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Kim BZ, Lim JZ, McGhee CNJ. Cysts and tumours of the iris: Diagnostic tools and key management considerations-A review. Clin Exp Ophthalmol 2024. [PMID: 38577954 DOI: 10.1111/ceo.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/24/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
The iris is a unique structure, with exquisite variations in colour and form. Pathological changes, specifically including iris cysts and tumours are relatively uncommon, difficult to diagnose, and yet potentially blinding or life-threatening. Based on a comprehensive literature review, with highly illustrated key case examples, this report aims to guide the clinician in filtering the differential diagnoses of iris cysts and tumours. Evaluation is in the context of key diagnostic clinical tools and management considerations. Diagnostic imaging techniques include serial anterior segment photography, ultrasound, anterior segment optical coherence tomography, and iris fluorescein angiography, however, the roles of computerised topography and magnetic resonance imaging are also considered in this review. Management includes categorisation in terms of solid iris tumours (melanocytic vs. non-melanocytic), or iris cysts (primary vs. secondary) that may be usefully differentiated by clinical assessment, avoiding more invasive interventions. Cystic lesions are generally benign, although implantation cysts in particular cause significant complications and surgical challenges. Most solid tumours are melanocytic and also typically benign. However, in larger lesions, rapid growth, symptoms and complications more likely indicate malignancy, requiring further investigation.
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Affiliation(s)
- Bia Z Kim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
| | - Joevy Z Lim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
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2
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Wang TT, Chen XY, Min QY, Han YZ, Zhao HF. Iris metastasis from clear cell renal cell carcinoma: A case report. World J Clin Cases 2023; 11:8535-8541. [PMID: 38188215 PMCID: PMC10768508 DOI: 10.12998/wjcc.v11.i36.8535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) is a common type of tumor that can metastasize to any organs and sites. However, it is extremely rare for ccRCC to metastasize to the iris. Here, we describe a rare case of iris metastasis from ccRCC with a history of left nephrectomy in 2010. CASE SUMMARY A 62-year-old male was admitted to the hospital due to blurred vision and red eyes, and a mass was found on the iris in the right eye. B-scan ultrasonography revealed a well-bounded high-density lesion at the corner of the anterior chamber at the 3-4 o'clock position. Phacoemulsification with simultaneous intraocular lens implantation and iridocyclectomy was performed in the right eye. The lesion was confirmed to be metastatic ccRCC by histological and immunohistochemical analyses. The patient was still alive at 9 mo after surgical treatment. Ocular metastasis can be an initial sign with a poor prognosis. Timely detection and treatment may improve survival. Clinicians should pay attention to similar metastatic diseases to prevent misdiagnosis leading to missed treatment opportunities. CONCLUSION This report of the characteristics and successful management of a rare case of iris metastasis from ccRCC highlights the importance of a comprehensive medical history, histopathology, immunohistochemistry, and clinical manifestation for successful disease diagnosis.
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Affiliation(s)
- Tong-Tong Wang
- Department of Graduate School, Hebei Medical University, Shijiazhuang 050017, Hebei Province, China
- Department of Pathology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Xiao-Yue Chen
- Department of Pathology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
| | - Qiao-Yun Min
- Department of Pathology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
- School of Basic Medicine, Hebei North University, Zhangjiakou 075000, Hebei Province, China
| | - Yi-Ze Han
- Department of Graduate School, Hebei Medical University, Shijiazhuang 050017, Hebei Province, China
| | - Huan-Fen Zhao
- Department of Pathology, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
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3
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Jindal A, Kapatia G, Gupta G. Ocular metastasis from renal malignancies - A comprehensive review. Indian J Ophthalmol 2023; 71:3281-3289. [PMID: 37787223 PMCID: PMC10683680 DOI: 10.4103/ijo.ijo_3073_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 10/04/2023] Open
Abstract
The most common cause of intraocular mass is metastasis from other tumors. Renal malignancies, though rare, have a substantial number of cases with ocular metastasis, few of which were misdiagnosed. Many a times renal malignancies present with ocular manifestations before the primary diagnosis. Here in this article, we comprehensively reviewed 106 cases of ocular metastasis from renal malignancies published till date to the best of our knowledge. The eye is a rare site for distant metastasis because of the lack of a lymphatic system. The most common ocular structures to get involved in distant metastasis are the uveal tract, i.e., choroid, iris, and ciliary body. The most common renal tumor which metastasizes to eyes is renal cell carcinoma (RCC). RCC accounts for less than 2% of all ophthalmic metastases. Out of total 106 cases, the type of renal malignancy was known in 95 cases only, of which 92 had RCC, 1 Wilm's tumor, 1 rhabdoid tumor, and 1 medullary carcinoma. The age ranged widely from 2 weeks old to 81 years old. The male to female ratio was 3.4:1. In total, 67.4% of cases had a previous history of RCC, while the rest 32.6% primarily presented with ophthalmic manifestations first. Treatment modalities included enucleation of the eye, debulking surgery followed by radiotherapy and/or chemotherapy and/or immunotherapy.
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Affiliation(s)
- Akriti Jindal
- Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gargi Kapatia
- Department of Pathology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gaurav Gupta
- Department of Ophthalmology, Eye Sure Super-Speciality Eye Hospital, Bathinda, Punjab, India
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4
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Shields CL, Kalafatis NE, Gad M, Sen M, Laiton A, Silva AMV, Agrawal K, Lally SE, Shields JA. Metastatic tumours to the eye. Review of metastasis to the iris, ciliary body, choroid, retina, optic disc, vitreous, and/or lens capsule. Eye (Lond) 2023; 37:809-814. [PMID: 35306540 PMCID: PMC10050009 DOI: 10.1038/s41433-022-02015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/31/2022] [Accepted: 02/28/2022] [Indexed: 11/09/2022] Open
Abstract
Metastasis to the eye can involve the choroid (90%), ciliary body (2%), iris (8%), and retina, optic disc, vitreous, and/or lens capsule (<1-4%). The mean number of uveal metastasis per eye (1.7), mean tumour base (11.6 mm) and thickness (3.2 mm), tumour colour (86% yellow), and presence of subretinal fluid (72%), are all clinical features suggestive of the diagnosis. Imaging with ultrasonography demonstrates an echodense mass (80%) and optical coherence tomography shows a "lumpy bumpy" choroidal surface (64%), both important diagnostic features. Uveal metastases typically emanate from primary cancer of the breast (37%), lung (27%), kidney (4%), gastrointestinal tract (4%), cutaneous melanoma (2%), lung carcinoid (2%), prostate (2%), thyroid (1%), pancreas (1%), and other sites (3%). Occasionally, fine needle aspiration biopsy is employed if the primary site is not known. In 16% of cases, the primary site remains unknown. Rarely, metastases affect the retina, vitreous, and lens capsule, most often originating from cutaneous melanoma and in patients previously treated with checkpoint inhibitor therapy. Kaplan-Meier analysis in a series of 1111 patients with uveal metastasis revealed 32% survival at 3 years and 24% at 5 years. Patients with uveal metastasis from carcinoid tumour showed most favourable survival at 5-years (92%), whereas pancreatic and kidney cancer demonstrated least favourable survival (0%). The 5-year survival was better for females (versus (vs.) males) (31% vs. 21%) and older adults (vs. children) (40% vs. 0%). In this review, we examine several large-cohort publications on the topic of ocular metastasis.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Nicholas E Kalafatis
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maikel Gad
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mrittika Sen
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrea Laiton
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ana Maria Velasco Silva
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kushal Agrawal
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sara E Lally
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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5
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Huang Z, Zhang Y. Iris metastasis as resistance mechanism to atezolizumab, carboplatin, and etoposide but responds to additional irinotecan and anlotinib in a small cell lung cancer patient. Thorac Cancer 2023; 14:779-782. [PMID: 36747371 PMCID: PMC10008681 DOI: 10.1111/1759-7714.14818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/08/2023] Open
Abstract
Small cell lung cancer (SCLC) is an aggressive malignancy associated with poor prognosis. Metastasis to sites outside the chest at the time of initial diagnosis, such as bone, brain, and liver metastasis have been found in most SCLC patients. Iris metastases from SCLC have rarely been previously reported, and often cause eye pain and blindness in patients. Here, we report a patient with SCLC who presented with iris metastasis in the right eye and metastasis in the left adrenal gland due to disease progression on first-line therapy, which subsequently caused pain and blindness in the right eye. The patient was treated with second-line irinotecan combined with anlotinib and atezolizumab and did not receive any local treatment in the right eye. After only one cycle of treatment, the iris metastases in the right eye were smaller than before, and the visual acuity in the right eye recovered. At the same time, her left adrenal metastases were also significantly smaller than before. Our case suggests that systemic therapy with effective treatment options can similarly improve iris metastases in patients.
