commonly occurs years after diagnosis of the primary tumor, but it may also be the presenting sign of the disease.1,3,4 External beam irradiation is an effective and noninvasive tool to help control metastatic ocular disease,1,3 and with early diagnosis and treatment, can help maintain a patient's quality of life. Corresponding author: Klaus-Martin Kreusel, MD, Augenklinik, Klinikum Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany. References 1. Harbour JWDe Potter PShields CLShields JA Uveal metastasis from carcinoid tumor. Ophthalmology. 1994;1011084- 1090Google ScholarCrossref 2. Minna JD Neoplasms of the lung. Fauci ASBraunwald EIsselbacher KJ et al. eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY McGraw-Hill Book Co1998;552- 561Google Scholar 3. Fan JTBuettner HBartley GBBolling JP Clinical features and treatment of seven patients with carcinoid tumor metastatic to the eye and orbit. Am J Ophthalmol. 1995;119211- 218Google Scholar 4. Riddle PJFont RLZimmerman LE Carcinoid tumors of the eye and orbit: a clinicopathologic study of 15 cases, with histochemical and electron microscopic observation. Hum Pathol. 1982;13459- 469Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Solitary Choroidal Metastasis as the First Sign of Metastatic Lung Carcinoid

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Publisher
American Medical Association
Copyright
Copyright © 1998 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.116.10.1396
Publisher site
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Abstract

A 65-YEAR-OLD white man had a progressive loss of visual field in the superotemporal quadrant of his right eye. He had laser photocoagulation of a juxtafoveal choroidal neovascularization in his right eye 18 months ago and had a macular scar in his left eye due to exudative age-related maculopathy for 3 years. Visual acuity was 16/20 OD and 20/400 OS. On ophthalmic examination, his right eye showed a highly elevated, orange choroidal mass resembling choroidal melanoma in the inferonasal quadrant (Figure 1). The tumor demonstrated lower signal intensities on magnetic resonance imaging by T1compared with the signals expected for choroidal melanoma (Figure 2 and Figure 3). The lesion was not present 18 months earlier during laser photocoagulation. Thus, rapid tumor growth was assumed and metastasis was suspected. Computed tomography of the lung revealed a peripheral bronchial carcinoma (Figure 4), classified as a carcinoid by bronchoscopic biopsy. After a total dose of 40 Gy of ocular external beam irradiation and chemotherapy (3 courses of etoposide [VePesid, Bristol-Meyers Oncology Division, Bristol-Meyers Squibb Co, Princeton, NJ] and cisplatin [Platinol, Bristol-Meyers Oncology Division]), the metastasis completely regressed without deterioration of visual acuity (Figure 5). The patient demonstrated no recurrence in the eye, but developed brain metastasis after 6 months of follow-up. Figure 1. View LargeDownload Fundus photograph of the right eye taken at first presentation, showing a highly elevated, orange choroidal mass in the inferonasal quadrant and a macular scar after laser coagulation of a juxtafoveal choroidal neovascularization 18 months before. Figure 2. View LargeDownload Magnetic resonance images using a high-resolution surface coil showed a large space-occupying lesion in the inferonasal quadrant of the right eye. On the plain T1-weighted image, the lesion was slightly hyperintense to vitreous and showed a relatively low signal intensity compared with uveal melanoma. Figure 3. View LargeDownload On T2-weighted images, the lesion was indistinguishable from uveal melanoma. Ghosting artifacts on the T2-weighted image are due to the requirement of full-gradient strength for high-resolution images. Note the different orientation of Figure 3 compared with Figure 2. Figure 4. View LargeDownload Computed tomographic scan of the lung showing a bronchogenic carcinoid in the periphery of the right middle lobe. Figure 5. View LargeDownload Ten weeks after external beam irradiation and chemotherapy, the choroidal metastasis showed complete regression. Visual acuity was still 16/20 OD. Comment Carcinoid tumors are a rare source of choroidal metastasis.1 Though carcinoid tumors are 3 times more common in the intestine than in the lung,2 choroidal metastasis from this tumor most commonly originates from bronchogenic primary tumors.1,3,4 Choroidal metastasis from carcinoid tumors shows a distinctive orange color.1 Metastasis commonly occurs years after diagnosis of the primary tumor, but it may also be the presenting sign of the disease.1,3,4 External beam irradiation is an effective and noninvasive tool to help control metastatic ocular disease,1,3 and with early diagnosis and treatment, can help maintain a patient's quality of life. Corresponding author: Klaus-Martin Kreusel, MD, Augenklinik, Klinikum Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany. References 1. Harbour JWDe Potter PShields CLShields JA Uveal metastasis from carcinoid tumor. Ophthalmology. 1994;1011084- 1090Google ScholarCrossref 2. Minna JD Neoplasms of the lung. Fauci ASBraunwald EIsselbacher KJ et al. eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY McGraw-Hill Book Co1998;552- 561Google Scholar 3. Fan JTBuettner HBartley GBBolling JP Clinical features and treatment of seven patients with carcinoid tumor metastatic to the eye and orbit. Am J Ophthalmol. 1995;119211- 218Google Scholar 4. Riddle PJFont RLZimmerman LE Carcinoid tumors of the eye and orbit: a clinicopathologic study of 15 cases, with histochemical and electron microscopic observation. Hum Pathol. 1982;13459- 469Google ScholarCrossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Oct 1, 1998

Keywords: lung,carcinoid tumor,secondary malignant neoplasm of choroid

References