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Giuseppe Agostara A, Curaba A, Carlo Stella G. Iris metastasis from endometrial carcinoma: a challenging diagnosis and individualized eye-sparing treatment. Gynecol Oncol Rep 2022; 44:101098. [DOI: 10.1016/j.gore.2022.101098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
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Kumar P, Kumar A, Dubakka S, Kaushik J, Agrawal M. Unilateral simultaneous optic nerve and choroidal infiltration - unusual presentation of metastatic disease in breast carcinoma. GMS OPHTHALMOLOGY CASES 2021; 11:Doc14. [PMID: 34650902 PMCID: PMC8495234 DOI: 10.3205/oc000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Breast carcinoma metastasis can involve any ocular structures, but involvement of the optic nerve is extremely rare. Choroidal metastasis is usually multifocal as well as bilateral and occurs late. We report an unusual initial presentation of metastasis from breast cancer; unilateral infiltrative optic neuropathy with concurrent choroid metastatic deposits in an adequately treated middle-aged female. Our present case, wherein for the first time in the literature, we illustrated unilateral infiltrative optic neuropathy and choroidal metastatic deposits secondary to breast carcinoma, will increase our knowledge about the various potential ocular presentations of this relatively common malignant disease.
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Affiliation(s)
- Poninder Kumar
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Ashok Kumar
- Department of Ophthalmology, Armed Forces Medical College, Pune, India,*To whom correspondence should be addressed: Ashok Kumar, Department of Ophthalmology, Armed Forces Medical College, 411040 Pune, India, E-mail:
| | - Srujana Dubakka
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Jaya Kaushik
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Mohini Agrawal
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
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Kang HG, Kim M, Byeon SH, Kim SS, Koh HJ, Lee SC, Kim M. Clinical Spectrum of Uveal Metastasis in Korean Patients Based on Primary Tumor Origin. Ophthalmol Retina 2021; 5:543-552. [PMID: 32942025 DOI: 10.1016/j.oret.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To describe the clinical features and prognosis of patients with uveal metastasis in Korea. DESIGN Retrospective, observational case series. PARTICIPANTS Patients diagnosed at 2 tertiary high-volume centers between November 2005 and November 2019. METHODS Evaluation of multimodal imaging and electronic medical records. MAIN OUTCOME MEASURES The clinical features and outcomes were assessed based on the primary cancer site. RESULTS A total of 134 uveal metastases (128 choroidal, 3 iris, and 3 ciliary body tumors) were diagnosed in 95 eyes of 80 patients. Mean age at diagnosis was 56 years (median, 55 years; range, 24-86 years), with a minor preponderance of women (61%). Tumors were bilateral in 15 patients (19%) and the primary origin was established in 49 patients (61%) before ocular detection. The primary tumor originated in the lung (48%), breast (24%), gastrointestinal tract (10%), liver (3%), pancreas (3%), kidney (1%), cervix (1%), and nasopharynx (1%), with some remaining unknown (10%). The overall 5-year survival rate was 21%. Kaplan-Meier analysis revealed that the worst survival was found in pancreatic cancers (mean survival, 5.9 months; P = 0.045), and the best survival was found in gastrointestinal tract cancers (mean survival, 44.5 months). CONCLUSIONS The primary tumor origins in Korean patients with uveal metastases differed from those reported in primarily population-based studies of White patients, with a higher prevalence of lung and gastrointestinal tract cancers.
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Affiliation(s)
- Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minha Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Arshad R, Barani M, Rahdar A, Sargazi S, Cucchiarini M, Pandey S, Kang M. Multi-Functionalized Nanomaterials and Nanoparticles for Diagnosis and Treatment of Retinoblastoma. BIOSENSORS 2021; 11:97. [PMID: 33810621 PMCID: PMC8066896 DOI: 10.3390/bios11040097] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022]
Abstract
Retinoblastoma is a rare type of cancer, and its treatment, as well as diagnosis, is challenging, owing to mutations in the tumor-suppressor genes and lack of targeted, efficient, cost-effective therapy, exhibiting a significant need for novel approaches to address these concerns. For this purpose, nanotechnology has revolutionized the field of medicine with versatile potential capabilities for both the diagnosis, as well as the treatment, of retinoblastoma via the targeted and controlled delivery of anticancer drugs via binding to the overexpressed retinoblastoma gene. Nanotechnology has also generated massive advancements in the treatment of retinoblastoma based on the use of surface-tailored multi-functionalized nanocarriers; overexpressed receptor-based nanocarriers ligands (folate, galactose, and hyaluronic acid); lipid-based nanocarriers; and metallic nanocarriers. These nanocarriers seem to benchmark in mitigating a plethora of malignant retinoblastoma via targeted delivery at a specified site, resulting in programmed apoptosis in cancer cells. The effectiveness of these nanoplatforms in diagnosing and treating intraocular cancers such as retinoblastoma has not been properly discussed, despite the increasing significance of nanomedicine in cancer management. This article reviewed the recent milestones and future development areas in the field of intraocular drug delivery and diagnostic platforms focused on nanotechnology.
