1
|
Babst N, Gniesmer S, Sonntag SR, Furashova O, Krestanova G, Heindl LM, Müller M, Grisanti S, Kakkassery V. [Clinical approach for solid intraocular metastases]. DIE OPHTHALMOLOGIE 2024:10.1007/s00347-024-02031-7. [PMID: 38649497 DOI: 10.1007/s00347-024-02031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Intraocular metastases arising from solid tumors are found in approximately 2% of patients with metastatic tumor diseases and are therefore more frequent than originally assumed. They often affect the uvea and are associated with a poor prognosis. Due to the difficult diagnosis and an inconsistent treatment regimen, ophthalmologists have a special responsibility here. OBJECTIVE This article gives a summary of the various types of intraocular metastases with respect to clinical features, diagnostics, treatment and prognosis as well as recommendations for follow-up care. METHODS A selective literature search was carried out on the topic of intraocular metastases using PubMed and Google Scholar. RESULTS Intraocular metastases most frequently affect the uvea, specifically the choroid. In most cases the underlying disease is breast or lung cancer, but other rarer primary tumors have also been reported in the literature. Metastatic lesions can show very different morphological manifestations but can be distinguished based on the corresponding structure of manifestation in the eye and with the aid of targeted staging, thus providing valid information on the type of primary tumor. The treatment is partly experimental and usually depends on the primary tumor and leading symptoms of the patient. A differentiation between a curative or palliative treatment situation must always be made. CONCLUSION Intraocular metastases are the most frequent intraocular tumor and are usually associated with a poor prognosis. Accurate diagnostics for finding the treatment as well as interdisciplinary collaboration and the presentation of the patient on the tumor board are essential.
Collapse
Affiliation(s)
- Neele Babst
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - Stefanie Gniesmer
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Svenja Rebecca Sonntag
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Olga Furashova
- Klinik für Augenheilkunde, Klinikum Chemnitz, Chemnitz, Deutschland
| | | | - Ludwig Maximilian Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - Martin Müller
- Klinik für Hämatologie, Onkologie und Immunologie, Klinikum Region Hannover, Hannover, Deutschland
| | - Salvatore Grisanti
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Vinodh Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
- Klinik für Augenheilkunde, Klinikum Chemnitz, Chemnitz, Deutschland
| |
Collapse
|
2
|
Fouad YA, Nowara M. BILATERAL CHOROIDAL METASTASIS WITH CONCURRENT UNILATERAL RHEGMATOGENOUS RETINAL DETACHMENT IN A PATIENT WITH STAGE IV BREAST CANCER. Retin Cases Brief Rep 2023; 17:635-638. [PMID: 37643055 DOI: 10.1097/icb.0000000000001259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE To describe an unusual case of bilateral choroidal metastasis with simultaneous rhegmatogenous retinal detachment in the right eye. METHODS Case Report. PATIENT A 65-year-old woman with Stage IV breast cancer and gradual deterioration of vision in the right eye. RESULTS Dilated fundus examination of the right eye revealed a large solitary choroidal mass with exudative retinal detachment and with an incidental discovery of a lower peripheral break with subretinal fluid, and the left eye revealed multiple choroidal masses. The diagnosis of bilateral CM was confirmed using optical coherence tomography. Pars plana vitrectomy with silicone oil injection was performed for the right eye followed by external beam radiotherapy to both choroids, which resulted in anatomical and visual success for 6 months. CONCLUSION Prompt ophthalmologic evaluation is a must in patients with advanced breast or lung malignancy with recent blurring of vision. External beam radiotherapy is a safe, available, relatively cheap, and effective means for managing CM. Choroidal metastasis with a concurrent vision-threatening pathology requiring intraocular surgery represents a dilemma, and the risks and benefits should be weighed carefully with proper counseling of the patient.
