Choroidal Metastasis - Both Eyes - Exudative Retinal Detachment - Adenocarcinoma - Probably Pulmonary
|
|
58-year-old man was seen in the office on 9/21/2012. He saw you a few months ago. His eyes were fine and then during a checkup today you noticed choroidal masses in both eyes. He does smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks.
He does see a cancer specialist at Moffitt but he has been under surveillance for possible melanoma because of his family history. He has not had melanoma.
VISUAL ACUITY: His vision is 20/25 in both eyes. IOP: OD 15, OS 20.
SLIT LAMP EXAM: There is 1+ nuclear sclerosis in both eyes. The left eye has 1+ cell and flare in the anterior chamber. He is dilated in that eye.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There is a choroidal lesion, which is elevated, dome-shaped, and hypopigmented superotemporal to the macula. It measures about 11 x 11 mm at the base.
OS: Vertical C/D ratio is 0.2. There is a choroidal mass just nasal to the optic nerve which is larger than the one in the other eye. It measures about 15 x 13 mm across. There is also a serous inferior retinal detachment.
ULTRASOUND: The ultrasound confirms the relatively low internal reflectivity of both of the masses and the retinal detachment. The height of the lesion in the right eye is 3.8 mm and the height of the lesion in the left eye is 5 mm.
COLOR PHOTOGRAPHY: The color photos show the masses to be mostly hypopigmented over the surface with stippling of the retinal pigment epithelium.
FLUORESCEIN ANGIOGRAPHY: The FA shows no significant internal circulation to either lesion with just increasing hyperfluorescence from pigment epithelial irregularities over the surface.
IMPRESSION:
1. PROBABLE BILATERAL CHOROIDAL METASTASES
2. SEROUS RETINAL DETACHMENT – LEFT EYE
DISCUSSION: I explained to the patient, given the time course of the appearance and the ultrasound and fluorescein characteristics of these lesions, they are likely choroidal metastases. As a smoker with
chest pain on his right flank, I think the most likely primary would be lung cancer; however, this has not yet been determined. I spoke with someone at Dr Glass’s office today, who is his cutaneous oncologist, and they are going to have a medical oncologist from Moffitt Cancer Center contact him at home later today with an appointment for an urgent evaluation.
FU: Biopsy of tumor showed adenocarcinoma, probably primary lung. Patient had tumor in virtually every organ including brain and was placed on medication for cerebral edema.
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment1136 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment631 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment630 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment616 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment659 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment519 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment406 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment421 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment391 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment376 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment366 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment325 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment349 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment324 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment350 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment319 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment393 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment336 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment323 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment352 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment358 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment446 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment475 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
Choroidal Metastases - Both Eyes - Exudative Retinal Detachment475 views58-year-old man smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks. vision is 20/25 in both eyes
(0 votes)
|
|
|
|
58-year-old man was seen in the office on 9/21/2012. He saw you a few months ago. His eyes were fine and then during a checkup today you noticed choroidal masses in both eyes. He does smoke a pack of cigarettes a day. He has had some ribcage pain for about the last two weeks. He also had a sinus infection for about two weeks, and he has also had hazy vision on the superior visual field in the left eye for about the last two weeks.
He does see a cancer specialist at Moffitt but he has been under surveillance for possible melanoma because of his family history. He has not had melanoma.
VISUAL ACUITY: His vision is 20/25 in both eyes. IOP: OD 15, OS 20.
SLIT LAMP EXAM: There is 1+ nuclear sclerosis in both eyes. The left eye has 1+ cell and flare in the anterior chamber. He is dilated in that eye.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There is a choroidal lesion, which is elevated, dome-shaped, and hypopigmented superotemporal to the macula. It measures about 11 x 11 mm at the base.
OS: Vertical C/D ratio is 0.2. There is a choroidal mass just nasal to the optic nerve which is larger than the one in the other eye. It measures about 15 x 13 mm across. There is also a serous inferior retinal detachment.
ULTRASOUND: The ultrasound confirms the relatively low internal reflectivity of both of the masses and the retinal detachment. The height of the lesion in the right eye is 3.8 mm and the height of the lesion in the left eye is 5 mm.
COLOR PHOTOGRAPHY: The color photos show the masses to be mostly hypopigmented over the surface with stippling of the retinal pigment epithelium.
FLUORESCEIN ANGIOGRAPHY: The FA shows no significant internal circulation to either lesion with just increasing hyperfluorescence from pigment epithelial irregularities over the surface.
IMPRESSION:
1. PROBABLE BILATERAL CHOROIDAL METASTASES
2. SEROUS RETINAL DETACHMENT – LEFT EYE
DISCUSSION: I explained to the patient, given the time course of the appearance and the ultrasound and fluorescein characteristics of these lesions, they are likely choroidal metastases. As a smoker with
chest pain on his right flank, I think the most likely primary would be lung cancer; however, this has not yet been determined. I spoke with someone at Dr Glass’s office today, who is his cutaneous oncologist, and they are going to have a medical oncologist from Moffitt Cancer Center contact him at home later today with an appointment for an urgent evaluation.
FU: Biopsy of tumor showed adenocarcinoma, probably primary lung. Patient had tumor in virtually every organ including brain and was placed on medication for cerebral edema.