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Affiliation(s)
- Rabia Arshad
- Department of Pharmacy, Quaid-I-Azam University, Islamabad 45320, Pakistan;
| | - Mahmood Barani
- Department of Chemistry, ShahidBahonar University of Kerman, Kerman 76169-14111, Iran;
| | - Abbas Rahdar
- Department of Physics, Faculty of Science, University of Zabol, Zabol 98613-35856, Iran
| | - Saman Sargazi
- Cellular and Molecular Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan 98167-43463, Iran;
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, 66421 Homburg/Saar, Germany;
| | - Sadanand Pandey
- Department of Chemistry, College of Natural Science, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Korea
- Particulate Matter Research Center, Research Institute of Industrial Science & Technology (RIST), 187-12, Geumho-ro, Gwangyang-si 57801, Korea
| | - Misook Kang
- Department of Chemistry, College of Natural Science, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, Korea
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Salcedo-Villanueva G, Medina-Andrade AA, Moreno-Paramo D, Golzarri MF, Moreno-Paramo E, Ortiz-Ramirez GY, Martinez-Aguilar U, De Dios-Cuadras U, Jimenez-Rodriguez M, Espinosa-Soto I, Mira-Lorenzo X, Guzman-Cerda J, Orozco-Moguel A, Becerra-Revollo C, Orozco-Gomez LP, Fulda E. Primary Cancer Sites and Clinical Features of Choroidal Metastasis in Mexican Patients. Clin Ophthalmol 2021; 15:201-209. [PMID: 33500613 PMCID: PMC7826071 DOI: 10.2147/opth.s285250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the primary cancer sites and clinical features of choroidal metastasis in Mexican patients. Methods This was a retrospective, observational, and multi-center study. Data were recollected from 6 ophthalmological hospitals in Mexico from patients with choroidal metastasis diagnosed from 2000 to 2018. Results Seventy-eight patients were studied: 43 were female and 35 were male. Mean age at presentation was 57.6 years. Overall, primary cancer sites were: 1) breast: 27 cases (34.6%); 2) lung: 19 cases (24.3%); 3) unknown: 8 cases (10.2%); 4) gastrointestinal: 7 cases (8.9%); 5) renal: 5 cases (6.4%); 6) testicular: 3 cases (3.8%); 7) ovary: 3 Cases (3.8%); 8) prostate: 2 cases (2.5%); 9) thyroid: 2 cases (2.5%); 10) carcinoid: 1 case (1.2%); and 11) multiple myeloma: 1 case (1.2%). Divided by gender, for women, the main three sites were: breast, unknown, and ovary. For men, the main three sites were: lung, gastrointestinal, and testicular. Oldest cases were breast cancer (87 and 85 years); youngest cases were testicular (23 and 25 years). Solitary lesions were observed in 56 cases (71.7%); multiple lesions were observed in 22 cases (28.2%). Forty-two cases had a white or yellowish color, while 6 cases presented an orange color. Conclusion Primary cancer sites and clinical features of choroidal metastasis in Mexican patients show important differences from other populations previously studied, mainly the presence of a higher proportion of gastrointestinal and renal cancer, as well as higher incidence of ovarian and testicular cancer. These types of cancer, although not as common as breast or lung, need to be taken into account when studying Mexican patients living abroad.
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Affiliation(s)
- Guillermo Salcedo-Villanueva
- Retina Department, Asociación Para Evitar la Ceguera en México, Hospital "Dr. Luis Sánchez Bulnes", Mexico City, Mexico
| | | | - Daniel Moreno-Paramo
- Ophthalmology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Maria Fernanda Golzarri
- Retina Department, Asociación Para Evitar la Ceguera en México, Hospital "Dr. Luis Sánchez Bulnes", Mexico City, Mexico
| | - Edel Moreno-Paramo
- Retina Department, Asociación Para Evitar la Ceguera en México, Hospital "Dr. Luis Sánchez Bulnes", Mexico City, Mexico
| | - Grecia Yael Ortiz-Ramirez
- Retina Department, Asociación Para Evitar la Ceguera en México, Hospital "Dr. Luis Sánchez Bulnes", Mexico City, Mexico
| | - Ursula Martinez-Aguilar
- Retina Department, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico
| | - Ulises De Dios-Cuadras
- Retina Department, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico
| | | | - Itzel Espinosa-Soto
- Retina Department, Fundación Hospital Nuestra Señora de la Luz, Mexico City, Mexico
| | - Ximena Mira-Lorenzo
- Retina Department, Instituto Mexicano de Oftalmología, Santiago de Queretaro, Mexico
| | - Juvenal Guzman-Cerda
- Retina Department, Instituto Mexicano de Oftalmología, Santiago de Queretaro, Mexico
| | | | - Catalina Becerra-Revollo
- Retina Department, Asociación Para Evitar la Ceguera en México, Hospital "Dr. Luis Sánchez Bulnes", Mexico City, Mexico
| | | | - Emiliano Fulda
- Retina Department, Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico
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Local and Systemic Management of Uveal Metastasis. Int Ophthalmol Clin 2020; 60:13-26. [PMID: 33093314 DOI: 10.1097/iio.0000000000000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Danek DJ, Blessing NW, Tse DT. Corneal perforation with uveal prolapse: An initial presentation of orbital metastatic breast cancer. Am J Ophthalmol Case Rep 2019; 16:100551. [PMID: 31650080 PMCID: PMC6804488 DOI: 10.1016/j.ajoc.2019.100551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose Metastasis to the orbit is a rare and typically late manifestation of a systemic malignancy. Breast cancer is the most common orbital metastatic malignancy and as the prevalence of breast cancer rises, the incidence of orbital metastasis is expected to increase concomitantly. The purpose of this report is to illustrate a unique case of orbital metastatic breast cancer with grave ophthalmic sequelae and to review the salient findings and features of orbital metastatic disease. Observations Herein, we describe the case of a 61-year-old woman with no known history of malignancy who presented with a large compressive orbital mass that resulted in corneal perforation with uveal prolapse after initial treatment for orbital cellulitis followed by orbital pseudotumor. Anterior orbitotomy with biopsy of the mass ultimately revealed a diagnosis of metastatic breast carcinoma. Conclusion As the incidence of breast cancer increases, ophthalmologists will play an increasingly important role in detecting both undiagnosed and recurrent breast cancer.
