Case of metastatic pulmonary carcinoma in optic disc diagnosed from results of biopsy performed during vitrectomy surgery

Metastatic squamous cell carcinoma masquerading as acute retinal necrosis

Purpose

To describe a case of retinal and optic nerve metastases masquerading as acute retinal necrosis secondary to primary squamous cell carcinoma of the lung.

Observations

A 66-year-old male with a history of Stage IV lung cancer, actively on chemotherapy, presented with right eye vision loss, an afferent pupillary defect, and partial visual field deficiencies. Exam revealed vitritis, macula-involving infiltrative retinitis, optic neuritis, and vasculitis of the right eye. The patient was treated empirically for acute viral retinitis with intravitreal foscarnet and ganciclovir injections and oral acyclovir and trimethoprim-sulfamethoxazole. A diagnostic pars plana vitrectomy with vitreous biopsy, intravitreal antivirals and silicone oil fill was performed. The resulting cytology was positive for malignant squamous cell carcinoma.

Conclusions and importance

We present a unique case of primary squamous cell carcinoma metastasizing to the retina and optic nerve which masqueraded as an acute viral retinitis. To date, there have not been any reported cases on Pubmed or Google Scholar at publication time of known squamous cell carcinoma metastases to the retina that demonstrated interval growth leading to emergent elevations in intraocular pressure (IOP). This case demonstrates the importance of considering metastasis when encountering an atypical acute retinal necrosis case, as well as bring awareness to the possibility that elevated IOP may be the first sign of interval metastases, despite surgical debulking, in cases involving known tumor metastases to the retina.

Differential Diagnosis of Vitritis in Adult Patients

The term "vitritis" refers to the presence of a cellular infiltration of the vitreous body, usually in the context of an intraocular inflammation, but not exclusively. Intermediate uveitis is the most prominent cause of vitritis, including infectious and auto-immune/auto-inflammatory etiologies. Corticosteroids and immunosuppressive therapies should not be started before ruling out the infectious causes of vitritis, especially in immunosuppressed individuals. Other situations can mimic intermediate uveitis such as amyloidosis and ocular tumors. Primary intraocular lymphoma should always be suspected in case of vitreous infiltrations in individuals aged over 50 years.

Optic disc metastasis presenting as an initial sign of non-small-cell lung cancer: a case report

Most intraocular metastases are detected in the choroid, iris, ciliary body, or retina. Conversely, tumors rarely metastasize to the optic disc, and they even less frequently present as the initial sign of cancer. In this study, we presented the case of a patient who first visited the ophthalmology department because of gradual visual impairment without any systemic symptoms, and she was ultimately diagnosed with non-small-cell lung cancer. This case report illustrated that visual impairment may be the first sign of non-small-cell lung cancer; therefore, we should not neglect ocular metastasis even when the patient has no systemic symptoms on her/his first visit to the ophthalmology department.

[Ocular Metastasis in Lung Cancer: a Retrospective Analysis in a Single Chinese Hospital and Literature Review]

背景与目的

眼部转移（ocular metastasis）是肺癌少见转移之一，影响患者生活质量。本研究旨在探讨肺癌合并眼转移患者的临床特征及预后。

方法

回顾性分析肺癌合并眼部转移9例患者的临床资料，回顾近10年文献报道共42例患者的临床特点。

结果

9例患者的中位年龄为51岁（范围：41岁-61岁），其中7例诊断为非小细胞肺癌（包括腺癌6例）；1例为小细胞肺癌；1例病理不详。眼转移部位方面，脉络膜8例，虹膜1例。文献回顾中，小细胞肺癌占21.4%（n=9），腺癌占47.6%（n=20），脉络膜是最常见的眼转移部位（66.7%, n=28）。肺癌合并眼转移患者，系统化疗的疾病控制率仅为28%，联合眼部局部治疗可有效控制眼部症状。

结论

肺癌合并眼部转移以肺腺癌多见，脉络膜转移是肺癌眼部转移的最常见转移部位。眼部局部治疗可控制局部症状，但系统性化疗疗效差。

Optic nerve metastasis caused by lung adenocarcinoma

INTRODUCTION

Isolated optic nerve metastases are extremely uncommon. Many cases are associated with involvement from locations such as the choroid, orbit, or central nervous system. Optic nerve metastases often have their origin in primary tumours of the breast, lung, and stomach, in adults.

CASE REPORT

The case is presented of a 57 year-old woman with a diagnosis of lung adenocarcinoma. Her first complaint was a sudden loss of visual acuity in her right eye. The diagnosis of optic nerve metastases was made based on her history, and the results of the MRI scan.

DISCUSSION

Isolated optic nerve metastases are an uncommon condition, but should be suspected in any patient with a history of oncology who has deteriorated visual acuity.

Vitreous diagnosis in neoplastic diseases

Vitreous body is an intraocular structure, origin of diverse pathologies, but is also the place where cells and inflammatory mediators are released coming from several pathologic processes. These inflammatory reactions can happen in any other ocular location like choroid, retina, optic nerve, or ciliary body and vitreous humor constitutes a stagnant reservoir for these resulting substances and debris. Through the recent techniques of vitreous collecting, handling, and analysis, increasingly more sophisticated and with fewer complications, cellularity and molecules in the vitreous of challenging pathologies for the ophthalmologist can now be studied. The most usefulness for vitreous diagnosis would be the masquerade syndromes, and the best exponent in this group is the primary vitreoretinal lymphoma (PVRL), in which cytology and an IL-10/IL-6 ratio more than 1 is fundamental for the diagnosis.