Collapse
Affiliation(s)
- Yousef A Fouad
- Al Mashreq Eye Center, Cairo, Egypt
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt; and
| | - Mohamed Nowara
- Al Mashreq Eye Center, Cairo, Egypt
- Department of Ophthalmology, Electricity Hospital, Cairo, Egypt
| |
Collapse
|
3
|
Mitamura M, Kase S, Hirooka K, Ishida S. Alterations of choroidal circulation and choroidal thickness before and after chemoradiotherapy in a case of metastatic choroidal tumor. BMC Ophthalmol 2023; 23:270. [PMID: 37312082 DOI: 10.1186/s12886-023-03026-9] [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: 08/29/2022] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Metastatic choroidal tumors are hematogenous intraocular metastases of malignant tumors in systemic organs; however, the details of choroidal circulation and morphological changes in the choroid are unknown. The aim of this study is to present a case of metastatic choroidal tumor and examine laser speckle flowgraphy (LSFG)-based choroidal circulation and central choroidal thickness (CCT) before and after chemoradiotherapy. CASE PRESENTATION A 66-year-old woman with a medical history of breast cancer 16 years ago was referred to our department struggling with blurred vision in her right eye. At the time of initial examination, her best-corrected visual acuity (BCVA) was 0.4 oculus dexter (OD) and 0.9 oculus sinister. Fundus revealed a yellowish-white choroidal elevated lesion measuring 8 papillary diameters with serous retinal detachment (SRD) in the posterior pole. Fluorescein angiography showed diffuse hyperfluorescence and fluorescent leakage due to SRD, and indocyanine green angiography demonstrated no abnormalities in the macula but hypofluorescence in the center of the tumor. Based on these clinical findings, she was diagnosed with metastatic choroidal tumor. After chemoradiotherapy, the metastatic choroidal tumor became scarred, and SRD disappeared. The rate of changes in macular blood flows assessed by mean blur rate on LSFG and CCT of her right eye were 33.8 and 32.8% decrease at 5 months after the initial visit, respectively. BCVA was 0.5 OD 27 months after the initial examination. CONCLUSION Chemoradiotherapy resulted in regression of the metastatic choroidal tumor and disappearance of SRD, with a decrease in central choroidal blood flow and CCT. The choroidal blood flow on LSFG could reflect an increased oxygen demand by cancer cells invading the choroid and substantial blood supply.
Collapse
Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan
| |
Collapse
|
4
|
Maheshwari A, Finger PT. Choroidal metastasis: Radiation and bevacizumab at presentation. Indian J Ophthalmol 2023; 71:2014-2019. [PMID: 37203075 PMCID: PMC10391475 DOI: 10.4103/ijo.ijo_1772_22] [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: 05/20/2023] Open
Abstract
Purpose To reveal early intervention outcomes for patients describing with choroidal metastasis. Methods A retrospective interventional case series on 27 eyes of 22 patients treated for choroidal metastasis with external beam radiation therapy (EBRT) With and without intravitreal injections. The prescribed radiation dose was a mean and median 30 Gy (range of 30-40 Gy in 180-200 cGy daily fractions). Outcome measures included change in tumor thickness, subretinal fluid, visual acuity, radiation oculopathy, and survival. Results Decreased vision was the most common presenting symptom (n = 20/27, 74%). Pre-treatment vision for subfoveal lesions was a mean 20/400, median 20/200, and range 20/40 to hand motions (HM). Pre-treatment vision for extrafoveal tumors were a mean 20/40, median 20/25, range 20/20 to counting fingers (CF) which improved to a mean 20/32, median 20/20, range 20/12.5 to 20/200. Local control, with ultrasonographic height regression (44.5%; mean: 2.7-1.5 mm), was observed in all eyes at mean follow-up of 16 months (range: 1-72 months). Intravitreal anti-vascular endothelial growth factor (anti-VEGF) was given in nine cases (n = 9/27, 33%) to slow the growth of the metastasis and suppress their exudative detachments and to treat radiation maculopathy in 10 cases (n = 10/27, 37%). Late radiation complications included keratoconjunctivitis sicca in four cases (n = 4/27, 15%), exposure keratopathy in two cases (n = 2/27, 7%), and radiation retinopathy in 10 cases (n = 10/27, 37%). Of the 23 phakic eyes, four (n = 4, 17%) developed cataract. Conclusion Radiation therapy with or without intravitreal anti-VEGF injections was a safe and effective treatment for choroidal metastasis. It was associated with local tumor control, reduction of secondary retinal detachments, and vision preservation.
Collapse
Affiliation(s)
- Abhilasha Maheshwari
- Department of Ocular Tumor, Orbital Disease and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, USA
| | - Paul T Finger
- Department of Ocular Tumor, Orbital Disease and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, USA
| |
Collapse
|
5
|
Stoyukhina AS. [Multimodal algorithm for differential diagnosis of tumors and tumor-like diseases of the ocular fundus]. Vestn Oftalmol 2023; 139:56-62. [PMID: 37144370 DOI: 10.17116/oftalma202313903256] [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: 05/06/2023]
Abstract
Diagnosing pathologies of the ocular fundus and performing differential diagnosis of intraocular tumors along with conventional ophthalmoscopy can involve additional visualization methods such as ultrasonography, fluorescein angiography and optical coherence tomography (OCT). Many researchers note the importance of employing a multimodal approach in differential diagnosis of intraocular tumors, but there is no universally established algorithm for a rational choice of both the combination of visualizing methods, and the sequence of their application with consideration of the ophthalmoscopy findings and the results of first-line diagnostic methods. The article presents author's own multimodal algorithm developed for differential diagnosis of tumors and tumor-like diseases of the ocular fundus. This approach involves the use of such methods as OCT and Multicolor fluorescence imaging, with exact sequence and combination determined on the basis of ophthalmoscopy and ultrasonography findings.
