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 coherence
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.
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