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Affiliation(s)
- Zhe Huang
- Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, China.,Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yongchang Zhang
- Graduate Collaborative Training Base of Hunan Cancer Hospital, Hengyang Medical School, University of South China, Hengyang, China.,Department of Medical Oncology, Lung Cancer and Gastrointestinal Unit, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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6
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Liu W, Ma W, Guo R, Ji J. Snowflakes in the Eye - An Uncommon Presentation of Iris Metastasis of Esophageal Carcinoma and Review of Literature. Ocul Immunol Inflamm 2022; 30:1568-1571. [PMID: 34003704 DOI: 10.1080/09273948.2021.1906910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To alert clinicians to an uncommon presentation of iris metastasis of esophageal carcinoma. We reported a 67-year-old man complained of blurred vision and ocular pain of his right eye for 1 month. He was diagnosed iridocyclitis of the right eye 2 weeks ago and he had a history of esophageal squamous cell carcinoma for 5 years with no regular treatment. Under slit-lamp microscopy, accumulating snowflakes-like deposits were found in the anterior chamber of the right eye. Ocular metastasis was then confirmed by atypical cells in the aqueous humor and positron emission tomography (PET-CT). METHODS Retrospective review of a case note and review of literature. CONCLUSION We presented a rare case of iris metastasis of esophageal carcinoma and highlighted the importance of maintaining suspicion for metastasis in any elderly patients with uveitis, since the diseases masquerading as uveitis are not only vision threatening but may be potentially fatal.
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Affiliation(s)
- Wei Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Wenjiang Ma
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ruru Guo
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jian Ji
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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7
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Liu T, Bai F, Yang L, Liu L, Xiao J, Liu X. Primary Tumour Type, Clinical Features, Treatment and Outcome of Patients with Iris Metastasis. Ocul Immunol Inflamm 2022; 30:1726-1732. [PMID: 34228589 DOI: 10.1080/09273948.2021.1939392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To describe the primary tumour type, clinical features, treatment and outcome of patients with Iris metastasis. METHODS Retrospectively analyzed articles published from 1934 to 2019 in the PubMed database. RESULTS In total, 133 eyes of 125 patients with iris metastatic carcinoma were retrieved. The average age at metastasis diagnosis of the patients was 56 ± 15 years; 60 left eyes and 49 right eyes were involved. The most common primary tumors were lung carcinoma (42%) and breast carcinoma (15%). Approximately one-third of the patients were first diagnosed in the ophthalmology department before the primary tumor was detected. Twenty-two percent of iris metastases were discovered before and 33% were discovered after systemic metastasis. The most common complaints were blurred vision and pain. The clinical features included iris masses, neovascularization and keratic precipitates. 57 patients (64%, N = 90) had an elevated intraocular pressure. Local administration of radiation therapy or intraocular injections of anti-VEGF drugs relieved eye discomfort and controlled the high intraocular pressures. CONCLUSIONS Iris nodules with increased intraocular pressure and neovascularization may indicate iris metastasis. Lung cancer is the most common primary tumor.
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Affiliation(s)
- Tao Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Feng Bai
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Li Yang
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Li Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Jun Xiao
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
| | - Xiaoli Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Changchun, P.R. China
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8
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Iris metastases from small cell lung carcinoma. Am J Med Sci 2022; 364:e15-e16. [PMID: 35595076 DOI: 10.1016/j.amjms.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/04/2021] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
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9
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Stephenson KAJ, O'Tuama B, Dooley I, Connell P. Colonic adenocarcinoma presenting as monocular metamorphopsia. BMJ Case Rep 2022; 15:e245828. [PMID: 35046074 PMCID: PMC8772426 DOI: 10.1136/bcr-2021-245828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Brian O'Tuama
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ian Dooley
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Paul Connell
- Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
- Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
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10
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Vautier A, Mourozeau L, Assad-Bordure S, Croué A, Gohier P. Uveal metastasis from a large B-cell lymphoma: Case report. J Fr Ophtalmol 2021; 45:e65-e66. [PMID: 34785070 DOI: 10.1016/j.jfo.2021.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- A Vautier
- Service d'ophtalmologie, CHU d'Angers, rue Larrey, 49100 Angers, France.
| | - L Mourozeau
- Service d'ophtalmologie, CHU d'Angers, rue Larrey, 49100 Angers, France
| | - S Assad-Bordure
- Service d'ophtalmologie, CHU d'Angers, rue Larrey, 49100 Angers, France
| | - A Croué
- Service d'ophtalmologie, CHU d'Angers, rue Larrey, 49100 Angers, France
| | - P Gohier
- Service d'ophtalmologie, CHU d'Angers, rue Larrey, 49100 Angers, France
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11
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Ozawa H, Usui Y, Takano Y, Horiuchi N, Kuribayashi T, Kurihara T, Smith LE, Tsubota K, Tomita Y. Iris metastasis as the initial presentation of metastatic esophageal cancer diagnosed by fine needle aspiration biopsy: A case report. Medicine (Baltimore) 2021; 100:e26232. [PMID: 34087906 PMCID: PMC8183745 DOI: 10.1097/md.0000000000026232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Metastasis of neoplasms to the eye is quite uncommon. In this case report, we describe a patient where primary esophageal cancer was diagnosed by fine needle aspiration biopsy (FNAB) of an iris tumor. PATIENT CONCERNS A 70-year-old male complained of redness and discomfort in the right eye. DIAGNOSIS AND INTERVENTIONS The patient's right eye was diagnosed as idiopathic uveitis, and a topical steroid was administered. As vitreous opacities were observed even after topical therapy, oral prednisolone was administered. On slit-lamp examination of the right eye, an iris mass with neovascularization was seen in the anterior chamber. A metastatic tumor was suspected, and FNAB was performed. Histology revealed squamous cell carcinoma. Systemic workup revealed esophageal cancer with several metastases. Best-corrected visual acuity decreased to 20/400, and intraocular pressure was 40 mmHg in the right eye. Two iris tumors with neovascularization were present extending into the anterior chamber with posterior iris synechiae and 360 degree peripheral anterior synechiae. Intraocular pressure in the right eye was medically managed with hypotensive eye drops and oral acetazolamide. Iris metastases were treated with 40 Gray of radiation therapy and concurrent chemotherapy. OUTCOMES The tumor regressed, but intraocular pressure was refractory to treatment because of 360 degree goniosynechial closure. The right eye lost light perception six months after treatment commenced, and the patient died 9 months after the onset of therapy due to multiple systemic metastases. LESSONS This is a rare case of masquerade syndrome without systemic symptoms in which FNAB of an iris tumor led to a diagnosis of metastatic esophageal squamous cell carcinoma. Although the patient lost his sight due to uncontrollable ocular hypertension, systemic chemotherapy, and radiation therapy were initially effective in the treatment of the metastatic iris tumor. As the prognosis of patients with metastatic iris tumors is poor, it is important for ophthalmologists to consider such diagnoses and conduct systemic investigations when necessary.