Collapse
Affiliation(s)
- A S Stoyukhina
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| |
Collapse
|
6
|
Zamora C, Castillo M, Puac-Polanco P, Torres C. Oncologic Emergencies in the Head and Neck. Radiol Clin North Am 2023; 61:71-90. [DOI: 10.1016/j.rcl.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
7
|
Hage DG, Wahab CH, Kheir WJ. Choroidal sarcoid granuloma: a case report and review of the literature. J Ophthalmic Inflamm Infect 2022; 12:31. [PMID: 36173484 PMCID: PMC9521566 DOI: 10.1186/s12348-022-00309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Choroidal sarcoid granulomas are often diagnosed in patients without a prior history of sarcoidosis. They are often mistaken for choroidal metastasis, choroidal nevi, amelanotic choroidal melanomas, and uveal lymphomas; however, are easily treatable when accurately identified. Observations We searched PubMed, Medline, and Scopus for English-Language case reports published before September 2021. Additionally, we presented a case of a 45-year-old woman with a right-sided amelanotic choroidal mass whose diagnosis was delayed by a COVID-19 infection. Of the 26 cases reported in the literature, 46% were female, 38% were African American, and 19% had bilateral involvement. There was a mean age of 42.15 years and a mean follow-up period of 27 months. The most common complaint was of a progressive, painless blurring of vision, and only five patients had been previously diagnosed with sarcoidosis. The choroidal granulomas were typically described as yellow lesions, single or multiple, found temporal to or at the macula. Most patients were administered steroids, with 69% receiving them systemically, 5% topically, and 8% locally with a triamcinolone injection. All patients reported symptomatic improvement at their final follow-up with resolution of the mass in 65% of patients and improved visual acuity in 76%. Conclusion Primary testing including fundoscopy, fluorescein angiography, fundus autofluorescence, A/B-scan, and OCT are useful for diagnosis, differentiation from other choroidal lesions, and monitoring treatment response. Steroids are a mainstay of treatment for sarcoidosis and are effective at treating choroidal granulomas. Therefore, early recognition and diagnosis of choroidal granulomas is imperative as treatment can be curative and sight-sparing.
Collapse
Affiliation(s)
- Dany G Hage
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.,Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Charbel H Wahab
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wajiha J Kheir
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.
| |
Collapse
|
8
|
Romero BF, Iglesias-García M, Gil-Molino M, Gómez L, Galapero J, Parejo C, Cuervo MM. BILATERAL UVEITIS IN A HORSE WITH A RENAL CARCINOMA. J Equine Vet Sci 2022; 118:104111. [PMID: 36031033 DOI: 10.1016/j.jevs.2022.104111] [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: 07/12/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022]
Abstract
Equine uveitis is a common eye disease that affect horses from different breeds, ages and genders. Uveitis has been described as inflammation of the uvea secondary immunomediated processes or eye trauma. Renal cell carcinoma (RCC) is the most common tumor that can affect the equine kidneys. The present case describe a horse that was referred to the Veterinary Teaching Hospital of the University of Extremadura with bilateral uveitis. The horse was treated for the primary complain but the horse collapse and die during hospitalization. At necropsy, a tumoral mass in kidney with extensive in other locations as liver, lung, and lymphonodes was described. Within peritoneal cavity a pedunculated mass has been observed next to severe hemoperitoneum. Histologically, primary neoplasia and its metastasis was composed by a proliferation of epithelial cells, which were organized in a tubulopapillary pattern, similarly in the ciliary body this pattern was also observed. The diagnosis of renal carcinoma with metastasis in both uveal structures was performed. Immunomarker with CD10, AE1-AE3 and vimentin evidenced the same origin of primary neoplasia. Uveal metastasis should be included as differential diagnoses in aged horses with uveitis that not response with the medical treatment.
