Non-small cell lung cancer presenting with choroidal metastasis as first sign and showing good response to chemotherapy alone: a case report

Journal of Medical Case Reports, Jun 2010

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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://www.jmedicalcasereports.com/content/pdf/1752-1947-4-185.pdf

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. - 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)


This is a preview of a remote PDF: http://www.jmedicalcasereports.com/content/pdf/1752-1947-4-185.pdf

Abhishek Singh, Parul Singh, Kamal Sahni, Preety Shukla, Vikas Shukla, Nirdosh K Pant. Non-small cell lung cancer presenting with choroidal metastasis as first sign and showing good response to chemotherapy alone: a case report, Journal of Medical Case Reports, 2010, pp. 185, 4, DOI: 10.1186/1752-1947-4-185