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Affiliation(s)
- Dagmara J Danek
- Lake Erie College of Osteopathic Medicine, 5000 Lakewood Ranch Blvd, Bradenton, FL, 34211, USA
| | - Nathan W Blessing
- Oculoplastic and Reconstructive Surgery, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA
| | - David T Tse
- Oculoplastic and Reconstructive Surgery, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA
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Arya M, Duker JS. Vinorelbine-induced regression of a choroidal metastasis from primary breast carcinoma. Int J Retina Vitreous 2018; 4:17. [PMID: 29785284 PMCID: PMC5950186 DOI: 10.1186/s40942-018-0121-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022] Open
Abstract
Background Various therapeutic options exist to treat choroidal metastatic lesions. However, they are all associated with potential long-term adverse effects. This case report discusses a case of choroidal metastasis from primary breast carcinoma that regressed after single-agent chemotherapy. Case presentation We report a case of choroidal metastasis from estrogen receptor (ER) positive breast carcinoma that became resistant to endocrine therapy. The primary malignancy was treated with surgical resection and adjuvant chemoradiation, followed by hormone therapy with various agents in combination with kinase inhibitors for ER resistance. The choroidal metastatic lesion regressed after the initiation of vinorelbine. Vinorelbine is a cytotoxic vinca alkaloid with tolerable systemic adverse effects. Conclusions This case report highlights the possible role of vinorelbine as a single chemotherapeutic agent for the conservative therapy of uveal metastasis from advanced breast carcinoma, irrespective of responsiveness to hormone therapy.
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Mathis T, Jardel P, Loria O, Delaunay B, Nguyen AM, Lanza F, Mosci C, Caujolle JP, Kodjikian L, Thariat J. New concepts in the diagnosis and management of choroidal metastases. Prog Retin Eye Res 2018; 68:144-176. [PMID: 30240895 DOI: 10.1016/j.preteyeres.2018.09.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/17/2022]
Abstract
The most frequent site of ocular metastasis is the choroid. The occurrence of choroidal metastases has increased steadily due to the longer survival of metastatic patients and the improvement of diagnostic tools. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy. There is currently no consensus on the treatment strategy. Most patients have a limited life expectancy and for these complex treatments are generally not recommended. However, recent advances in systemic therapy have significantly improved survival of certain patients who may benefit from an aggressive ocular approach that could preserve vision. Although external beam radiation therapy is the most widely used treatment, more advanced forms of radiotherapy that are associated with fewer side effects can be proposed in select cases. In patients with a shorter life expectancy, systemic therapies such as those targeting oncogenic drivers, or immunotherapy can induce a regression of the choroidal metastases, and may be sufficient to temporarily decrease visual symptoms. However, they often acquire resistance to systemic treatment and ocular relapse usually requires radiotherapy for durable control. Less invasive office-based treatments, such as photodynamic therapy and intravitreal injection of anti-VEGF, may also help to preserve vision while reducing time spent in medical settings for patients in palliative care. The aim of this review is to summarize the current knowledge on choroidal metastases, with emphasis on the most recent findings in epidemiology, pathogenesis, diagnosis and treatment.
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Affiliation(s)
- Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Pauline Jardel
- Department of Radiation Oncology, Chicoutimi Hospital, Saguenay, QC, Canada
| | - Olivier Loria
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Benoit Delaunay
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Anh-Minh Nguyen
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France
| | - Francesco Lanza
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | - Carlo Mosci
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, 69317, Lyon, France; UMR-CNRS 5510 Matéis, 69100, Villeurbane, France
| | - Juliette Thariat
- Department of Radiation Therapy, Centre François Baclesse - ARCHADE, Unicaen - Normandie University, 14000, Caen, France.
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Balestrazzi E, Blasi MA, Marullo M, Greco IM, Spadea L. Local Excision of Retinal Metastasis from Cutaneous Melanoma. Eur J Ophthalmol 2018; 5:149-54. [PMID: 8845681 DOI: 10.1177/112067219500500301] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The incidence of cutaneous melanoma is constantly rising. Ocular involvement is rare and the choroid is the most accessible structure to metastatic emboli. The case described is noteworthy on account of several particular features: 1) the missed diagnosis of the primary malignancy. This might be because either cutaneous melanoma or cutaneous nevi show several common features; 2) the rarity of the retinal metastatic site. Unlike the choroid, the retina is an unusual metastatic site but, regardless of organ blood flow, the metastatic efficiency may be related to interactions between tumour cells and host tissue; 3) the treatment of the retinal metastasis, excised conservatively. As far as we know, this is the first report of a retinal metastasis being treated by local resection.
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Affiliation(s)
- E Balestrazzi
- Department of Ophthalmology, San Salvatore Hospital, University of L'Aquila, Italy
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Reynolds MM, Arnett AL, Parney IF, Kumar R, Laack NN, Maloney PR, Kozelsky TF, Garces YI, Foote RL, Pulido JS. Gamma knife radiosurgery for the treatment of uveal melanoma and uveal metastases. Int J Retina Vitreous 2017; 3:17. [PMID: 28560050 PMCID: PMC5447304 DOI: 10.1186/s40942-017-0070-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/02/2017] [Indexed: 12/26/2022] Open
Abstract
Background This study retrospectively analyzed outcomes for patients undergoing gamma knife radiosurgery (GKR) for uveal melanoma (UM) and intraocular metastases. Methods Patients who underwent GKR for UM or intraocular metastases between 1/1/1990 and 6/1/2015 at Mayo Clinic, Rochester, MN, USA, were retrospectively analyzed. Results Eleven patients (11 eyes) had UM while seven patients (7 eyes) had intraocular metastases. Patients with UM were followed for a median of 19.74 ± 10.4 months. Visual acuity (VA) logMAR 0.30 ± 0.53 (Snellen 20/40) versus 0.40 ± 0.97 (Snellen 20/50), tumor thickness (5.30 ± 2.17 vs. 3.60 ± 2.32 mm), were not significantly different between preoperative and postoperative measurements, respectively. Nine percent (1/11) patients required enucleation. Subsequently, no patients experienced metastases. Patients with intraocular metastases were followed for a median of 6.03 ± 6.32 months. They did not have significant changes in VA (logMAR 0.30 ± 0.59 vs. 0.30 ± 1.57; Snellen 20/40 vs. 20/40) or tumor thickness (3.50 ± 1.36 vs. 1.30 ± 0.76 mm) postoperatively. Fourteen percent (1/7 patients) required enucleation. Complications experienced by patients with UM include radiation retinopathy (2/11), papillopathy (1/11), cystoid macular edema (1/11), vitreomacular traction (1/11), exudative retinal detachment (1/11). Patients with metastases had treatment complicated by recurrence (2/7). Dose to the margin, maximum dose of radiation, and clinical target volume did not correlate with post-procedural VA, risk of enucleation, or death in patients with either UM or patients with intraocular metastases. Conclusions Visual outcomes were satisfactory for patients undergoing GKR without significant morbidity and without significant risk of enucleation or metastases.
