Choroidal metastasis as the presenting feature of lung chondrosarcoma

A woman in her late 30s presented with a 3 week history of rapidly worsening vision in her right eye. Examination revealed a large amelanotic choroidal mass with subretinal fluid and progressive growth on serial imaging, raising suspicion of malignancy. Systemic workup identified a 14 cm lung mass, which was resected and histologically confirmed as grade II chondrosarcoma. Meanwhile, the choroidal lesion enlarged rapidly to a collar-stud configuration involving the posterior pole, suggesting this to be a chondrosarcoma metastasis. External beam radiotherapy was declined due to lack of histological confirmation and minimal evidence of choroidal metastasis developing from chondrosarcoma in the literature. Given the poor visual prognosis, rapid tumour growth and diagnostic uncertainty, enucleation was performed, confirming metastatic chondrosarcoma. Subsequent imaging demonstrated multifocal skeletal metastases and the patient was placed on palliative care. This case highlights choroidal metastasis as the first manifestation of pulmonary chondrosarcoma and underscores the diagnostic and management challenges in such rare presentations.