Non-small cell lung cancer presenting with choroidal metastasis as first sign and showing good response to chemotherapy alone: a case report
Abhishek Singh
0
Parul Singh
2
Kamal Sahni
1
Preety Shukla
1
Vikas Shukla
3
Nirdosh K Pant
0
0
Department of Radiation and Clinical Oncology, Swami Rama Cancer Institute, UFHT Medical College
,
Haldwani, 263139
,
India
1
Department of Radiation Oncology, GSVM Medical College
,
Kanpur, 208002
2
Department of Ophthalmology, UFHT Medical College
,
Haldwani, 263139
,
India
3
Department of Neurosurgery, GSVM Medical College
,
Kanpur, 208002
,
India
Introduction: Metastatic tumors are the most common intra-ocular malignancies and choroid is by far the most common site for intra-ocular malignancies. Multiple foci are usually involved, and bilateral involvement is frequently seen. The primary sites for choroidal metastasis in decreasing order and by gender are: breast, lung, unknown primary, gastrointestinal and pancreas, skin melanoma and other rare sources in females, and lung, unknown primary, gastrointestinal and pancreas, prostate, kidney, skin melanoma and other rare sources in males. Available treatment options are external beam radiotherapy and plaque radiotherapy, while new methods like surgical resection, transpupillary thermotherapy and intravitreal chemotherapy offer promises for the future. The use of chemotherapy alone for choroidal metastases is not widely reported. Case presentation: We report the case of a 50-year-old Indian man who had a unilateral solitary lesion in his right eye. He was found to have an adenocarcinoma of the lung with choroidal metastasis as the first presenting sign. There were no findings of metastasis involving his contralateral eye. He was administered chemotherapy based on gemcitabine and carboplatin. He had significant progressive subjective and objective improvement since his first chemotherapy. His current best corrected visual acuity is 20/30 after six cycles of chemotherapy. Conclusions: Chemotherapy alone can be used as an effective mode of treatment in patients who have primary tumors that respond to chemotherapy.
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Introduction
Metastatic tumors are the most common intra-ocular
malignancies, and choroid is by far the most common
site for intra-ocular malignancies. Multiple foci are
usually involved and bilateral involvement is
frequently seen. Available treatment options are external
beam radiotherapy and plaque radiotherapy.
Meanwhile, newer modalities such as surgical resection,
transpupillary thermotherapy and intravitreal
chemotherapy offer promises for future. The use of
chemotherapy alone for choroidal metastases is not
widely reported.
Case presentation
A 50-year-old Indian man presented with headache, and
blurred vision in his right eye for the last three months.
He had no history of seizures, vomiting or dizziness.
However, he stated that he had occasional dry cough for
the past four to five months.
A thorough ophthalmic and systemic examination was
carried out. Ocular examination revealed his best
corrected visual acuity to be counting fingers at one foot in
the right eye and 20/20 in the left eye. Results of his slit
lamp examination were unremarkable. His pupils were
of normal size and normal reaction. His ocular
movements were normal in all gazes. His intra-ocular
pressure was also normal. His systemic examination showed
bilaterally symmetrical chest movements. Vesicular
breath sounds were audible bilaterally, but sounds on
the right side were decreased as compared to the left
Figure 1 Fundus fluorescein angiography of the involved eye.
Fundus fluorescein angiography of the right eye showing
hyperfluorescence from the surface of the choroidal tumor in its
late phase with the accumulation of sub-retinal fluid.
side. Vocal fremitus and vocal resonance were decreased
over the right side from the first to fourth intercostal
space. No added sounds were audible. No lymph nodes
were palpable clinically. A fundus picture of his right
eye showed an ill-defined, yellow-white elevated lesion
in choroid about three to four times the disc diameter
in size, superior-temporal to the disc. A fundus picture
of his left eye was normal.
Meanwhile, fluorescein angiography of our patients
right eye revealed hyperfluorescence from the surface of
his choroidal tumor. The tumor was on its late phase and
it had already accumulated sub-retinal fluid (Figure 1). A
B-scan ultrasound revealed a flat-surfaced, elevated
choroidal lesion with moderate internal reflectivity (Figure 2).
Routine systemic investigations including complete blood
cell count, platelet count, bleeding time, clotting time,
urine analysis, serum electrolytes, blood biochemical
studies for hepatic and renal functions, as well as specific
Figure 3 Computed tomography-guided fine needle aspiration
cytology. Photomicrograph of fine needle aspiration cytology of
the right lung lesion showing adenocarcinoma.
investigations like carcinoembryonic antigen, prostatic
specific antigen and serum acid phosphates were all
within normal limits.
Results of our patients bone scan, and upper and
lower gastrointestinal (...truncated)