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Affiliation(s)
- Margaret M Reynolds
- Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
| | - Andrea L Arnett
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | - Ian F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, MN USA
| | - Ravi Kumar
- Department of Neurosurgery, Mayo Clinic, Rochester, MN USA
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | | | | | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN USA
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA.,Department of Molecular Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905 USA
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Grader I, Southard TL, Neaderland MH. Renal transitional cell carcinoma with bilateral ocular metastasis in a cat. JFMS Open Rep 2017; 2:2055116916659516. [PMID: 28491432 PMCID: PMC5362896 DOI: 10.1177/2055116916659516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2016] [Indexed: 11/16/2022] Open
Abstract
Case summary A 4-year-old, spayed female, domestic shorthair cat was presented for evaluation due to a 4 day history of inappetence and lethargy. Physical examination revealed mild dehydration and blindness of the left eye. Abnormal imaging findings included a well-margined soft tissue mass with irregular central cavity located in the dorsal aspect of the caudal lung lobe. Cytological examination of the mass revealed chronic inflammation with hemorrhage. Tests for parasitic and fungal diseases were negative. Ophthalmic examination 17 days after the cat was initially presented revealed severe diffuse pathology of both retinas. Left renomegaly was noted 22 days after the initial presentation, and cytological examination of samples obtained from the right vitreous, left kidney and the pulmonary mass yielded atypical epithelial cells exhibiting malignant changes. Post-mortem examination following euthanasia revealed renal transitional cell carcinoma with metastasis to both eyes, lungs and skeletal muscle. Immunohistochemical evaluation of the neoplastic cells in the eye revealed moderate cytoplasmic reactivity for CK7. CK20 immunohistochemistry was negative. Relevance and novel information To the best of our knowledge, this is the first report of renal transitional cell carcinoma with ocular metastasis in a cat. In addition, this report describes immunohistochemistry results of transitional cell carcinoma in a cat using CK7 and CK20.
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Affiliation(s)
- Irit Grader
- Noah's Ark Animal Hospital, Danbury, CT, USA
| | - Teresa L Southard
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornel University, Ithaca, NY, USA
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Konstantinidis L, Damato B. Intraocular Metastases--A Review. Asia Pac J Ophthalmol (Phila) 2017; 6:208-214. [PMID: 28399345 DOI: 10.22608/apo.201712] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/29/2017] [Indexed: 11/08/2022] Open
Abstract
Intraocular metastases almost invariably arise in the uveal tract, mostly in the posterior choroid. They are the most common type of intraocular malignancy and often the first sign of tumor dissemination. Choroidal metastases generally appear as a creamy white or pale yellow mass associated with subretinal fluid and may be multifocal and bilateral. The most common primary sites are breast and lung. Diagnosis is aided by a variety of tests, particularly ultrasonography and optical coherence tomography. Intraocular biopsy is useful in patients with clinical suspicion of uveal metastasis but no evidence of primary malignancy despite systemic evaluation. If systemic treatment fails to control the ocular tumor, a good response is usually achieved with local therapies such as external beam radiation therapy, photodynamic therapy, and transpupillary thermotherapy. The life expectancy of patients with choroidal metastases is generally poor but has been improving thanks to the therapeutic advances taking place.
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Affiliation(s)
| | - Bertil Damato
- Ocular Oncology Service, University of California, San Francisco, San Francisco, California
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Clark AJ, Coury EL, Meilhac AM, Petty HR. WO3/Pt nanoparticles are NADPH oxidase biomimetics that mimic effector cells in vitro and in vivo. NANOTECHNOLOGY 2016; 27:065101. [PMID: 26683660 DOI: 10.1088/0957-4484/27/6/065101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
To provide a means of delivering an artificial immune effector cell-like attack on tumor cells, we report the tumoricidal ability of inorganic WO3/Pt nanoparticles that mimic a leukocyte's functional abilities. These nanoparticles route electrons from organic structures and electron carriers to form hydroxyl radicals within tumor cells. During visible light exposure, WO3/Pt nanoparticles manufacture hydroxyl radicals, degrade organic compounds, use NADPH, trigger lipid peroxidation, promote lysosomal membrane disruption, promote the loss of reduced glutathione, and activate apoptosis. In a model of advanced breast cancer metastasis to the eye's anterior chamber, we show that WO3/Pt nanoparticles prolong the survival of 4T1 tumor-bearing Balb/c mice. This new generation of inorganic photosensitizers do not photobleach, and therefore should provide an important therapeutic advance in photodynamic therapy. As biomimetic nanoparticles destroy targeted cells, they may be useful in treating ocular and other forms of cancer.
