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Retinal metastasis from unknown primary: diagnosis, management, and clinicopathologic correlation
Kenneth J Taubenslag1, Stephen J Kim1, Albert Attia2
1Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee;
Digital Journal of Ophthalmology : DJO
|June 23, 2016
Summary
A rare case of non-small cell lung cancer presented as a retinal metastasis. Despite extensive workup, the primary tumor remained unidentified, highlighting diagnostic challenges in ocular oncology.
Area of Science:
- Ophthalmology
- Oncology
- Pathology
Background:
- Retinal metastasis is a rare but serious condition.
- Early diagnosis and treatment are crucial for visual preservation and systemic management.
Observation:
- A 75-year-old man presented with a retinal lesion initially misdiagnosed as viral retinitis.
- Retinal biopsy revealed metastasis, later confirmed as non-small cell lung carcinoma via histopathology and immunohistochemistry.
- Systemic imaging failed to locate the primary tumor.
Findings:
- The patient underwent silicone oil removal before external beam radiotherapy (EBRT) due to silicone oil's radiation-attenuating properties.
- Retinal metastasis showed a complete response to EBRT.
- No primary tumor was identified even after 18 months of follow-up.
Implications:
- This case underscores the importance of considering metastatic disease in unexplained retinal lesions, even without a known primary cancer.
- Ocular metastasis can be the initial presentation of an occult malignancy.
- Multidisciplinary management involving ophthalmology, oncology, and pathology is essential for optimal patient outcomes.
