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OPHTHALMIC IMAGE
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 463

Isolated retinal metastasis from non-small cell lung cancer


Ocular Oncology Service , Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA

Date of Web Publication02-Jul-2021

Correspondence Address:
Dr. Basil K Williams Jr.
231 Albert Sabin Way, Suite 5414, Cincinnati - 45267-0527, OH
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_3195_20

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How to cite this article:
Storey PP, Williams Jr. BK, Shields CL. Isolated retinal metastasis from non-small cell lung cancer. Indian J Ophthalmol Case Rep 2021;1:463

How to cite this URL:
Storey PP, Williams Jr. BK, Shields CL. Isolated retinal metastasis from non-small cell lung cancer. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Jul 26];1:463. Available from: https://www.ijoreports.in/text.asp?2021/1/3/463/320112



A 73-year-old white man with a past medical history of nonsmall cell lung carcinoma with metastases to the brain, treated with chemotherapy and stereotactic radiation 2 years prior was referred for an elevated white mass in his left eye. Best-corrected visual acuity was 20/60.

Fundus examination of the left eye revealed a white lesion with prominent intrinsic vessels and associated subretinal fluid, hemorrhage, and presumed subretinal seeds [Figure 1]a. B-scan ultrasonography demonstrated an abruptly elevated, echodense lesion measuring 3.4 mm in thickness and arising anterior to the choroid [Figure 1]b. Optical coherence tomography revealed a full-thickness retinal mass causing posterior shadowing that obscured visualization of the choroid [Figure 1]c. The subretinal fluid and presumed seeding noted on clinical examination were documented. In the setting of previous metastatic lung cancer, the findings were consistent with retinal metastasis. Magnetic resonance imaging of the brain and positron emission tomography-computed toography did not reveal recurrent primary disease or other foci of metastasis. The retinal tumor was treated with I-125 plaque radiotherapy with tumor apex dose of 35 Gy over 102 hours. Five months later, the tumor had completely regressed [Figure 1]d, and visual acuity improved to 20/40.
Figure 1: (a) Montage color photograph of the left eye showing a white retinal mass with intrinsic vasculature and surrounding subretinal fluid. Hemorrhage appears to be present in the inferior portion of subretinal fluid and yellow-white seeding vs exudation is noted most prominently along the superior margin of the subretinal fluid cuff (b) B-scan ultrasonography revealing an abruptly elevated retinal mass with a surrounding cuff of subretinal fluid. (c) Optical coherence tomography at the level of the retinal metastasis demonstrates a full thickness lesion with a hyperrefective anterior surface (arrow), posterior shadowing, adjacent subretinal fluid (asterisk) and presumed subretinal seeding (arrowhead) (d) Wide field fundus photograph documenting the post-radiation atrophic retinal appearance with resolved subretinal fluid

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Retinal metastasis from systemic cancer is rare with the largest series to date reporting only 8 cases over 40 years.[1] Control of the retinal metastasis can be achieved with local radiation, but death from other foci of metastasis generally occurs within 2 years.[1],[2],[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Support provided by the Eye Tumor Research Foundation, Philadelphia, PA (CLS).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shields CL, McMahon JF, Atalay HT, Hasanreisoglu M, Shields JA. Retinal metastasis from systemic cancer in 8 cases. JAMA Ophthalmol 2014;132:1303-8.  Back to cited text no. 1
    
2.
Coassin M, Ebrahimi KB, O'Brien JM, Stewart JM. Optical coherence tomography for retinal metastasis with unknown primary tumor. Ophthalmic Surg Lasers Imaging 2011;42 Online:e110-3.  Back to cited text no. 2
    
3.
Leys AM, Van Eyck LM, Nuttin BJ, Pauwels PA, Delabie JM, Libert JA. Metastatic carcinoma to the retina. Clinicopathologic findings in two cases. Arch Ophthalmol 1990;108:1448-52.  Back to cited text no. 3
    


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