RAPIDLY GROWING CHOROIDAL METASTASIS SIMULATING IMMUNE-RELATED CHOROIDAL ADVERSE REACTION

Area of Science:

• Ophthalmology
• Oncology
• Medical Imaging

Background:

• Multifocal breast cancer can metastasize to the choroid.
• Choroidal metastases can be mistaken for other inflammatory or immune-related conditions.
• Systemic cancer therapies may face challenges with acquired resistance.

Purpose of the Study:

• To present a clinical case of multifocal breast cancer with a rapidly progressing choroidal metastasis.
• To illustrate how choroidal metastasis can mimic immune-related adverse events.
• To emphasize the importance of multimodal imaging in diagnosing ocular metastasis.

Main Methods:

• Multimodal imaging techniques were employed, including wide-field fundus photography, spectral domain optical coherence tomography (OCT), OCT angiography, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography.
• Magnetic resonance imaging (MRI) and B-scan ultrasonography were also utilized.
• Clinical presentation and response to treatment were documented.

Main Results:

• A patient with metastatic breast cancer developed a rapidly growing choroidal lesion despite targeted therapy (trastuzumab and docetaxel).
• Initial imaging suggested a Vogt-Koyanagi-Harada-like reaction, but the lesion progressed despite corticosteroid treatment.
• Advanced imaging confirmed the lesion as choroidal metastasis with signs of extraocular spread.

Conclusions:

• Choroidal metastases can emerge and grow rapidly even during systemic cancer treatment due to acquired resistance.
• The rapid growth of choroidal metastasis can simulate inflammatory conditions like Vogt-Koyanagi-Harada disease.
• Comprehensive multimodal imaging and vigilant follow-up are crucial for accurate diagnosis and management of suspected ocular metastases.