[Small cell lung cancer presenting as a metastatic conjunctival tumor]

A 65-year-old man complaining of a left medial ocular angle mass and hemoptysis was admitted to our hospital. Chest radiography revealed a right hilar mass and bronchoscopy revealed widespread cancerous invasion of the carina, both main bronchi, right upper lobe bronchus, truncus intermedius, and middle lobe bronchus. Histological examination of a biopsied specimen revealed small cell carcinoma. Brain CT scan, abdominal CT scan, and bone scintigram showed solitary brain, multiple liver, and multiple bone metastases. Partial response was obtained with three courses of combined chemotherapy with carboplatin and etoposide, and the ocular tumor until it was almost invisible to the unaided eye. However, complete response could not be obtained with additional two courses of combined chemotherapy, and the patient was discharged. Seven months after the first admission, he was readmitted with dyspnea and an enlarged (6 mm in diameter) left ocular mass. Histological examination of the resected mass revealed a small cell carcinoma that had metastasized to the conjunctival substantia propria. He died of respiratory failure one month after readmission. Metastasis to the eye from primary lung cancer is uncommon and patients such as this are extremely rare. Although some cases of uveal or orbital metastasis from lung cancer have been reported, we can find no other report of conjunctival metastasis from lung cancer.