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Affiliation(s)
- Hiroko Ozawa
- Department of Ophthalmology, Kawasaki Municipal Hospital, Kanagawa
- Department of Ophthalmology, Keio University School of Medicine
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo
| | - Yoji Takano
- Department of Ophthalmology, Keio University School of Medicine
- Department of Ophthalmology, Kawasaki Municipal Ida Hospital
| | - Naoki Horiuchi
- Department of Ophthalmology, Keio University School of Medicine
| | - Tohru Kuribayashi
- Department of Radiation Oncology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | | | - Lois E.H. Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Yohei Tomita
- Department of Ophthalmology, Keio University School of Medicine
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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12
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Siddiqui MAR, Hussain SZM, Mubarak M. Iris metastasis as the initial presentation of upper gastrointestinal tract carcinoma: a case report. J Med Case Rep 2019; 13:367. [PMID: 31831049 PMCID: PMC6909480 DOI: 10.1186/s13256-019-2303-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/24/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND We report a case of a patient with iris metastasis as the initial manifestation of a systemic cancer: upper gastrointestinal tract carcinoma. CASE PRESENTATION A 24-year-old Asian man presented to our hospital with complaints of red left eye, decreased visual acuity, pain, and photophobia for about 3 weeks with no prior history of cancer or any other medical abnormality. Ocular examination showed a pinkish white lesion on the superonasal part of the iris. The patient's intraocular pressure was progressively increasing despite medications, followed by lymphadenopathy 4 weeks later. Comprehensive examination was performed along with a complete systemic workup, which detected systemic malignancy. Histopathology and immunohistochemistry revealed signet ring cells, which indicated an upper gastrointestinal tract tumor as a primary source of iris metastasis. The systemic condition of the patient deteriorated rapidly thereafter and led to his death in the 12th week of the disease. CONCLUSION A red eye with iris lesions in otherwise healthy individuals should be considered as a possible initial manifestation of underlying systemic malignancy. Prompt referral of such patients to an oncologist is warranted.
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Affiliation(s)
- M A Rehman Siddiqui
- Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan. .,Department of Ophthalmology, Shahzad Eye Hospital, Karachi, Pakistan. .,Department of Ophthalmology, South City Hospital, Karachi, Pakistan.
| | - Syed Zohaib Maroof Hussain
- Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
| | - Muhammed Mubarak
- Javed I. Kazi Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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13
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Welch RJ, Malik K, Mayro EL, Newman JH, Honig SE, Ang SM, Selzer EB, Acaba-Berrocal LA, McGarrey MP, Graf AE, Considine SP, Shields JA, Shields CL. Uveal metastasis in 1111 patients: Interval to metastasis and overall survival based on timing of primary cancer diagnosis. Saudi J Ophthalmol 2019; 33:229-237. [PMID: 31686963 PMCID: PMC6819751 DOI: 10.1016/j.sjopt.2019.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/08/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate interval between primary cancer diagnosis and uveal metastasis and assess survival outcomes based on whether the primary cancer was diagnosed before or after uveal metastasis. Methods In this retrospective analysis, all patients with uveal metastasis evaluated on the Ocular Oncology Service, Wills Eye Hospital, Philadelphia, PA, USA between February 1, 1974 and June 1, 2017 were included. Features and outcomes based on timing of primary cancer diagnosis, whether before or after diagnosis of uveal metastasis, were assessed. Results A total of 2214 uveal metastases were diagnosed in 1310 eyes of 1111 consecutive patients. Primary cancer was known prior to uveal metastasis in 742 patients (67%) and not known in 369 (33%). Of those not known, the primary cancer was later found in 192 patients (17%) and never found in 177 patients (16%). For those with known primary cancer, mean interval from primary cancer diagnosis to uveal metastasis was 5.2 years with differences in primary sites of gastrointestinal (2.1 years, p = 0.003), lung (2.2 years, p < 0.001), breast (6.5 years, p < 0.001), and thyroid (13 years, p < 0.001). By Kaplan-Meier analysis, the 5-year overall survival showed no difference between patients with primary cancer found before (28%) vs after (20%) vs never found (33%), relative to uveal metastasis. Conclusion Of 1111 patients with uveal metastasis, early-onset uveal metastases were found with lung and gastrointestinal tract cancers, whereas late-onset metastases were found with breast and thyroid cancers. Overall survival did not vary on whether the primary tumor was diagnosed before, after, or never found, relative to uveal metastasis.
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Affiliation(s)
- R Joel Welch
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Kunal Malik
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Eileen L Mayro
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jennifer H Newman
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Stephanie E Honig
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Su Mae Ang
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Evan B Selzer
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Luis A Acaba-Berrocal
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Mark P McGarrey
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Alexander E Graf
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Sean P Considine
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jerry A Shields
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
| | - Carol L Shields
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, United States
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Welch RJ, Malik K, Considine SP, Acaba-Berrocal LA, Selzer EB, Newman JH, Shields JA, Shields CL. Uveal Metastasis Based on Patient Sex in 2214 Tumors of 1111 Patients. A Comparison of Female Versus Male Clinical Features and Outcomes. Asia Pac J Ophthalmol (Phila) 2019; 8:298-303. [PMID: 31373911 PMCID: PMC6727921 DOI: 10.1097/apo.0000000000000247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/13/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Lacking in previous studies on uveal metastasis is a robust statistical comparison of patient demographics, tumor features, and overall survival based on patient sex. OBJECTIVE The aim of this study was to evaluate demographics, clinical features, and overall survival of patients with uveal metastasis based on sex. METHOD This is a retrospective analysis. All patients were evaluated on the Ocular Oncology Service, Wills Eye Hospital, PA between January 1, 1974 and June 1, 2017. RESULTS A total of 2214 uveal metastases were diagnosed in 1310 eyes of 1111 consecutive patients. A comparison (female versus male) revealed differences across several demographic and clinical features including, among others, mean age at metastasis diagnosis (58 vs 63 years, P < 0.001), bilateral disease (21% vs 11%, P < 0.001), and mean number of metastases per eye (1.8 vs 1.6 tumors per eye, P = 0.04). There were differences in overall mean survival (20 vs 13 months, P = 0.03) and 5-year survival (Kaplan-Meier estimate) (31% vs 21%, P < 0.001). CONCLUSIONS There are demographic, clinical, and survival differences when patients with uveal metastases are compared by sex. Understanding these differences can aid the clinician in better anticipating patient outcomes.
