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Unusual presentation of metastatic carcinoma to the eye
Tatyana Milman1, Codrin Iacob, Richard B Rosen
1From the *Department of Pathology and Laboratory Medicine, The New York Eye and Ear Infirmary; †Department of Ophthalmology, The New York Eye and Ear Infirmary; ‡Eye Care for the Adirondacks, New York; §Retina Associates of New York PC; and ¶The New York Eye and Ear Infirmary, New York, New York.
Purpose:
To describe four patients with an unusual presentation of metastatic carcinoma to the eye, diagnosed by histopathologic and immunohistochemical evaluation of vitrectomy material.
Methods:
Retrospective case series of four patients with metastatic carcinoma to the retina/vitreous. The New York Eye and Ear Infirmary database was searched to identify patients with metastatic carcinoma to the retina or vitreous, diagnosed from 1995 to 2006. Diagnoses were established through histopathologic and immunohistochemical evaluation of vitreous fluid obtained via pars plana vitrectomy.
Results:
The New York Eye and Ear Infirmary Pathology database search resulted in 19,149 vitrectomy specimens, 4 of which were positive for metastatic carcinoma. The diagnosis was clinically unsuspected in three patients. The oncologic work-up revealed the origin of metastases to be from the breast in two patients and from the lung in two patients.
Conclusion:
Metastatic carcinoma to the eye can present with clinically innocuous metastases, masquerading as epiretinal membrane and macular hole, central serous chorioretinopathy, rhegmatogenous retinal detachment, retinal granuloma, and endophthalmitis. These findings suggest that submission of vitrectomy specimens for pathologic evaluation should be considered in patients with an oncologic history or in those with atypical clinical presentation.
Insights
Metastatic cancer to the eye can mimic other conditions, making diagnosis challenging. Histopathologic evaluation of vitrectomy samples is crucial for identifying ocular metastases from breast or lung cancer.
Area of Science:
- Ophthalmology
- Oncology
- Pathology
Background:
- Metastatic carcinoma to the eye is rare.
- Ocular metastases can present with varied and sometimes subtle clinical signs.
Purpose of the Study:
- To report on four cases of metastatic carcinoma to the eye.
- To highlight unusual presentations of ocular metastases.
Main Methods:
- Retrospective case series.
- Histopathologic and immunohistochemical analysis of vitrectomy specimens.
- Database search of ophthalmic pathology records.
Main Results:
- Four cases of metastatic carcinoma to the retina/vitreous identified.
- Primary tumors originated from breast (2) and lung (2).
- Clinical diagnosis was unsuspected in three of the four patients.
Conclusions:
- Ocular metastases can masquerade as common retinal pathologies like macular holes or retinal detachments.
- Vitrectomy specimen analysis is vital for diagnosing metastatic carcinoma in patients with a history of cancer or atypical presentations.
- Early diagnosis through pathological evaluation aids in timely oncologic management.
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