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Affiliation(s)
- Andrea J Clark
- Department of Ophthalmology and Visual Sciences, 1000 Wall Street, University of Michigan Medical School, Ann Arbor, MI 48105, USA
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Jakobiec FA, Ramsey DJ, Stagner AM, Wu DM, Yoon MK. Pulmonary Adenocarcinoma Metastatic to the Choroid Diagnosed by Biopsy of an Extrascleral Nodule. Ocul Oncol Pathol 2015; 2:24-8. [PMID: 27171574 DOI: 10.1159/000430098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/30/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE/BACKGROUND To report a patient with orbital extension of a choroidal metastasis produced by a pulmonary adenocarcinoma which was diagnosed by biopsy of the extrascleral nodule. METHODS Clinical history and imaging studies (including fundus photography, autofluorescence, fluorescein angiography, B-scan, and orbital MRI) were reviewed along with histopathologic and immunohistochemical studies. RESULTS A 60-year-old woman presented with decreased vision in the right eye. Fundus examination revealed a leopard-spotted choroidal lesion and associated serous retinal detachment. Imaging disclosed an enhancing orbital lesion abutting the sclera near the choroidal mass, which had spread outside of the eye. Histopathology revealed lumen-forming cells elaborating mucin. The cells were immunohistochemically positive for epithelial membrane antigen, thyroid transcription factor 1, and cytokeratin 7 and negative for cytokeratin 20. This was consistent with a pulmonary adenocarcinoma. Widespread metastases were subsequently found. CONCLUSIONS This is the first detailed case report of a successful biopsy of the orbital extension of an essentially posterior intraocular tumor. Such a maneuver permits a much more generous tissue sample than a needle biopsy. In the current case, a large tissue sample provided the basis for complete immunohistochemical evaluation, leading to the diagnosis of an intraocular metastatic mucin-producing adenocarcinoma of lung origin.
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Affiliation(s)
- Frederick A Jakobiec
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Mass., USA; David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Mass., USA
| | - David J Ramsey
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Mass., USA
| | - Anna M Stagner
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Mass., USA; David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Boston, Mass., USA
| | - David M Wu
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Mass., USA
| | - Michael K Yoon
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Mass., USA
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Ophthalmic Metastasis of Breast Cancer and Ocular Side Effects from Breast Cancer Treatment and Management: Mini Review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:574086. [PMID: 26078956 PMCID: PMC4442260 DOI: 10.1155/2015/574086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/01/2015] [Accepted: 04/12/2015] [Indexed: 11/18/2022]
Abstract
Breast cancer is one of the most common malignant diseases occurring in women, and its incidence increases over the years. It is the main site of origin in ocular metastatic disease in women, and, due to its hematogenous nature of metastatic spread, it affects mainly the uveal tissue. The purpose of this paper is to summarize the clinical manifestations of the breast cancer ocular metastatic disease, alongside the side effects of the available treatment options for the management and regression of the systematic and ophthalmic disease.
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Riechardt AI, Gundlach E, Joussen AM, Willerding GD. The Development of Orange Pigment Overlying Choroidal Metastasis. Ocul Oncol Pathol 2015; 1:93-7. [PMID: 27171491 DOI: 10.1159/000369823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/28/2014] [Indexed: 11/19/2022] Open
Abstract
AIMS The aim of this study was to correlate the ophthalmoscopic and histopathological findings of orange pigment overlying a choroidal metastasis. METHODS This is a single case report with clinical follow-up and histopathological examination. RESULTS Histopathology revealed a choroidal metastasis with subretinal CD68-positive macrophages showing autofluorescent deposits in fluorescence microscopy. CONCLUSION The development of orange pigment is not pathognomonic for choroidal melanoma but may be seen in other lesions such as carcinoma metastasis.
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Affiliation(s)
| | - Enken Gundlach
- Department of Ophthalmology, Charité Universitätsmedizin, Berlin, Germany
| | - Antonia M Joussen
- Department of Ophthalmology, Charité Universitätsmedizin, Berlin, Germany
| | - Gregor D Willerding
- Department of Ophthalmology, Charité Universitätsmedizin, Berlin, Germany; Klinik für Augenheilkunde, DRK Kliniken Westend, Berlin, Germany
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Abstract
Metastatic renal carcinoma is the third most common source of ocular and second most common source of orbital metastases. This is the first published case of von Hippel-Lindau (vHL) disease that developed renal cell carcinoma metastatic to an eye with a retinal hemangioblastoma. A 73-year-old woman had a history of vHL disease that included prior retinal hemangioblastomas, 2 cerebellar hemangioblastomas, and bilateral renal cell carcinomas with sacral metastasis. After presenting with progressive, painful proptosis secondary to a large mass observable by ocular CT, an enucleation-orbitotomy was performed, and the surgical specimen was sent for histopathological analysis. The ophthalmic renal metastatic tumor, like the primary tumor, was a clear cell variant that involved both the eyeball and orbit in continuity. The intraocular component was larger than the extraocular portion, which was interpreted as an outward extension of an initial retinal metastasis that probably first settled within a hemangioblastoma. Clusters of ectatic ghost vessels with thickened walls produced by periodic acid Schiff-positive, redundant basement membrane material were partially infiltrated by tumor cells at their periphery, thereby lending some support for this hypothesis. Immunohistochemical positivity for the biomarkers cytokeratin 18, vimentin, carbonic anhydrase IX, PAX2, and PAX 8 confirmed the diagnosis. The patient has refused further treatment. Her anophthalmic socket has comfortably retained a porous polyethylene implant without clinical evidence of local recurrence during 5 months of follow up.
