Neuroendocrine tumor of the lung presenting as slowly progressive, painful bilateral choroidal masses

To report a rare case of a metastatic slow growing neuroendocrine tumor of the lung that presented as slow-growing bilateral choroidal masses with progressive vision loss and retrobulbar pain.

A 64-year-old male presented with vision loss and retrobulbar pain bilaterally, progressively worsened for four months. He had no significant past medical history but had seen an ophthalmologist in Mexico starting 1.5 years earlier and was informed he may have a mass in the eye when last seen five months earlier. Ophthalmic examination revealed visual acuity of 20/400 bilaterally with large elevated amelanotic choroidal masses in both maculae with overlying pigmentary changes and subretinal fluid. The initial differential diagnosis included choroidal metastasis and infectious and inflammatory etiologies such as posterior scleritis and granuloma. Whole body PET-CT scan revealed a focus of hypermetabolic activity in the lung suspicious for a slow growing malignancy or infectious/inflammatory lesion. Due to insurance issues, there was a delay in referral to medical oncology. The choroidal lesions gradually increased in size over four months. Eventual biopsy of the lung confirmed the diagnosis of a slow-growing neuroendocrine tumor of the lung. Systemic treatment with octreotide, Capecitabine, and Temozolomide was initiated with regression of choroidal tumors, improvement in visual acuity, and resolution of eye pain.

We describe a rare case of a bilateral choroidal metastasis from a slow growing neuroendocrine tumor of the lung that presented with slowly progressive bilateral vision loss and eye pain. Despite delays in diagnosis and treatment, eye pain resolved, and vision loss improved with systemic therapy alone.