Controlled aspiration of subretinal fluid in the diagnosis of carcinoma metastatic to the choroid

Choroidal metastasis as a presenting manifestation of lung cancer: a report of 3 cases and systematic review of the literature

Symptomatic choroidal metastasis is a rare presenting manifestation of lung cancer. We describe here 3 patients with non-squamous non-small cell lung cancer who presented with choroidal metastasis and who were diagnosed and treated by the authors. We performed a systematic literature review of the previously reported patients with choroidal metastasis from lung cancer in the English-language literature. We excluded case series lacking individual patient data and identified 75 patients. In 23 of these patients, choroidal metastasis was not the presenting manifestation of lung cancer. Therefore, we included 55 patients (3 index and 52 previously reported) in the analysis. We present the demographic profile, histology, disease stage, ocular and lung lesions, diagnostic and treatment (systemic and ocular) modalities, and treatment outcomes. The majority of patients were male (67.3%) and were current or ex-smokers (78.3%); the mean age was 55.1 (standard deviation 11.2) years. Adenocarcinoma (n = 23) was the most common histologic type followed by squamous (n = 11) and small cell (n = 8). Left eye (n = 32) involvement was more common than right eye (n = 19) or bilateral (n = 4). Among patients for whom the location of primary lesion was specified, the left upper lobe (n = 13) was the most common site. The most common diagnostic modalities were bronchoscopic lung biopsy (n = 15) and enucleation (n = 13), while the liver (30.9%) was the most common extraocular metastatic site identified. Systemic chemotherapy was given in 56.4% of cases, and disease progression was the most common outcome among evaluable patients. Ocular treatment modalities included radiation (n = 23), enucleation (n = 14), and systemic steroids (n = 8). Regression of choroidal metastases with treatment was observed in 66.7% of patients who did not undergo enucleation as the primary treatment modality. Of the 3 index patients, 2 each received pemetrexed-cisplatin (as first-line therapy), gefitinib or erlotinib (as second- or third-line therapy), and intravitreal bevacizumab; and 1 patient received systemic bevacizumab. Two patients had partial response radiologically with systemic treatment, and all 3 patients had regression of choroidal metastases with ocular treatment. Recommendations regarding systemic and local (ocular) management of patients with choroidal metastasis as the presenting manifestation of lung cancer are provided.

Cytologic specimens from the eye: a clinicopathologic study of 33 patients

Cytologic specimens from the eye (CSE) (fine-needle aspirates and intraocular [vitrectomy] washings) are uncommon in most cytology practices. We reviewed our experience and diagnostic accuracy in lesions from this site over a 13-yr period. Thirty-three patients (12 males, 21 females, age 7-85 yr; mean 56 yr) were identified. Eighteen specimens were submitted to rule out malignancy. Of these, four CSE were positive, including melanoma (n = 1), large-cell lymphoma (n = 2), and carcinoma (n = 1). None of the 14 patients with negative cytology showed clinical evidence of malignancy over a 1-28-mo follow-up period (mean, 8.4 mo). Fourteen specimens were submitted to rule out infectious agents. Cytology material contained culture-proven organisms in one case each of Candida and Aspergillus. Of serology-confirmed specimens, four CSE failed to reveal toxoplasma, and three lacked herpes viral inclusions. One case each of culture-positive P. acnes and C. albicans lacked the organisms in the CSE. Twelve specimens were submitted to rule out inflammatory lesions. CSE showed chronic inflammation (n = 5), acute and chronic inflammation (n = 1), macrophages (n = 5), and nonnecrotizing granulomas (n = 1). Of 3 patients with sarcoidosis, CSE contained mature lymphocytes in all 3 cases, but no granulomas. Although the numbers are small, there is greater sensitivity in the detection of malignancy than of infectious agents.

Choroidal metastasis of mixed carcinoma of the parotid gland

BACKGROUND

A case of mixed carcinoma of the parotid gland (an epidermoid carcinoma located in a pleomorphic adenoma) metastatic to the choroid is presented. The histopathology of the tumor is discussed.

METHODS

A 65-year-old man was admitted complaining of blurred vision in his right eye for 1 day. He underwent parotidectomy for mixed carcinoma of the parotid gland (an epidermoid carcinoma located in a pleomorphic adenoma that was completely excised) 6 months before. Funduscopic examination showed a nasal retinal detachment, with gray-whitish, minimally elevated nodular choroidal lesions. Fluorescein angiography and contact B-scan ultrasonography confirmed the presence of an underlying mass.

RESULTS

The right eye was enucleated and an epidermoid infiltrating carcinoma was identified.

CONCLUSIONS

Metastatic tumors are the most common intraocular malignancies, and the choroid is by far the most common location for intraocular metastases. There are few cases reported of parotid tumors metastatic to the orbit. To the best of our knowledge, no histological examination of an ocular metastatic mixed carcinoma of the parotid gland has yet been reported.

Coats'-type retinitis pigmentosa

Coats'-like changes (i.e., retinal telangiectasia and/or exudative detachment) have been reported in as many as 1.2 to 3.6 percent of patients with retinitis pigmentosa. In severe cases this disorder may progress to total retinal detachment and visual loss in the context of longstanding retinitis pigmentosa. Forty-six cases of Coats'-type retinitis pigmentosa gathered from the literature are reviewed. Historical and epidemiological features, hereditary factors, clinical features, histopathological findings, pathogenesis, differential diagnosis, prognosis and possible treatment are discussed.