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Affiliation(s)
- R Joel Welch
- Wills Eye Hospital, Ocular Oncology Service, Thomas Jefferson University, Philadelphia, PA
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15
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Kaneko M, Namisaki T, Takaya H, Mori H, Kitade M, Okura Y, Seki K, Sato S, Nakanishi K, Kitagawa K, Ozutsumi T, Shimozato N, Kaji K, Otani T, Nakai T, Obayashi C, Mitoro A, Yamao J, Yoshiji H. Calcified mucinous adenocarcinoma of the stomach metastatic to the iris: a case report. J Med Case Rep 2019; 13:64. [PMID: 30841908 PMCID: PMC6404271 DOI: 10.1186/s13256-019-1977-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/10/2019] [Indexed: 12/19/2022] Open
Abstract
Background Gastric cancer has a wide spectrum of clinical features, imaging manifestations, and pathology. Punctate calcifications in gastric cancer are infrequent but are usually found in mucinous adenocarcinoma. However, there have only been a few autopsy case reports describing the correlation between the radiology and pathology findings of calcified mucinous adenocarcinoma of the stomach. We present an autopsy case of mucinous gastric adenocarcinoma with iris metastases as the initial symptom. Case presentation A 74-year-old Japanese woman presented with blurred vision. Her treating ophthalmologist diagnosed acute iritis with secondary glaucoma. The histopathological and immunohistochemical features of a trabeculectomy specimen favored metastatic carcinoma, most likely of gastrointestinal tract origin. Esophagogastroduodenoscopy revealed multiple irregularly shaped ulcerative lesions, multiple erosions, and thickened folds in the corpus of her stomach. Histologic examination of a gastric tissue specimen obtained by endoscopic biopsy revealed poorly differentiated carcinoma with signet ring cell features. Computed tomography revealed a tumor with multiple punctate calcifications in the thickened gastric wall with diffuse low attenuation and multiple lymph node metastases, including the para-aortic lymph nodes, and peritoneal dissemination. She was diagnosed with stage IV gastric cancer (T4N3M1) and underwent seven cycles of 5-weekly TS-1, a novel oral fluoropyrimidine derivative, plus cisplatin therapy. Serial follow-up computed tomography revealed successive increases in the gastric wall calcifications. Her disease stabilized, but she died of aspiration pneumonia 8 months after the first visit. Autopsy tissue specimens had miliary, punctate calcifications present in abundant extracellular mucin pools in the submucosa, corresponding to the thickened low-attenuating middle layer on computed tomography. The final diagnosis was mucinous gastric adenocarcinoma because mucinous adenocarcinoma is diagnosed when more than half of the tumor area contains extracellular mucin pools. Conclusions We report the pathology and computed tomography imaging characteristics of a case of calcified mucinous adenocarcinoma of the stomach metastatic to the iris, including findings at autopsy. Metastatic carcinomas in the iris originating in the stomach are exceedingly rare. Multiple punctate calcifications were present in pools of extracellular mucin, a diagnostic clue for mucinous adenocarcinoma. Possible mechanisms underlying scattered punctuate calcifications in gastric mucinous adenocarcinoma warrant further investigation.
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Affiliation(s)
- Miki Kaneko
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tadashi Namisaki
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Hiroaki Takaya
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hitoshi Mori
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuteru Kitade
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasushi Okura
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kenichiro Seki
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shinya Sato
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Keisuke Nakanishi
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Koh Kitagawa
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takahiro Ozutsumi
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Naotaka Shimozato
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kosuke Kaji
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tomoyuki Otani
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Chiho Obayashi
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Akira Mitoro
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Junichi Yamao
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hitoshi Yoshiji
- Third Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Mathis T, Jardel P, Loria O, Delaunay B, Nguyen AM, Lanza F, Mosci C, Caujolle JP, Kodjikian L, Thariat J. New concepts in the diagnosis and management of choroidal metastases. Prog Retin Eye Res 2018; 68:144-176. [PMID: 30240895 DOI: 10.1016/j.preteyeres.2018.09.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/17/2022]
Abstract
The most frequent site of ocular metastasis is the choroid. The occurrence of choroidal metastases has increased steadily due to the longer survival of metastatic patients and the improvement of diagnostic tools. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy. There is currently no consensus on the treatment strategy. Most patients have a limited life expectancy and for these complex treatments are generally not recommended. However, recent advances in systemic therapy have significantly improved survival of certain patients who may benefit from an aggressive ocular approach that could preserve vision. Although external beam radiation therapy is the most widely used treatment, more advanced forms of radiotherapy that are associated with fewer side effects can be proposed in select cases. In patients with a shorter life expectancy, systemic therapies such as those targeting oncogenic drivers, or immunotherapy can induce a regression of the choroidal metastases, and may be sufficient to temporarily decrease visual symptoms. However, they often acquire resistance to systemic treatment and ocular relapse usually requires radiotherapy for durable control. Less invasive office-based treatments, such as photodynamic therapy and intravitreal injection of anti-VEGF, may also help to preserve vision while reducing time spent in medical settings for patients in palliative care. The aim of this review is to summarize the current knowledge on choroidal metastases, with emphasis on the most recent findings in epidemiology, pathogenesis, diagnosis and treatment.
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Affiliation(s)
- Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Pauline Jardel
- Department of Radiation Oncology, Chicoutimi Hospital, Saguenay, QC, Canada
| | - Olivier Loria
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Benoit Delaunay
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Anh-Minh Nguyen
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Francesco Lanza
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | - Carlo Mosci
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Juliette Thariat
- Department of Radiation Therapy, Centre François Baclesse - ARCHADE, Unicaen - Normandie University, 14000, Caen, France.
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18
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Shields CL, Welch RJ, Malik K, Acaba-Berrocal LA, Selzer EB, Newman JH, Mayro EL, Constantinescu AB, Spencer MA, McGarrey MP, Knapp AN, Graf AE, Altman AJ, Considine SP, Shields JA. Uveal Metastasis: Clinical Features and Survival Outcome of 2214 Tumors in 1111 Patients Based on Primary Tumor Origin. Middle East Afr J Ophthalmol 2018; 25:81-90. [PMID: 30122853 PMCID: PMC6071342 DOI: 10.4103/meajo.meajo_6_18] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE: The purpose of this study is to evaluate patients with uveal metastasis based on primary tumor site. METHODS: Retrospective analysis from Wills Eye Hospital, Philadelphia, PA, USA, for uveal metastasis clinical features and outcomes based on the primary tumor site. RESULTS: There were 2214 uveal metastases diagnosed in 1111 consecutive patients. The demographics included mean age of 60 years (median 61 years), Caucasian race (88%), and female gender (64%). The tumor was unilateral (82%) and primary site was established before uveal metastasis (67%). The primary tumor originated in the breast (37%), lung (26%), kidney (4%), gastrointestinal (GI) tract (4%), cutaneous melanoma (2%), lung carcinoid (2%), prostate (2%), thyroid (1%), pancreas (1%), other sites (3%), and unknown (16%). Comparative analysis of the 5 most common primary sites (breast, lung, kidney, GI tract, and cutaneous melanoma), revealed metastasis at mean age (57, 62, 66, 61, 59 years), as unilateral tumor (74%, 86%, 85%, 93%, 85%), with mean number of metastasis/eye (1.9, 1.7, 1.0, 1.1, 2.0), and in females (99%, 46%, 26%, 25%, 30%). Choroidal metastases measured mean base (9.3, 10.2, 9.1, 11.0, 7.3 mm), mean thickness (2.4, 3.6, 4.4, 4.0, 2.9 mm), and demonstrated predominant color yellow (94%, 91%, 56%, 97%, 36%). Of the 769 patients with documented follow-up, mean patient survival was poor (22.2, 11.5, 8.6, 12.4, 11.4 months) and Kaplan–Meier analysis revealed 3-year survival (33%, 19%, 0%, 14%, 21%) and 5-year survival (24%, 13%, 0%, 14%, 21%). The worst survival was found in patients with pancreatic metastasis (mean 4.2 months) and best survival with lung carcinoid (92% at 5 years). CONCLUSION: In a tertiary referral service, uveal metastasis originates from cancer in the breast, lung, kidney, GI tract, cutaneous melanoma, or others. Overall prognosis is poor with 5-year survival at 23% and worst survival with pancreatic metastasis whereas best survival with lung carcinoid metastasis.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - R Joel Welch
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kunal Malik
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Luis A Acaba-Berrocal
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Evan B Selzer
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer H Newman
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eileen L Mayro
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Meredith A Spencer
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark P McGarrey
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Austen N Knapp
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander E Graf
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alex J Altman
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sean P Considine
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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19
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Hidaka T, Chuman H, Nao-I N. A Case Report of Intravitreal Bevacizumab for Iris Metastasis of Small Cell Lung Carcinoma with Neovascular Glaucoma. Case Rep Ophthalmol 2018; 9:401-404. [PMID: 30283326 PMCID: PMC6167676 DOI: 10.1159/000492713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 08/07/2018] [Indexed: 02/01/2023] Open
Abstract
A 79-year-old man who had been diagnosed with small cell lung carcinoma (SCLC) complained of right ocular pain and blurred vision. His right intraocular pressure (IOP) was 30 mm Hg, and anterior chamber cells and multiple grayish white iris masses associated with peripheral anterior synechia (PAS) and neovascularization of the right iris were observed. We presumed that the iris masses were iris metastasis of SCLC. Despite therapy with topical eye drops and oral acetazolamide, the IOP was poorly controlled, so we injected intravitreal bevacizumab into his right eye for neovascular glaucoma. Neovascular glaucoma disappeared rapidly, but the IOP did not improve because of total PAS. To our knowledge, there is only one report of the use of intravitreal bevacizumab for SCLC metastasis in that eye and they reported that intravitreal injection resulted in successful short-term regression of presumed iris metastasis and improved control of secondary neovascular glaucoma, and the case had over one-half PAS. The previous report and our results suggest that secondary neovascular glaucoma with iris metastasis may be controlled by early intravitreal bevacizumab injection.
