Germ cell tumors. Case 1. Intraocular metastases from testicular cancer

Choroidal metastases in testicular choriocarcinoma, successful treatment with chemo- and radiotherapy: a case report

Background

Choriocarcinoma is a very rare cause of ocular metastasis. Only 18 male patients have been reported on, 4 of whom survived, but with significant loss of vision.

Case presentation

A 26-year-old Caucasian man, suffering from testicular choriocarcinoma with pulmonary, cerebral, renal, hepatic and osseous metastases, underwent left radical orchiectomy. While being treated with chemotherapy, he presented with loss of vision in the left eye. Ophthalmoscopy revealed bilateral non-pigmented, hemorrhagic choroidal tumours, compatible with secondary lesions. Continued chemotherapy and stereotactic radiotherapy of the skull and spine lead to full remission with excellent vision, after more than 4 years of follow up.

Conclusion

Testicular choriocarcinoma is an exceptional cause of choroidal metastasis, potentially asymptomatic and with specific clinical features. Radiotherapy can complement radical orchiectomy and chemotherapy, to achieve full remission and maintain good vision.

Testicular mixed germ-cell tumor metastatic to the choroid

PURPOSE

To describe the fundus findings, ultrasonography, and fluorescein angiography of a testicular mixed germ-cell tumor metastatic to the choroid and to report prompt resolution of the choroidal lesion with systemic chemotherapy.

METHODS

Observational case report. A 21-year-old man presented with a 10-cm testicular tumor. Ophthalmic examination revealed a large, dome-shaped choroidal lesion in the left eye, filling the entire superotemporal quadrant and extending into the macula. Ultrasonography showed a 10.3 mm in thickness hyperechoic mass. The patient was started on vinblastine, mesna, ifosfamide, and cisplatin.

RESULTS

On ophthalmic examination 6 weeks after initiation of chemotherapy, the choroidal lesion had completely resolved, leaving only pigmentary changes. Final ophthalmology follow-up 8 months after presentation demonstrated no recurrence of choroidal metastases.

CONCLUSION

Testicular germ-cell tumors have now been well described to metastasize to the choroid. These choroidal metastases can show a prompt, favorable response to chemotherapy.