Multimodal imaging features of choroidal metastasis of non-small-cell lung cancer: a case report
Keywords:
Carcinoma, non-small-cell lung, Choroid neoplasms, Fluorescein angiography, Liquid biopsy, Tomography, optical coherenceAbstract
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.
References
Shields CL, Shields JA, Gross NE, Schwartz GP, Lally SE. Survey of 520 eyes with uveal metastases. Ophthalmology 1997;104:1265-76.
Shah SU, Mashayekhi A, Shields CL, et al. Uveal metastasis from lung cancer: clinical features, treatment, and outcome in 194 patients. Ophthalmology 2014;121:352-7.
Kreusel KM, Bechrakis NE, Wiegel T, Krause L, Foerster MH. Incidence and clinical characteristics of symptomatic choroidal metastasis from lung cancer. Acta Ophthalmol 2008;86:515-9.
Arevalo JF, Fernandez CF, Garcia RA. Optical coherence tomography characteristics of choroidal metastasis. Ophthalmology 2005;112:1612-9.
Arepalli S, Kaliki S, Shields CL. Choroidal metastases: origin, features, and therapy. Indian J Ophthalmol 2015;63:122-7.
Cennamo G, Montorio D, Carosielli M, Romano MR, Cennamo G. Multimodal imaging in choroidal metastasis. Ophthalmic Res 2021;64:411-6.
Mathis T, Jardel P, Loria O, et al. New concepts in the diagnosis and management of choroidal metastases. Prog Retin Eye Res 2019;68:144-76.
Konstantinidis L, Rospond-Kubiak I, Zeolite I, et al. Management of patients with uveal metastases at the Liverpool Ocular Oncology Centre. Br J Ophthalmol 2014;98:92-8.
Heitzer E, Ulz P, Geigl JB. Circulating tumor DNA as a liquid biopsy for cancer. Clin Chem 2015;61:112-23.
Leighl NB, Page RD, Raymond VM, et al. Clinical utility of comprehensive cell-free DNA analysis to identify genomic biomarkers in patients with newly diagnosed metastatic non-small cell lung cancer. Clin Cancer Res 2019;25:4691-700.
Shields JA, Shields CL, Singh AD. Metastatic neoplasms in the optic disc: the 1999 Bjerrum Lecture: part 2. Arch Ophthalmol 2000;118:217-24.
Brown GC, Shields JA. Mechanisms of optic disc swelling with diffuse choroidal melanomas: clinicopathologic correlations. Br J Ophthalmol 1982;66:77-82.
Szalai E, Wells JR, Grossniklaus HE. Mechanisms of optic nerve invasion in primary choroidal melanoma. Ocul Oncol Pathol 2017;3:267-75.
Demirci H, Cullen A, Sundstrom JM. Enhanced depth imaging optical coherence tomography of choroidal metastasis. Retina 2014;34:1354-9.
Pichi F, Invernizzi A, Tucker WR, Munk MR. Optical coherence tomography diagnostic signs in posterior uveitis. Prog Retin Eye Res 2020;75:100797.
Ishida T, Morohoshi K, Takeuchi Y, Soma R, Uchida M, Ohno-Matsui K. Swept-source optical coherence tomographic findings in eyes with metastatic choroidal tumor. Am J Ophthalmol Case Rep 2017;8:44-7.
Cennamo G, Romano MR, Breve MA,et al. Evaluation of choroidal tumors with optical coherence tomography: enhanced depth imaging and OCT-angiography features. Eye (Lond) 2017;31:906-15.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Hong Kong Journal of Ophthalmology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The Journal has a fully Open Access policy and publishes all articles under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. For any use other than that permitted by this license, written permission must be obtained from the Journal.