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Affiliation(s)
- Takako Hidaka
- Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hideki Chuman
- Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Nobuhisa Nao-I
- Department of Ophthalmology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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20
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Yoshikawa T, Miyata K, Nakai T, Ohbayashi C, Kaneko M, Ogata N. Iris metastasis preceding diagnosis of gastric signet ring cell adenocarcinoma: a case report. BMC Ophthalmol 2018; 18:125. [PMID: 29801472 PMCID: PMC5970520 DOI: 10.1186/s12886-018-0795-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background A case of iris metastasis preceding the diagnosis of gastric signet ring cell adenocarcinoma is very rare. To report the findings in a patient who presented with an iris tumor that was later identified to have metastasized from a gastric signet ring cell adenocarcinoma. Case presentation A-74-year-old woman presented with visual disturbance and an increased intraocular pressure (IOP) in the right eye. She had no history of systemic cancer. She was initially diagnosed with acute iritis from diabetes mellitus and secondary glaucoma. She underwent trabeculectomy because of the uncontrolled IOP. After the IOP was controlled, she presented thick iris with corectopia, iris hemorrhage, and white, frog spawn-like mass resembling fibrin in the anterior chamber. An analysis of an iris biopsy suggested that the iris mass was an adenocarcinoma. Examination by esophagogastroduodenoscopy revealed advanced gastric signet ring cell adenocarcinoma as the primary source for the iris tumor. Conclusions We recommend that patients with acute iritis with atypical iris mass resembling fibrin and secondary glaucoma should be examined comprehensively for systemic tumors.
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Affiliation(s)
- Tadanobu Yoshikawa
- Department of Ophthalmology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Kimie Miyata
- Department of Ophthalmology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University School of Medicine, Nara, Japan
| | - Miki Kaneko
- Department of Internal Medicine, Kokuho Central Hospital, Nara, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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21
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Métastase irienne d’un carcinome prostatique : à propos d’un cas. J Fr Ophtalmol 2018; 41:e63-e65. [DOI: 10.1016/j.jfo.2017.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 10/17/2022]
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22
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Alacacioǧlu A, Öztop İ, Fidan F, Akkoçlu A, Kargi A, Osma E, Ada E, Yilmaz U. Diabetes Insipidus Caused by Pituitary Gland Metastasis Accompanied by Iris Metastasis of Small Cell Lung Cancer: Case Presentation and Review of the Literature. TUMORI JOURNAL 2018; 94:765-8. [DOI: 10.1177/030089160809400524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Metastasis to the pituitary gland and iris is rarely seen in cancer patients. Breast cancer and lung cancer are the most common tumors that metastasize to these sites. Most lung cancer patients have non-small cell lung cancer and metastasis of small cell lung cancer to the pituitary gland and iris have been very rarely reported in the literature. Here we present a case of iris metastasis and pituitary gland metastasis which caused diabetes insipidus in a patient with small cell lung cancer.
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Affiliation(s)
- Ahmet Alacacioǧlu
- Institute of Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - İlhan Öztop
- Institute of Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Fatma Fidan
- Department of Chest Disease, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Atila Akkoçlu
- Department of Chest Disease, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Aydanur Kargi
- Department of Pathology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Emine Osma
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Emel Ada
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Uǧur Yilmaz
- Institute of Oncology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Abstract
In this report, a case of ocular scleral metastasis was reported in a patient with a past history of esophageal squamous cell carcinoma. The patient was a 58-year-old male who was admitted to Urmia Imam Khomeini Hospital, Urmia, Iran, 8 years ago with progressive dysphasia. Seven years after initial diagnosis and treatment of esophageal cancer, the patient had no signs or symptoms of the disease. But 2 months ago, he was referred to the hospital due to ocular swelling, redness and watering. Pathologic examination of the excised lesion at Farabi Hospital reported metastasis of squamous cell carcinoma to the connective tissue of the sclera.
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24
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Chen Y, Hu Y. Photodynamic Therapy for an iris metastasis from pulmonary adenocarcinoma. Photodiagnosis Photodyn Ther 2017; 20:246-247. [DOI: 10.1016/j.pdpdt.2017.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/15/2022]
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Georgalas I, Petrou P, Papaconstantinou D, Brouzas D, Koutsandrea C, Kanakis M. Iris cysts: A comprehensive review on diagnosis and treatment. Surv Ophthalmol 2017; 63:347-364. [PMID: 28882598 DOI: 10.1016/j.survophthal.2017.08.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 08/26/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
Iris cysts, both primary and secondary, are a diagnostic and treatment challenge. Primary cysts arise either from the iris pigment epithelium or the iris stroma. Posterior pigment epithelial cysts are subdivided according to their location as central, midzonal, and peripheral. Iris stromal cysts are classified either as congenital or acquired. Free-floating cysts are usually dislodged pigment epithelial cysts. Secondary cysts are classified according to the underlying cause as implantation cysts, drug-induced, uveitic, tumor-induced, parasitic, or as cysts associated with systemic disorders. Differential diagnosis is based on the clinical presentation and imaging. Ultrasound biomicroscopy is the gold standard for the imaging of iris cysts, combining excellent resolution with sufficient tissue penetration. Treatment of iris cysts depends largely on whether they become symptomatic or not. Symptoms include obstruction of the visual axis, corneal decompensation, secondary uveitis, and secondary glaucoma. Treatment options cover a range from simple observation to fine-needle aspiration (with or without intracystic injection of absolute alcohol or antimitotic agents), laser (argon, Nd:YAG), or surgical excision. In the past, the prevailing notion was that of a radical surgical intervention in the form of iridectomy or iridocyclectomy. Given the high rate of recurrence, a stepwise conservative approach is currently favored by most clinicians.