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Haidar YM, Korn BS, Rose MA. Complete regression of a choroidal metastasis secondary to breast cancer with stereotactic radiation: case report and review of literature. JOURNAL OF RADIOSURGERY AND SBRT 2013; 2:155-164. [PMID: 29296355 PMCID: PMC5658888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/20/2012] [Indexed: 06/07/2023]
Abstract
Metastatic choroidal tumors from breast carcinoma are an uncommon entity but the signs must be recognized immediately in order to avoid delays in treatment and irreversible blindness. We present the case of a 49-year-old woman who presented with vision loss and redness of her right eye two years after being treated for a stage I infiltrating ductal carcinoma status-post lumpectomy, chemotherapy, and radiation treatment to the left breast. Computed tomographic (CT) scans and magnetic resonance imaging (MRI) of the head demonstrated an intraocular metastasis to the right eye with development of a serous retinal detachmentcausing vision loss. The posterior pole and peripheral retina of the right globe were treated for the ocular metastasis and received a total dose of 25 Gy in 5 Gy fractions given every other day. MRI obtained one month after completion of radiation therapy demonstrated complete resolution of the right posterior chamber lesion with reduction in retinal thickening and resolution of subretinal fluid. The patient had moderate improvement of her vision and a more comfortable sensation in her eye after treatment. Subsequent PET, CT, and MRI demonstrated progression of pulmonary, abdominal, and CNS metastatic disease, which were unsuccessfully attempted to control with multiple chemotherapeutic and radiotherapy attempts. Despite the continued metastatic progression of her disease 5 years after diagnosis, the patient's vision remained stable and there was no evidence of recurrence of the choroidal metastasis 3 years after treatment with stereotactic radiation. An overview of the diagnosis and management of metastatic choroidal tumors is presented here.
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Affiliation(s)
- Yarah M. Haidar
- UC San Diego School of Medicine, Department of Radiation Oncology, La Jolla, CA, USA
| | - Bobby S. Korn
- UC San Diego School of Medicine, Department of Ophthalmology, Shiley Eye Center, La Jolla, CA, USA
| | - Mary Ann Rose
- UC San Diego School of Medicine, Department of Radiation Oncology, La Jolla, CA, USA
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21
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Vega LG, Dipasquale J, Gutta R. Head and neck manifestations of distant carcinomas. Oral Maxillofac Surg Clin North Am 2009; 20:609-23. [PMID: 18940627 DOI: 10.1016/j.coms.2008.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Metastatic tumors to the head and neck from distant carcinomas are rare lesions that epitomize the "zebras." They represent a diagnostic and therapeutic challenge for clinicians and health providers. These lesions usually rank low in the differential diagnosis list, but a history of cancer should prompt clinicians about the possibility of a metastatic lesion from a distant carcinoma. The presence of these lesions usually represents a poor prognosis. The surgeon's role in treating these lesions is to improve or maintain the patient's quality of life, taking into consideration the overall prognosis.
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Affiliation(s)
- Luis G Vega
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Florida, Health Science Center, 653-1 West 8th Street, Jacksonville, FL 32209, USA.
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Bucerius J, Meyka S, Bangard M, Biersack HJ, Eter N. Papillary Thyroid Carcinoma with an Uncommon Spread of Hematogenous Metastases to the Choroid and the Skin. J Natl Med Assoc 2008; 100:104-7. [DOI: 10.1016/s0027-9684(15)31183-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kanthan GL, Jayamohan J, Yip D, Conway RM. Management of metastatic carcinoma of the uveal tract: an evidence-based analysis. Clin Exp Ophthalmol 2007; 35:553-65. [PMID: 17760639 DOI: 10.1111/j.1442-9071.2007.01550.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Uveal metastasis from carcinoma is the most common cause of ocular malignancy in adults and represents an increasing problem in the context of an ageing population and enhanced survival of stage IV cancer patients. The reported prevalence of clinically evident uveal metastases in carcinoma patients ranges from 2% to 9%, with breast and lung cancer together accounting for between 71% and 92% of cases. Most patients (66-97%) have a known history of cancer and, although the majority have metastatic lesions elsewhere, up to 33% may present with an isolated ocular metastasis. These lesions may progress rapidly and are potentially sight-threatening. Early diagnosis and appropriate timely treatment are therefore of paramount importance to maintain patients' quality of life. The diagnosis is usually clinical and detailed descriptions of symptomatology and physical characteristics are provided. In 21-50% of patients, involvement is bilateral. External beam radiotherapy (EBRT), chemotherapy, hormone and biological therapies, brachytherapy, transpupillary thermotherapy, laser photocoagulation/photodynamic therapy and enucleation are therapeutic modalities described in the literature for the management of uveal metastases. The strongest evidence favours timely EBRT for the management of sight-threatening uveal metastases. The published evidence supporting EBRT for sight-threatening uveal metastases was given a grade B (strong support for recommendation). Newer alternative therapies are emerging and may have a role in selected patients; however, there are unfortunately few large studies examining such treatments for carcinoma metastatic to the eye. The role of these modalities will be further clarified with the results of larger comparative trials.
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Affiliation(s)
- Gowri L Kanthan
- Ocular Oncology Centre, Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
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Abstract
PURPOSE To report two cases in which malignancy masqueraded as scleritis, delaying the diagnosis. METHODS Two patients initially diagnosed and treated for unilateral scleritis were referred for management of persistent inflammation. Additional evaluation uncovered underlying malignant processes. RESULTS The first patient presented with scleritis initially responsive to systemic corticosteroids, with relapse one month later. Upon referral, peripheral fundus examination revealed elevated lesions. Additional studies confirmed the diagnosis of choroidal melanoma. The patient was treated with proton-beam irradiation. The second patient developed necrotizing scleritis unresponsive to systemic steroids, methotrexate, and cyclophosphamide. A scleral biopsy disclosed an undifferentiated high-grade carcinoma, likely metastatic. Exenteration was performed. CONCLUSIONS Scleritis can present a diagnostic challenge. It is often the sole initial manifestation of an occult systemic problem. Treatment-resistant scleritis should raise the suspicion of an infectious or malignant masquerade.
