Pulmonary Adenocarcinoma Metastatic to the Choroid Diagnosed by Biopsy of an Extrascleral Nodule

From Blurred Vision to Stage IV Lung Cancer: Choroidal Metastases

Metastatic choroidal tumors are the most common type of intraocular malignancy and are often linked to advanced-stage systemic cancers. Lung cancer, a leading cause of cancer-related mortality worldwide, occasionally presents with choroidal metastasis as the initial sign of systemic disease. This case series, which presents two distinct presentations of choroidal metastases as the first clinical manifestation of advanced lung adenocarcinoma, contributes to the understanding of the atypical presentations of lung cancer and the importance of considering ocular symptoms in the diagnosis of systemic diseases.

Sclerosing Signet Ring Cell Carcinoma of the Lacrimal Gland: A Potentially New Primary Entity

An 88-year-old man presented with diplopia, limitation of extraocular movements, and a firm palpable mass in the superolateral orbit. Biopsy revealed a sclerosing signet ring cell carcinoma with histopathologic features mimicking those of a primary signet ring cell (histiocytoid) carcinoma of the eyelid of eccrine or apocrine gland origin, a metastasis from an invasive lobular breast carcinoma or a metastatic diffuse-type gastric carcinoma. An extensive panel of immunohistochemical stains and molecular genetic analyses unequivocally failed to establish a precise diagnosis. Electron microscopy demonstrated features of a primary lacrimal gland lesion with intracytoplasmic lumens and zymogen granules typical of lacrimal secretory pyramidal cells. A thorough initial systemic work-up failed to reveal a primary visceral malignancy. Fifteen months of follow-up have failed to detect the emergence of another primary malignancy. To the best of our knowledge, a tumor with the morphology of the current lesion has not been previously described in the major or accessory lacrimal glands.

Choroidal Mucinous Metastatic Adenocarcinoma from the Colon: A Diagnostic Challenge

An enucleated globe was submitted from an outside hospital to the Ophthalmic Pathology Laboratory for evaluation. There was a minimal amount of accompanying clinical history. Histopathologic examination revealed a mucinous adenocarcinoma of the choroid. The determination of the origin of the tumor proved to be challenging based on the lack of a definitive systemic diagnosis. Initial suspicions that the tumor may represent a breast carcinoma were disproved when immunohistochemical biomarkers for breast carcinoma were negative. Similarly, typical markers of colon adenocarcinoma were not expressed. Positive immunostaining with a newer immunohistochemical marker, SATB2, and defects in DNA mismatch repair helped to confirm that the ocular metastasis was of colonic origin. Further clinical evaluation including imaging studies established that the patient had a primary colonic adenocarcinoma with widespread systemic metastases. The diagnostic utility and biologic significance of these latest immunohistochemical biomarkers for colon cancer are reviewed. Clinicians are encouraged to provide detailed clinical histories with the tissue specimens to enable the discovery of undetected "silent primaries" at the time an ocular metastasis develops and is discovered.