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Affiliation(s)
- Ilias Georgalas
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece.
| | - Petros Petrou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Dimitrios Papaconstantinou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Dimitrios Brouzas
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Chrysanthi Koutsandrea
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Menelaos Kanakis
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
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Liu SL, Nie YH, He T, Yan XX, Xing YQ. Iris metastasis as the first sign of small cell lung cancer: A case report. Oncol Lett 2017; 13:1547-1552. [PMID: 28454289 PMCID: PMC5403398 DOI: 10.3892/ol.2017.5648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/16/2016] [Indexed: 11/24/2022] Open
Abstract
The current study documents an unusual case of iris metastasis as the first sign of small cell lung cancer (SCLC) and reviews the relevant literature to increase understanding and awareness of this rare condition. A 59-year-old male chronic smoker presented with a painful and red right eye without any disturbance of vision. The patient also complained of associated chronic cough and anorexia. Upon examination, an exfoliative, pinkish-white lesion of the right iris was observed. A systemic work-up was performed, which incidentally detected metastatic SCLC in the lower lobe of the right lung and was confirmed by histopathological examination. A thorough evaluation demonstrated no organ metastases, except in the iris. Following the failure of conservative approaches, the eye had to be enucleated. The clinical features, treatment and prognosis of this condition are briefly reviewed and the results of contrast-enhanced ultrasound (CEUS) examination observed in this case are presented. Despite their rarity, iris lesions should be considered as possible manifestations of underlying malignancies. Imaging techniques, particularly CEUS, may aid the detection, diagnosis and monitoring of such lesions.
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Affiliation(s)
- Shi-Liang Liu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yu-Hong Nie
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Tao He
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xi-Xi Yan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yi-Qiao Xing
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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28
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Une métastase de l’iris révélée par une diplopie monoculaire. J Fr Ophtalmol 2016; 39:e275-e277. [DOI: 10.1016/j.jfo.2015.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 11/11/2015] [Accepted: 11/13/2015] [Indexed: 11/22/2022]
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Das C, Shields CL. Radiotherapy for iris metastasis from esophageal carcinoma: A series of three cases. Oman J Ophthalmol 2016; 9:93-6. [PMID: 27433035 PMCID: PMC4932802 DOI: 10.4103/0974-620x.184526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Description of three cases of metastatic esophageal carcinoma to the iris and focus on management strategies. Methods: A 48-year-old man (Case 1) with previously treated stage IV esophageal carcinoma presented with blurred vision in the left eye (OS) for 3 weeks. Initial fine needle aspiration biopsy (FNAB) was negative for malignant cells, so incisional biopsy was performed and confirmed metastatic carcinoma. A 53-year-old man (Case 2) with previously treated stage III esophageal cancer experienced 2 months of pain and 1 month of blurred vision OS. Documented tumor growth suggested esophageal carcinoma metastasis. A 65-year-old man (Case 3) with previously treated stage IV esophageal carcinoma developed hyphema in the right eye (OD), and FNAB confirmed metastatic carcinoma. Results: Case 1 was treated with external beam radiotherapy (EBRT), delivered over 16 days which resulted in complete tumor regression. Case 2 received stereotactic body radiotherapy (SBRT) over 21 days leading to complete tumor regression. Case 3 was treated with plaque radiotherapy over 4 days, resulting in complete tumor regression. Conclusions: In all three cases, radiotherapy was employed, and enucleation was avoided. Plaque radiotherapy achieved tumor control in a shorter period of time (4 days) compared to EBRT (16 days) or SBRT (21 days). Knowing the short life expectancy of these patients, plaque radiotherapy appears most favorable.
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Affiliation(s)
- Chandana Das
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol L Shields
- The Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Celebi ARC, Kilavuzoglu AE, Altiparmak UE, Cosar CB, Ozkiris A. Iris metastasis of gastric adenocarcinoma. World J Surg Oncol 2016; 14:71. [PMID: 26957317 PMCID: PMC4782568 DOI: 10.1186/s12957-016-0840-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/05/2016] [Indexed: 11/12/2022] Open
Abstract
Background Iris metastasis in patients with gastric cancer is extremely rare. Herein, it is aimed to report on a patient with gastric adenocarcinoma and iris metastasis. Case presentation A 65-year-old patient with the history of gastric cancer was admitted for eye pain and eye redness on his left eye. There was ciliary injection, severe +4 cells with hypopyon in the anterior chamber and a solitary, friable, yellow-white, fleshy-creamy vascularized 2 mm × 4 mm mass on the upper nasal part of the iris within the left eye. The presented patient’s mass lesion in the iris fulfilled the criteria of the metastatic iris lesion’s appearance. The ocular metastasis occurred during chemotherapy. Conclusions Iris metastasis can masquerade as iridocyclitis with pseudohypopyon or glaucoma. In patients with a history of gastric cancer that present with an iris mass, uveitis, and high intraocular pressure, ocular metastasis of gastric cancer should be a consideration.
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Affiliation(s)
| | | | | | - C Banu Cosar
- Acibadem University School of Medicine, Istanbul, Turkey
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Sakellakis M, Peroukides S, Iconomou G, Kalofonos H. Iris Metastasis in a Patient With Small Cell Lung Cancer: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e21522. [PMID: 27257509 PMCID: PMC4888847 DOI: 10.5812/ircmj.21522] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 03/30/2015] [Accepted: 05/08/2015] [Indexed: 11/22/2022]
Abstract
Introduction Small cell carcinoma constitutes the most aggressive type of lung cancer, with the greatest propensity for early disseminated disease. Although commonly neglected due to its rarity and the presence of other comorbidities, cases of iris metastasis from small cell lung cancer have been reported in the literature. Case Presentation We present the case of a 76-year-old female. Once diagnosed, the patient already had disseminated disease with metastatic foci found in the spleen, liver, and brain. The patient received six cycles of combination carboplatin/etoposide chemotherapy, followed by cranial irradiation. After an initial response, two months after the completion of cranial irradiation, the patient complained of visual impairment and was referred to an ophthalmologist. A diagnosis of secondary glaucoma was made, caused by metastasis to the left iris. Conclusions Physicians should be aware of this rare site of metastasis. Early diagnosis is of paramount importance in order to effectively prevent the significant morbidity this condition can cause if left untreated.
