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Are iris masses in lung carcinoma always a metastasis: Two case reports
Bhagabat Nayak1, Prasanta Raghab Mohapatra2, Koyel Chakraborty1
1Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneshwar 751019, Odisha, India.
Background:
Small cell lung cancer (SCLC) constitutes about 15% of lung cancers and is an aggressive disease with uveal metastasis. An isolated iris lesion in such patients may or may not be a manifestation of disseminated disease. We report two cases - one patient with SCLC and another with non-small cell lung cancer, each with varied presentation.
Case Summary:
The first case was a 49-year-old female who presented with redness in the left eye. She was a known case of SCLC with multi-organ involvement. The best corrected visual acuity (BCVA) was 20/100. Slit-lamp bio-microscopy showed an iris mass with neovascularization. Cytology from anterior chamber paracentesis was suggestive of malignancy. Subsequently she received whole-brain radiotherapy followed by six cycles of platinum doublet chemotherapy. On follow-up, the iris lesion subsided with BCVA of 20/50. The second case was a 54-year-old female with lung adenocarcinoma and brain metastasis. She presented with pain and redness in the right eye (BCVA 20/200). Slit lamp bio-microscopy showed multiple iris nodules in the affected eye. Trabeculectomy was done due to raised intraocular pressure (IOP). Aqueous tap and tissue biopsy for cytology and histopathology respectively, were negative for secondaries. Postoperatively, BCVA improved to 20/70, with an IOP of 12 mmHg and resolution of the nodules.
Conclusion:
Iris lesions in lung carcinoma patients may not necessarily be metastases. Sometimes they can be reactive nodules mimicking secondaries.