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Affiliation(s)
- Chrysanthi Kafkala
- Ocular Immunology and Uveitis Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Abstract
Herein, we review the associations between the kidney, renal cancers, and the eye. Renal cancers have been reported to metastasize to the eye and the orbit. As these tumors can be confused with other amelanotic or vascular tumors, a high index of suspicion is required for early detection and management of the primary tumor. We discuss the physiology of metastases, clinical features and management of metastatic disease. A variety of ocular anomalies have been associated with renal disease. Wilms tumor, a renal tumor of childhood, can present with aniridia, which may be the first clue leading to the diagnosis of the primary tumor. Paraneoplastic syndromes are common manifestations of renal cancers and can present as retinopathies and neuro-ophthalmic disorders. Multiple cancer syndromes involve both the eye and the kidney. For example, the diagnosis of von Hippel retinal tumors can lead to a systemic evaluation and discovery of associated visceral tumors. The prognosis, screening, and counseling of such patients is discussed. Newer systemic treatments available for renal tumors, such as interferon alfa, may lead to ocular side effects including retinopathy. These patients require periodic ophthalmic examinations. This review demonstrates the essential role of the ophthalmologist, for early diagnosis and treatment that can help reduce the morbidity and mortality associated with kidney tumors and renal-associated disease.
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Affiliation(s)
- Madhavi Kurli
- The New York Eye Cancer Center, and the New York University School of Medicine, New York, NY 10021, USA
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McCowan C, Stanley R, Lynch M. Transitional cell carcinoma metastatic to the eye in a collared peccary (Tayassu tajacu). Vet Ophthalmol 2002; 5:235-9. [PMID: 12236879 DOI: 10.1046/j.1463-5224.2002.00241.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 15-year-old female collared peccary (Tayassu tajacu) was presented for ophthalmic examination following sudden onset of blindness. Bilateral retinal detachment was diagnosed, neoplasia suspected, and euthanasia performed. Widespread tumor dissemination was apparent at autopsy, and transitional cell carcinoma was diagnosed histologically. The tumor was identified as arising from the ovary. Epidemiologic features of this case are discussed.
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Affiliation(s)
- Christina McCowan
- Department of Veterinary Science, University of Melbourne, 250 Princes Highway, Werribee, Victoria 3030, Australia.
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Wiegel T, Bottke D, Kreusel KM, Schmidt S, Bornfeld N, Foerster MH, Hinkelbein W. External beam radiotherapy of choroidal metastases--final results of a prospective study of the German Cancer Society (ARO 95-08). Radiother Oncol 2002; 64:13-8. [PMID: 12208569 DOI: 10.1016/s0167-8140(02)00134-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE In 1994 a prospective study of the 'Arbeitsgemeinschaft Radiologische Onkologie' of the German Cancer Society was initiated to examine the results of a standardized radiation therapy for choroidal metastases with 40 Gy. Recommendations in the literature vary from 21 to 50 Gy of total dose and from 2 to 5 Gy per single fraction. To date, no larger series treated with both a standardized technique and dose has been reported. PATIENTS AND METHODS Between 1994 and 1998, 56 patients were enrolled and 50 patients with 65 involved eyes were available for analysis. Thirty-five patients (70%) had unilateral and 15 patients (30%) had bilateral choroidal metastases. Fifty eyes (77%) were symptomatic and 15 eyes (23%) were asymptomatic. Thirty-one patients (62%) had breast cancer and 13 patients (26%) lung cancer as the primary tumor. Patients were treated with 40 Gy in 20 fractions with bilateral asymmetric fields for bilateral or a unilateral field for unilateral choroidal metastasis. Seventeen patients had additional chemotherapy after radiotherapy for general tumor progression. RESULTS With a median follow-up of 5.8 months (1-44 months) 41 out of 50 patients were dead. The median survival of all patients was 7 months and for patients with breast cancer 10 months. Of the 50 symptomatic eyes visual acuity increased for two or more lines in 36% (18/50), was stabilized in 50% (25/50 eyes), and decreased in 14% (7/50). No patient with asymptomatic metastasis (n = 15 eyes) developed ocular symptoms during follow-up. No patient with unilateral tumor and unilateral irradiation developed contralateral metastasis. Severe side effects, possibly related to tumor progression, occurred in three eyes (5%). CONCLUSION Radiation therapy with 40 Gy is an effective and safe palliative treatment for symptomatic and asymptomatic choroidal metastases to preserve vision in the majority of the patients. A unilateral field for unilateral metastasis seems to be sufficient to prevent contralateral disease. Side effects of radiotherapy are acceptable: 50% of patients developed a mild skin erythema and conjunctivitis (RTOG I). Late side effects were seen in three eyes (5%).
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Affiliation(s)
- Thomas Wiegel
- Department of Radiotherapy, University-Hospital Benjamin Franklin, Freie Universität Berlin, Hindenburgdamm 30, 12200 Berlin, Germany
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29
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Rennie IG. Things that go bump in the light. The differential diagnosis of posterior uveal melanomas. Eye (Lond) 2002; 16:325-46. [PMID: 12101438 DOI: 10.1038/sj.eye.6700117] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Mela EK, Koliopoulos JX, Lagogiannis PK, Giannopoulou AD, Georgakopoulos KD, Gartaganis SP. Bilateral multifocal choroidal metastases as the first manifestation of a breast carcinoma. Eye (Lond) 2000; 14 ( Pt 3A):392-3. [PMID: 11027010 DOI: 10.1038/eye.2000.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Kosmas C, Malamos NA, Tsavaris N, Antonopoulos M. Chemotherapy-induced complete regression of choroidal metastases and subsequent isolated leptomeningeal carcinomatosis in advanced breast cancer: a case report and literature review. J Neurooncol 2000; 47:161-5. [PMID: 10982158 DOI: 10.1023/a:1006449215047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Choroidal metastases from breast cancer represent an unusual metastatic presentation that has been traditionally treated with radiation therapy. Herein, we report a case of metastatic breast cancer presenting with pulmonary, cutaneous, lymph node and symptomatic choroidal metastases treated with systemic combination chemotherapy incorporating docetaxel and mitoxantrone without induction or consolidation radiation therapy to control visual symptoms from choroidal metastases. The patient experienced a durable complete remission in all metastatic sites that was maintained for 21 months since the initiation of chemotherapy, afterwhich she developed isolated leptomeningeal carcinomatosis managed successfully with intensive intrathecal methotrexate and whole brain irradiation leading to a new complete remission maintained until this report; 11 months after its presentation. This is the first case to our knowledge reporting complete regression of choroidal metastases with docetaxel-based chemotherapy as the only treatment modality and subsequent isolated leptomeningeal carcinomatosis recurrence.