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Affiliation(s)
- Minas Sakellakis
- Division of Oncology, Department of Medicine, University Hospital, Patras Medical School, University of Patras, Rion 26504, Patras, Greece
- Corresponding Author: Minas Sakellakis, Division of Oncology, Department of Medicine, University Hospital of Patras, Rion 26504, Greece. Tel: +30-2610999535, Fax: +30-2610994645, E-mail:
| | - Stavros Peroukides
- Division of Oncology, Department of Medicine, University Hospital, Patras Medical School, University of Patras, Rion 26504, Patras, Greece
| | - Gregoris Iconomou
- Division of Oncology, Department of Medicine, University Hospital, Patras Medical School, University of Patras, Rion 26504, Patras, Greece
| | - Haralabos Kalofonos
- Division of Oncology, Department of Medicine, University Hospital, Patras Medical School, University of Patras, Rion 26504, Patras, Greece
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Intravitreal Ranibizumab as Palliative Therapy for Iris Metastasis Complicated With Refractory Secondary Glaucoma. J Glaucoma 2016; 25:e53-5. [DOI: 10.1097/ijg.0000000000000163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martin V, Cuenca X, Lopez S, Albertini AF, Lang P, Simon JM, Hémery CG, Feuvret L, Mazeron JJ. Iris metastasis from prostate carcinoma: A case report and review of the literature. Cancer Radiother 2015; 19:331-3. [DOI: 10.1016/j.canrad.2014.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 12/15/2014] [Accepted: 12/24/2014] [Indexed: 11/25/2022]
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Iris metastasis from esophageal squamous cell carcinoma: A case report. Oncol Lett 2015; 10:790-792. [PMID: 26622571 DOI: 10.3892/ol.2015.3255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 05/12/2015] [Indexed: 11/05/2022] Open
Abstract
Carcinoma metastatic to the eye is a rare condition, typically associated with a poor prognosis. Breast and lung cancers are the most common sources of intraocular metastases, and the majority of metastatic lesions involve the posterior uvea, with <8% of reported cases arising in the iris. Intraocular metastasis as the presenting form of esophageal carcinoma is highly uncommon. In the present report, a rare case of metastatic iris tumor resulting from esophageal squamous cell carcinoma is discussed. A 64-year-old patient presented with a progressively distending pain in the right eye, with associated blurred vision. Local and systemic evaluation was performed, followed by treatment. Multiple examinations identified a neoplasm in the right iris and postoperative pathology revealed that the iris lesion was a metastasis of esophageal squamous cell cancer origin. The patient was treated with adjuvant radiation. To the best of our knowledge, this was only the second reported case of esophageal squamous cell carcinoma metastasizing to the iris.
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Ophthalmic Metastasis of Breast Cancer and Ocular Side Effects from Breast Cancer Treatment and Management: Mini Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:574086. [PMID: 26078956 PMCID: PMC4442260 DOI: 10.1155/2015/574086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/01/2015] [Accepted: 04/12/2015] [Indexed: 11/18/2022]
Abstract
Breast cancer is one of the most common malignant diseases occurring in women, and its incidence increases over the years. It is the main site of origin in ocular metastatic disease in women, and, due to its hematogenous nature of metastatic spread, it affects mainly the uveal tissue. The purpose of this paper is to summarize the clinical manifestations of the breast cancer ocular metastatic disease, alongside the side effects of the available treatment options for the management and regression of the systematic and ophthalmic disease.
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Kinoshita Y, Takasu K, Kobayashi TK, Yuri T, Tsubura A, Shikata N. Diagnosis of intraocular lesions using vitreous humor and intraocular perfusion fluid cytology: Experience with 83 Cases. Diagn Cytopathol 2014; 43:353-9. [DOI: 10.1002/dc.23222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 10/07/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Yuichi Kinoshita
- Department of Pathology II; Kansai Medical University; Hirakata Osaka Japan
- Division of Diagnostic Cytopathology and Histopathology; Kansai Medical University, Takii Hospital; Moriguchi Osaka Japan
| | - Kosho Takasu
- Division of Diagnostic Cytopathology and Histopathology; Kansai Medical University, Takii Hospital; Moriguchi Osaka Japan
- Division of Surgical Pathology, Hyogo Prefectural Amagasaki Hospital; Amagasaki Hyogo Japan
| | - Tadao K Kobayashi
- Cancer Education and Research Center, Osaka University Graduate School of Medicine and Health Science; Osaka Japan
| | - Takashi Yuri
- Department of Pathology II; Kansai Medical University; Hirakata Osaka Japan
| | - Airo Tsubura
- Department of Pathology II; Kansai Medical University; Hirakata Osaka Japan
| | - Nobuaki Shikata
- Division of Diagnostic Cytopathology and Histopathology; Kansai Medical University, Takii Hospital; Moriguchi Osaka Japan
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Proton beam therapy for presumed and confirmed iris melanomas: a review of 36 cases. Graefes Arch Clin Exp Ophthalmol 2014; 252:1515-21. [PMID: 25038910 DOI: 10.1007/s00417-014-2735-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/23/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND To report the clinical features and outcomes of iris melanomas treated by proton beam therapy. MATERIALS AND METHODS A retrospective study was conducted at the Croix-Rousse University Hospital of Lyon, Department of Ophthalmology, in 36 patients treated by proton beam therapy for presumed (n = 29) and confirmed (n = 7) iris melanomas between July 1997 and October 2010. Ciliary body melanomas with iris involvement were excluded. The patients' mean age was 54.4 years (range, 22-82 years). The average tumor diameter was 3.8 mm (range, 2.5-8.0). The iridocorneal angle was invaded by the tumor in 47% of cases (n = 17), the ciliary body in 17% of cases (n = 6), and the sclera in 3% (n = 1). Raised intraocular pressure was present before treatment in 11.1 % of cases (n = 4). Tumor biopsy was performed in 19% of cases (n = 7). Four patients had undergone an initial incomplete surgical excision of tumor before radiotherapy. Surgical preparation of the eye with tantalum ring positioning had been performed in all cases 3-4 weeks before irradiation. The prescribed dose was 60 Cobalt Gray Equivalent (CGE) of proton beam radiotherapy delivered in four fractions on four consecutive days. RESULTS The median follow-up was 50 months (mean 60.5, range 15-136). One patient (2.7%) was lost to follow-up. None of the patients showed tumor progression, local recurrence, or metastasis. None of the patients required secondary enucleation. Cataract was developed in 62% of patients, glaucoma in two cases (6%) after irradiation, and hyphema with the aggravation of pre-existing glaucoma in one patient. No patients developed neovascular glaucoma. CONCLUSIONS Proton beam therapy appears to be the treatment of choice for the conservative treatment of iris melanomas with excellent tumor control and an acceptable rate of complications. Longer follow-up studies on a larger series is necessary to consolidate these results.
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Shields CL, Shields PW, Manalac J, Jumroendararasame C, Shields JA. Review of cystic and solid tumors of the iris. Oman J Ophthalmol 2014; 6:159-64. [PMID: 24379549 PMCID: PMC3872564 DOI: 10.4103/0974-620x.122269] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Iris tumors are broadly classified into cystic or solid lesions. The cystic lesions arise from iris pigment epithelium (IPE) or iris stroma. IPE cysts classically remain stable without need for intervention. Iris stromal cyst, especially those in newborns, usually requires therapy of aspiration, possibly with alcohol-induced sclerosis, or surgical resection. The solid tumors included melanocytic and nonmelanocytic lesions. The melanocytic iris tumors include freckle, nevus (including melanocytoma), Lisch nodule, and melanoma. Information from a tertiary referral center revealed that transformation of suspicious iris nevus to melanoma occurred in 4% by 10 years and 11% by 20 years. Risk factors for transformation of iris nevus to melanoma can be remembered using the ABCDEF guide as follows: A=age young (<40 years), B=blood (hyphema) in anterior chamber, C=clock hour of mass inferiorly, D=diffuse configuration, E=ectropion, F=feathery margins. The most powerful factors are diffuse growth pattern and hyphema. Tumor seeding into the anterior chamber angle and onto the iris stroma are also important. The nonmelanocytic iris tumors are relatively uncommon and included categories of choristomatous, vascular, fibrous, neural, myogenic, epithelial, xanthomatous, metastatic, lymphoid, leukemic, secondary, and non-neoplastic simulators. Overall, the most common diagnoses in a clinical series include nevus, IPE cyst, and melanoma. In summary, iris tumors comprise a wide spectrum including mostly iris nevus, IPE cyst, and iris melanoma. Risk factors estimating transformation of iris nevus to melanoma can be remembered by the ABCDEF guide.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
| | - Patrick W Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
| | - Janet Manalac
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
| | | | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA., USA
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Abstract
PURPOSE Lung cancer is the leading cause of cancer-related death in North America. It is often diagnosed at an advanced stage, lending to a poor prognosis. Symptoms of lung cancer often do not present until more advanced stages. Common sites of lung cancer metastasis are the bones, liver, and brain. The etiology of eye masses ranges from the relatively benign to those with tremendous risk of morbidity, and the differentiation is often difficult clinically. This case highlights the importance of more detailed workup, including biopsy, to determine the exact nature of the lesion. CASE REPORT A 50-year-old white man was referred for evaluation of a "bump" on his right upper eyelid. He had noticed it for 1 month and noted enlargement during the past 2 weeks. He also reported that he had been smoking about one pack per day since 1969. External examination was remarkable for a 1.5-cm nodule pushing up from under the right upper lid. When the lid was everted, there was a 0.9-cm red and black vascularized sessile lesion on the palpebral conjunctiva. The patient was referred to an oculoplastics specialist to rule out a malignant or metastatic conjunctival neoplasm. The oculoplastics service performed an excisional biopsy, and the pathologic examination showed a poorly differentiated and highly aggressive non-small-cell lung cancer (NSCLC). After systemic evaluation, he was diagnosed as having stage IV NSCLC, with metastases to the right eyelid, brain, liver, and right lung. He underwent multiple radiotherapy sessions. He died 5 months after our initial examination. CONCLUSIONS Stage IV NSCLC is incurable, and its treatment is often palliative. Conjunctival metastasis of stage IV NSCLC is rare, and it is clinically difficult to differentiate eyelid tumors as benign or concerning by examination alone. This case highlights the importance of a thorough history, referral, proper imaging, and biopsy to diagnose a metastatic neoplasm in a patient at high risk for cancer.
