Multimodal imaging features of choroidal metastasis of non-small-cell lung cancer: a case report

Authors

  • Simon Ka Ho Szeto HKEH https://orcid.org/0000-0001-9377-7377
  • Shaheeda Mohamed Hong Kong Eye Hospital
  • Chi Wai Tsang Hong Kong Eye Hospital
  • Timothy YY Lai Chinese University of Hong Kong
  • Vivian Hui Hong Kong Eye Hospital
  • Carmen KM Chan Hong Kong Eye Hospital

Keywords:

Carcinoma, non-small-cell lung, Choroid neoplasms, Fluorescein angiography, Liquid biopsy, Tomography, optical coherence

Abstract

We describe multimodal imaging features of right eye choroidal metastasis of non-small-cell lung cancer in a 25-year-old woman. This case report highlights the importance of multimodal imaging and liquid biopsy in making the diagnosis of choroidal metastasis. Spectral domain optical coherence tomography showed a dome-shaped choroidal elevation with subretinal fluid and subretinal hyper-reflective foci. Fundus autofluorescence showed hyper-autofluorescence with alternating spots of hypo-autofluorescence. Fluorescein angiography showed hypofluorescence followed by diffuse and pin-point leakage. Indocyanine green angiography showed a hypofluorescence lesion. The patient was initially misdiagnosed as having choroiditis and treated with oral corticosteroid. However, the exudative retinal detachment progressed and optic disc edema developed. The working diagnosis was thus shifted towards choroidal neoplasm. Positron emission tomography and lung biopsy confirmed the diagnosis of metastatic non-small-cell lung cancer. Blood-based comprehensive genomic profiling detected a rare epidermal growth factor receptor mutation. Target therapy with osimertinib achieved good oncological response. Vision improved to 6/7.5, and the choroidal lesion and subretinal fluid regressed. At 1-year follow-up, the patient had no systemic or ocular relapse.

Author Biographies

Chi Wai Tsang, Hong Kong Eye Hospital

Consultant, Hong Kong Eye Hospital

Timothy YY Lai, Chinese University of Hong Kong

Honoary Professor, Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong

Vivian Hui, Hong Kong Eye Hospital

Resident Trainee, Hong Kong Eye Hospital

Carmen KM Chan, Hong Kong Eye Hospital

Consultant, Hong Kong Eye Hospital

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Published

2022-12-29

How to Cite

1.
Szeto SKH, Mohamed S, Tsang CW, Lai TY, Hui V, Chan CK. Multimodal imaging features of choroidal metastasis of non-small-cell lung cancer: a case report. Hong Kong J Ophthalmol [Internet]. 2022Dec.29 [cited 2023Feb.3];26(2). Available from: https://hkjo.hk/index.php/hkjo/article/view/344

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Section

Case Report