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Affiliation(s)
- C Kosmas
- Department of Medicine, Helena-Venizelou Hospital, Athens, Greece.
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Wiegel T, Kreusel KM, Schmidt S, Bornfeld N, Foerster MH, Hinkelbein W. Radiotherapy of unilateral choroidal metastasis: unilateral irradiation or bilateral irradiation for sterilization of suspected contralateral disease? Radiother Oncol 1999; 53:139-41. [PMID: 10665791 DOI: 10.1016/s0167-8140(99)00135-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Radiotherapy is the highly effective standard in the treatment of choroidal metastasis. Visual acuity can be stabilized or increased in about 70-80% of eyes treated, thus prevailing the quality of life in these worse prognostic patients. In about 30-40% bilateral macroscopic disease is found at diagnosis. The best treatment for unilateral metastasis remains controversial: unilateral or bilateral irradiation for sterilization of suspected contralateral metastasis or unilateral irradiation without irradiation of the contralateral choroidea. In the analysis of a prospective study (ARO 95-08) 35 out of 50 patients with choroidal metastasis had unilateral disease and received unilateral irradiation with a lateral field using 6 MeV-photons (40 Gy in 20 fractions) without sparing the contralateral choroidea. Therefore the posterior contralateral choroidea received 50-70% of the total dose (20-28 Gy) for suspected micrometastasis. None of these patients developed contralateral choroidal metastasis during the median follow up time of 11.5 months. A unilateral field with 40 Gy for unilateral choroidal metastasis without sparing the contralateral choroidea seems to be effective in destroying contralateral micrometastasis with a lower risk of late side effects compared with bilateral fields.
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Affiliation(s)
- T Wiegel
- Department of Radiotherapy, University Hospital Benjamin Franklin, Freie Universität Berlin, Germany
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Wiegel T, Kreusel KM, Bornfeld N, Bottke D, Stange M, Foerster MH, Hinkelbein W. Frequency of asymptomatic choroidal metastasis in patients with disseminated breast cancer: results of a prospective screening programme. Br J Ophthalmol 1998; 82:1159-61. [PMID: 9924304 PMCID: PMC1722389 DOI: 10.1136/bjo.82.10.1159] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To determine the frequency of visually asymptomatic choroidal metastasis in patients with disseminated breast cancer and its dependence on the incidence of metastasis by number and site of other organ metastases. METHODS From January 1995 until April 1997 120 patients irradiated for disseminated breast cancer underwent ophthalmological screening for choroidal metastasis. No patient was symptomatic for ocular disease. 68 out of 120 patients were found to have metastases in one organ and 52 patients had metastases in more than one organ. 80% of the patients had bone metastases, 25% lung metastases, 22% liver metastases, 15% brain metastases, and 22% had metastases in other organs. RESULTS Six patients (5%) were found to have asymptomatic choroidal metastases. Five patients had unilateral and one patient bilateral metastases. 52 patients with more than one involved organ had a significantly higher risk for asymptomatic choroidal metastasis (6/52, 11%) than 68 patients with metastases in only one organ (0/68) (p = 0.006). In univariate analysis a significantly higher risk was seen for patients with lung metastases (14% choroidal metastases versus 2% in patients without lung metastases, p = 0.03) and for patients with brain metastases (17% choroidal metastases versus 3% in those without brain metastases, p = 0.04). CONCLUSION In disseminated breast cancer the incidence of asymptomatic choroidal metastases was 5% and increased to 11% when more than one organ was involved in metastatic spread. Risk factors for choroidal metastases were dissemination of disease in more than one organ and the presence of lung and brain metastases.
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Affiliation(s)
- T Wiegel
- Department of Radiotherapy, University Hospital Benjamin Franklin, Freie Universität Berlin, Germany
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O'shea JG. Environmental factors in the epidemiology and aetiology of malignant tumours of the eye. Clin Exp Optom 1996. [DOI: 10.1111/j.1444-0938.1996.tb04995.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- John G O'shea
- Department of Ophthalmology, Victoria Hospital, Blackpool
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Carty NJ, Foggitt A, Hamilton CR, Royle GT, Taylor I. Patterns of clinical metastasis in breast cancer: an analysis of 100 patients. Eur J Surg Oncol 1995; 21:607-8. [PMID: 8631404 DOI: 10.1016/s0748-7983(95)95176-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Many patients diagnosed with breast cancer will develop metastases and these have diverse presentations. We have reviewed 100 consecutive patients who have died with metastatic breast cancer, to determine the frequency, sites and mode of presentation of recurrent disease. The commonest site of failure was loco-regional (n = 61), this usually presented with a mass, but a minority of patients also complained of pain. Bone metastases developed in 60 patients and produced bone pain, pathological fracture (n = 6) or cord compression (n = 5). Pulmonary metastases producing shortness of breath were diagnosed in 34 patients and were asymptomatic in a further 10. Intra-abdominal metastases were found at some time in 23 patients, most commonly in the liver (n = 20) and the majority complained of epigastric pain (n = 17). Brain metastases occurred in 23 patients and produced a wide range of symptoms including those of a space-occupying lesion (n = 10), cranial nerve palsy (n = 7), diabetes insipidus (n = 3), focal limb weakness (n = 2) and meningitis (n = 1). Three patients had choroid metastases producing reduced visual acuity. Recurrent breast carcinoma can present in a variety of ways, therefore any new symptom or sign should be considered to represent recurrence until proved otherwise.
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Affiliation(s)
- N J Carty
- Breast Unit, Royal South Hants Hospital, Southampton, UK
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