Choroidal metastases in testicular choriocarcinoma, successful treatment with chemo- and radiotherapy: a case report

BMC Urology, Dec 2011

Background Choriocarcinoma is a very rare cause of ocular metastasis. Only 18 male patients have been reported on, 4 of whom survived, but with significant loss of vision. Case presentation A 26-year-old Caucasian man, suffering from testicular choriocarcinoma with pulmonary, cerebral, renal, hepatic and osseous metastases, underwent left radical orchiectomy. While being treated with chemotherapy, he presented with loss of vision in the left eye. Ophthalmoscopy revealed bilateral non-pigmented, hemorrhagic choroidal tumours, compatible with secondary lesions. Continued chemotherapy and stereotactic radiotherapy of the skull and spine lead to full remission with excellent vision, after more than 4 years of follow up. Conclusion Testicular choriocarcinoma is an exceptional cause of choroidal metastasis, potentially asymptomatic and with specific clinical features. Radiotherapy can complement radical orchiectomy and chemotherapy, to achieve full remission and maintain good vision.

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Choroidal metastases in testicular choriocarcinoma, successful treatment with chemo- and radiotherapy: a case report

BMC Urology Choroidal metastases in testicular choriocarcinoma, successful treatment with chemo- and radiotherapy: a case report Ivo Guber 0 Leonidas Zografos 0 Ann Schalenbourg 0 0 Jules-Gonin Eye Hospital, University of Lausanne, Switzerland , Avenue de France 15, CH-1004 Lausanne , Switzerland Background: Choriocarcinoma is a very rare cause of ocular metastasis. Only 18 male patients have been reported on, 4 of whom survived, but with significant loss of vision. Case presentation: A 26-year-old Caucasian man, suffering from testicular choriocarcinoma with pulmonary, cerebral, renal, hepatic and osseous metastases, underwent left radical orchiectomy. While being treated with chemotherapy, he presented with loss of vision in the left eye. Ophthalmoscopy revealed bilateral non-pigmented, hemorrhagic choroidal tumours, compatible with secondary lesions. Continued chemotherapy and stereotactic radiotherapy of the skull and spine lead to full remission with excellent vision, after more than 4 years of follow up. Conclusion: Testicular choriocarcinoma is an exceptional cause of choroidal metastasis, potentially asymptomatic and with specific clinical features. Radiotherapy can complement radical orchiectomy and chemotherapy, to achieve full remission and maintain good vision. - Background Intraocular metastases are present in up to 10% of patients with systemic malignancies [1]. With tumour cells spreading hematogenously, the posterior choroid is frequently involved because of its rich vasculature [2]. In females, the most common primary site is the breast, whereas, in males, it is the lung. Choriocarcinoma is a highly malignant metastatic tumour, derived from undifferentiated placental trophoblasts (gestational choriocarcinoma) or from non-placental totipotent cells, present in the testis, the ovary or the pineal gland (non gestational choriocarcinoma). It is characterized by the large amounts of chorionic gonadotropin produced. Choriocarcinoma is a rare cause of choroidal metastasis. Only 18 male patients have been reported on, and most of them had a poor prognosis [2-4]. We present a man who developed bilateral choroidal metastases from a testicular choriocarcinoma under chemotherapy. The ocular tumours regressed following irradiation. Four years later, he is in remission and has excellent vision. Case presentation A 26-year-old man was referred to the Jules-Gonin Eye Hospital with loss of vision and a non-pigmented tumour in his left eye. In the previous two weeks, he had been diagnosed with a left testicular tumour and multiple metastases to the lung, brain, cerebellum, kidney, liver and spine. Histopathology following left radical orchiectomy had revealed a non-seminomatous testicular choriocarcinoma, positive for b-human chorionic gonadotropin (b-HCG) and pancytokeratin, slightly positive for a-fetoprotein (AFP) while negative for carcinoembryonic antigen (CEA). Serum levels were for b-HCG 271 052 U/l (normal < 3.0 U/l)), for AFP 0.9 ng/ml (normal < 10 ng/ml) and for LDH 1757 U/l (normal < 450 U/l). He was receiving chemotherapy with bleomycin, etoposide and cisplatin. Visual acuity was 6/6 in the right eye and counting fingers (CF) in the left eye. The left posterior fundus showed a large amelanotic choroidal tumour associated with a hemorrhagic retinal detachment. On B-scan ultrasonography, thickness was 7 mm. In the right inferior choroid, a second non pigmented, flat lesion was also present, compatible with a diagnosis of bilateral choroidal metastases (Figure 1). Figure 1 Panoramic fundus pictures: Choroidal metastases from testicular choriocarcinoma at presentation: RE (Right Eye): a non pigmented, flat lesion is discovered in the inferior choroid. LE (Left Eye): a large amelanotic tumour with associated hemorrhagic retinal detachment occupies the posterior pole and is responsible for the vision loss. Chemotherapy was continued, with a total of 4 cycles over 3 months time. Additionally, a stereotactic radiotherapy of the spine and head was performed, the latter including the posterior part of both eyes, using two lateral accelerated photon fields of 6 MV with a total dose of 30.80 Gy in 14 fractions. After four years follow-up, the patient is in remission without any evidence of metastases. All tumour markers are within normal ranges (b-HCG < 0.1 U/l; AFP 1.2 ng/ml; LDH 284 U/l). Visual acuity is 6/6 in the right Discussion We describe a rare case of a patient with bilateral choroidal metastases secondary to testicular choriocarcinoma, successfully treated with chemo- and radiotherapy. MacDonald described the first case in 1936 [5]. A meta-analysis of the literature in 2006 listed 14 male Figure 2 Panoramic fundus pictures: Four years after chemo- and radiotherapy, both lesions have become flat chorioretinal scars. Despite the unfavourable localisation of the left scar near the fovea, visual acuity has recovered to 6/9. patients with testicular choriocarcinoma, as well as one with med (...truncated)


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Ivo Guber, Leonidas Zografos, Ann Schalenbourg. Choroidal metastases in testicular choriocarcinoma, successful treatment with chemo- and radiotherapy: a case report, BMC Urology, 2011, pp. 24, 11, DOI: 10.1186/1471-2490-11-24