1. Patient Presentation
A 55-year-old woman presented to the emergency department with a 1-week history of painless visual reduction in the left eye. The patient had received a diagnosis of left invasive breast carcinoma, with distant organ metastases to the bone, lung, liver, and brain. She denied any history of ocular surgery or trauma. At presentation, her visual acuity was 20/200. Her anterior segment was unremarkable. Fundus photography of the left eye showed an ill-defined, yellow-white choroidal lesion approaching the macula, combined with macular edema and superficial retinal hemorrhage (Fig 1). B-ultrasound revealed a mass with medium internal reflectivity and exudative retinal detachment (Fig 2).
Figure 1.
Fundus photography showed an ill-defined, yellow-white choroidal lesion approaching the macula (white arrowheads), combined with macular edema (asterisk) and superficial retinal hemorrhage (white arrow) in the left eye.
Figure 2.
B-ultrasound revealed a mass with medium internal reflectivity and exudative retinal detachment (white arrow) in the left eye.
2. Diagnosis: Choroidal Metastasis Secondary to Invasive Breast Carcinoma
Fat-suppressed T2-weighted magnetic resonance imaging of the orbit demonstrated a dome-shaped mass with medium internal isointensity in the left eye (Fig 3). The patient immediately underwent an intravitreal anti-vascular endothelial growth factor drug (ranibizumab) injection and retinal photocoagulation (Fig 4). Ten days later, her visual acuity improved to 20/40. However, her general condition deteriorated at a further 6-month follow-up appointment.
Figure 3.
Fat-suppressed T2-weighted magnetic resonance imaging demonstrated a dome-shaped mass with medium internal isointensity (white arrow) in the left eye.
Figure 4.
Retinal photocoagulation was visible (white arrowheads).
Choroidal metastasis is a rare ocular condition that arises secondary to malignant tumors, with breast carcinoma being the primary source.1,2 It may occur even during the course of targeted chemotherapy following oncology protocols. Medical history, ocular examinations, and imaging studies help in early diagnosis.2 Patients often present with painless visual reduction, especially for macular involvement.1,2 The presence of choroidal metastasis is a predictor for distant systemic involvement and poor clinical prognosis.3 Patients need multidisciplinary management from oncologists, radiation therapists, and ophthalmologists.3,4
Funding and Support
By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.
Consent to Participate
Informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict of Interest
All authors have affirmed they have no conflicts of interest to declare.
Footnotes
Supervising Editor: James Fletcher, MD.
References
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