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Courjaret JC, Denis D, Rojat-Habib MC, Barlési F, Matonti F. [Ocular hypertension secondary to iridocorneal angle metastasis of an anaplastic bronchial carcinoma]. J Fr Ophtalmol 2014; 37:e61-3. [PMID: 24657216 DOI: 10.1016/j.jfo.2013.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 09/09/2013] [Accepted: 09/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- J-C Courjaret
- Service d'ophtalmologie, université d'Aix-Marseille, CHU hôpital Nord, 265, chemin de Bourrely, 13915 Marseille, France.
| | - D Denis
- Service d'ophtalmologie, université d'Aix-Marseille, CHU hôpital Nord, 265, chemin de Bourrely, 13915 Marseille, France
| | - M-C Rojat-Habib
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - F Barlési
- Service d'oncologie médicale et innovations, CHU hôpital Nord, 265, chemin de Bourrely, 13915 Marseille, France
| | - F Matonti
- Service d'ophtalmologie, université d'Aix-Marseille, CHU hôpital Nord, 265, chemin de Bourrely, 13915 Marseille, France
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Intravitreal bevacizumab for ocular metastasis of multiple myeloma. Optom Vis Sci 2014; 90:e236-40; discussion 1028. [PMID: 23811608 DOI: 10.1097/opx.0b013e31829caaf7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Multiple myeloma is the most common plasma cell tumor; however, ocular plasmacytomas are rare. Few cases of binocular metastasis have been reported. The authors review a case study using intraocular bevacizumab to treat secondary glaucoma and binocular metastasis from multiple myeloma. CASE REPORT A 59-year-old woman with a 13-month history of multiple myeloma was found to have a suspected masquerade syndrome OS and subsequently developed a neovascular glaucoma within 2 months. Intravitreal bevacizumab injection OS controlled the intraocular pressure and inhibited ocular metastasis. The methods of therapy administration in this case are consistent with procedures commonly used in clinical practice when using bevacizumab to treat other etiologies, such as choroidal neovascular membranes. Lost to follow-up until 2 months later, the patient presented with ocular metastasis OD with the same changes as observed OS. Conjunctival biopsy revealed subconjunctival plasmoma OD. After intravitreal bevacizumab injection, neovascular glaucoma OD was partly controlled. CONCLUSIONS Secondary ocular plasmacytoma, despite its rarity, should be considered in patients with multiple myeloma. Intravitreal bevacizumab injection may be a promising treatment for ocular metastases and associated secondary or neovascular glaucoma.
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Small-cell lung carcinoma metastasis to the iris - case presentation. Contemp Oncol (Pozn) 2013; 17:331-3. [PMID: 24596526 PMCID: PMC3934058 DOI: 10.5114/wo.2013.35288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/24/2012] [Accepted: 08/16/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction Metastatic tumors are the most common intraocular malignancies in adults. Anterior segment metastases account for about 7.2–14.1% of all intraocular metastatic tumors with those to the iris representing 3.6–7.8% of the cases. Breast and lung are the most frequent primary sites of metastasizing cancer. The aim of this study is to present the case of a 43-year-old patient with a rare small-cell lung carcinoma metastasis to the iris. Case report A patient with small-cell lung carcinoma and metastases in the brain who had been treated with chemo- and radiotherapy attended an outpatient clinic because of redness of her left eye. Based on the ophthalmological examination, a diagnosis of numerous metastatic tumors to the iris was made and the patient was referred for re-chemotherapy. Complete regression of the iris lesions was observed after 5 months but unfortunately two months later the patient died, due to progression of her systemic disease. Discussion Among lung cancers, adenocarcinomas are much more likely to produce distant metastases to the iris than small-cell carcinomas [4]. More than 50% of patients with small-cell lung carcinoma have metastases in the brain. The survival rate in cases of lung cancer with eye involvement is poor and approximates to 7 months. However, since there is a strong probability of angle involvement and subsequent secondary glaucoma, the early onset of treatment can improve the patient's quality of life during the terminal phase of the disease.
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Intravitreal bevacizumab for iris tumor metastasized from large cell neuroendocrine carcinoma of lung. Graefes Arch Clin Exp Ophthalmol 2012; 251:2243-5. [PMID: 23250479 DOI: 10.1007/s00417-012-2218-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/17/2012] [Accepted: 11/20/2012] [Indexed: 10/27/2022] Open
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Dhakal S, Lema GMC, Diloreto DA, Katz AW. Esophageal metastasis to the iris effectively palliated using stereotactic body radiation therapy and adjuvant intravitreal chemotherapy: case report and literature review. Case Rep Oncol 2012; 5:639-43. [PMID: 23275779 PMCID: PMC3531953 DOI: 10.1159/000345955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a case of isolated iris metastasis from esophageal adenocarcinoma that was successfully managed with local application of stereotactic body radiation therapy (SBRT) and adjunctive intravitreal therapy. A 53-year-old man with locally advanced esophageal adenocarcinoma achieved a complete clinical and radiographic response after surgery and chemotherapy. Four months later, he developed headache and decreased vision and was diagnosed with metastasis to the iris by slit-lamp examination. The decrease in vision was secondary to cystoid macular edema. The metastatic tumor and the patient's symptoms resolved after treatment with SBRT and intravitreal injections of bevacizumab and triamcinolone. We conclude that SBRT combined with intravitreal chemotherapy is an effective and well-tolerated palliative treatment for metastasis of esophageal adenocarcinoma to the iris.
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Affiliation(s)
- Sughosh Dhakal
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, N.Y., USA
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Fukui S, Takagi Y, Ozaki N, Nakahara Y, Akahane M, Okuma Y, Hosomi Y, Iguchi M, Okamura T, Hishima T, Shibuya M. Asymptomatic iris metastasis of small-cell lung cancer. Int Cancer Conf J 2012. [DOI: 10.1007/s13691-012-0026-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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