Treatment of choroidal metastasis from choriocarcinoma. Case report

Metastatic choriocarcinoma to the choroid with concurrent optic nerve involvement: a case report and review of the literature

PURPOSE

To describe a case of choroidal metastasis of choriocarcinoma, which presented as a rapidly progressive hemorrhagic retinal detachment with concurrent optic nerve involvement suggestive of inflammation or metastasis.

METHOD

This is a case report of a 43-year-old patient with a known history of choriocarcinoma metastases to both lungs who presented with 1 week of right eye pain and decreased vision. Dilated fundus examination was significant for a large, bullous, hemorrhagic retinal detachment, with the appearance of an underlying choroidal mass in the superonasal retina. Magnetic resonance imaging result was significant for a 1.6 × 1.3-cm heterogeneous mass in the right globe, suggestive of metastasis, and inflammatory changes in the sclera, optic nerve, and optic nerve sheath. Additionally, hemorrhagic metastases were found in the right occipital and left frontal lobes.

RESULTS

To our knowledge, this is the first case of metastatic choriocarcinoma to the choroid with concurrent optic nerve involvement.

CONCLUSION

Choroidal metastases may be diagnosed in the setting of more widespread central nervous system involvement and should be investigated accordingly.

Complete remission of gestational choriocarcinoma with choroidal metastasis treated with systemic chemotherapy alone: case report and review of literature

BACKGROUND

Gestational choriocarcinoma is a malignant tumor that frequently metastasizes to the highly vascularized organs such as the lung, brain, and liver via hematogenous spread. However, this tumor rarely metastasizes to the eye and only a few cases of metastasis to the choroid have been reported.

CASE

A 17-year-old woman presented with visual field defects, decreased vision, and increasing pain in her left eye. She had undergone evacuation of a complete hydatidiform mole 32 months prior to the presentation. Ophthalmologic evaluation revealed a metastatic choroidal tumor, and a CT scan showed a metastatic tumor in the left lung. The serum hCG level was elevated at 7780 mIU/ml. A clinical diagnosis of metastatic gestational choriocarcinoma involving the choroid and lung was made. The patient received 13 courses of combination chemotherapy, resulting in complete remission. Radiotherapy and surgical treatment were unnecessary.

CONCLUSION

This is a very rare case of the successful treatment of gestational choriocarcinoma metastatic to the choroid using systemic chemotherapy alone.