Área Técnica: Oncologia
BILATERAL CHOROIDAL METASTASIS AS THE FIRST SIGN OF LUNG CARCINOMA: A CASE REPORT
Report a case of a female patient with bilateral choroidal masses due to metastasis from a lung oat-cell carcinoma.
A 79-year- old, female patient was referred to the Ocular Oncology sector of the Federal University of São Paulo with a complaint of decreased visual acuity in both eyes for the past six months. She complained of sudden and painless visual loss that started in the right eye and a few months later affected the left eye. Patient also reported loss of weight and appetite, as well as a smoking habit for five years that she had stopped 40 years before presentation. Ophthalmological examination revealed visual acuity of hand movements in the right eye and counting fingers on the left eye. Anterior biomicroscopy of both eyes showed that the patient was pseudophakic. Fundoscopic examination was impossible on the right eye due to vitreous hemorrhage and on the left eye revealed an elevated, orange-colored subretinal mass on the posterior pole. Patient underwent bilateral ocular ecographic evaluation which made possible the observation of a solid, subretinal lesion, with irregular surface and heterogeneous reflectivity, associated with vitreous hemorrhage on the right eye, and a more regular lesion with sound attenuation and absence of vitreous hemorrhage on the left eye . Complete body tomographic scans were made and a pulmonary mass associated with multiple hepatic lesions was found. Fine needle aspiration biopsy was performed on one of the hepatic lesions and histopathological evaluation diagnosed an oat-cell lung carcinoma.
The occurrence of ocular metastasis from lung cancer is uncommon however, they can be the first sign of disseminated disease. This case highlights the importance of a thorough systemic evaluation in patients with choroidal tumors in which early diagnosis can be life sparing.