Collapse
Affiliation(s)
- B Fuentes Romero
- Veterinary Teaching hospital of the University of Extremadura, Avenida de la Universidad SN. 10071 Cáceres, España
| | - M Iglesias-García
- Veterinary Teaching hospital of the University of Extremadura, Avenida de la Universidad SN. 10071 Cáceres, España
| | - M Gil-Molino
- Veterinary Teaching hospital of the University of Extremadura, Avenida de la Universidad SN. 10071 Cáceres, España
| | - L Gómez
- Animal Medicine department, pathological anatomy unit, University of Extremadura. Avenida de la Universidad SN. 10071 Cáceres, España
| | - J Galapero
- Animal Medicine department, pathological anatomy unit, University of Extremadura. Avenida de la Universidad SN. 10071 Cáceres, España
| | - C Parejo
- Hospital Espírito Santo E.P.E, Èvora Serviço de Anatomia Patológica Largo Senhor da Pobreza s/n 7000, Évora
| | - M Martín- Cuervo
- Veterinary Teaching hospital of the University of Extremadura, Avenida de la Universidad SN. 10071 Cáceres, España.
| |
Collapse
|
9
|
Aichouni N, Ziani H, Kamaoui I, Nasri S, Skiker I. Choroidal Metastasis Revealing a Lung Adenocarcinoma: A Case Report. Cureus 2021; 13:e18968. [PMID: 34815909 PMCID: PMC8606043 DOI: 10.7759/cureus.18968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/05/2022] Open
Abstract
Choroidal metastasis is the most common malignant intraocular tumor. Its diagnosis in a patient with known lung cancer is usually easy. However, without any context of already known cancer, further elements are needed to guide the diagnosis. We report the case of a 47-year-old patient with a history of smoking who presented a choroidal metastasis of left lower pulmonary lobe adenocarcinoma discovered on imaging. Imaging techniques, mainly ultrasonography, CT scan, and MRI can help guide the diagnosis of choroidal metastasis even in the absence of a known origin initially.
Collapse
Affiliation(s)
- Narjisse Aichouni
- Radiology, Mohammed VI University Hospital, Oujda, MAR.,Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Hamid Ziani
- Radiology, Mohammed VI University Hospital, Oujda, MAR.,Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Imane Kamaoui
- Radiology, Mohammed VI University Hospital, Oujda, MAR.,Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Siham Nasri
- Radiology, Mohammed VI University Hospital, Oujda, MAR.,Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, MAR
| | - Imane Skiker
- Radiology, Mohammed VI University Hospital, Oujda, MAR
| |
Collapse
|
10
|
Li Z, Gao W, Tian YM, Xiao Y. Choroidal metastatic mucinous abscess caused by Pseudomonas aeruginosa: A case report. World J Clin Cases 2021; 9:9244-9254. [PMID: 34786411 PMCID: PMC8567527 DOI: 10.12998/wjcc.v9.i30.9244] [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: 05/26/2021] [Revised: 06/22/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pseudomonas aeruginosa (P. aeruginosa) is considered a common pathogenic bacterium. Choroidal metastatic mucinous abscess caused by P. aeruginosa is rarely reported.
CASE SUMMARY We describe the diagnostic and treatment processes of a case involving a complex choroidal space-occupying lesion. Our analyses of early clinical manifestations revealed a high possibility of choroidal melanoma, as indicated by the choroidal space-occupying lesion and uveitis. Further magnetic resonance imaging results revealed no positive evidence for the diagnosis of choroidal melanoma. The exact properties of the space-occupying lesion could not be ascertained prior to surgery. However, the lesion was subsequently confirmed as a metastatic abscess by diagnostic vitrectomy. The occupying lesion was found to occupy 75% of the vitreous cavity in the surgery. The entire white viscous tissue was completely removed, and the necrotic retina was cleaned up. After surgery, microbiological culture revealed mucoid P. aeruginosa, which was sensitive to a variety of antibiotics. The bacterial infection grew and disseminated towards the outside of the eye. After the fifth injection, the left eye was successfully retained.
CONCLUSION This is a peculiar case because a huge, local, space-occupying lesion had formed due to the dissemination of low-toxic mucinous P. aeruginosa in the blood from the lungs to the choroid. After surgical removal, the bacteria were able to re-grow; thus, local infection re-spread following surgery. The patient lost vision, but we managed to retain the full structure of the eyeball and eliminated the focus of infection.
Collapse
Affiliation(s)
- Zhao Li
- Ophthalmic Center, General Hospital of Xinjiang Military Region, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Wen Gao
- Ophthalmic Center, General Hospital of Xinjiang Military Region, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Yan-Ming Tian
- PLA Eye Center, General Hospital of Xinjiang Military Region, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Yun Xiao
- Ophthalmic Center, General Hospital of Xinjiang Military Region, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| |
Collapse
|