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Ocular Metastasis of Bronchial Typical Carcinoid

Open ArchivePublished:April 07, 2018DOI:https://doi.org/10.1016/j.jtho.2018.04.001
      An 86-year-old Caucasian female who was never a smoker was diagnosed with bronchial typical carcinoid and cervical lymph node metastases in December 2008 (Fig. 1). She underwent chemotherapy with octreotide acetate, dacarbazine, carboplatin, and etoposide for 5 cycles. However, the tumor became aggravated and disseminated to the liver, lymph nodes of the upper abdomen, lungs inside, pulmonary hilus, and pleura (Fig. 2A), consecutively. In June 2016, she reported a 1-year history of visual deterioration and diplopia in the right eye. Fundus and ultrasound examination revealed a large subretinal mass involving the optic disc in the right eye (Figs. 2B and 2C). Four months later, she presented with an emergency for redness, pain, and hand motion vision in the right eye with the intraocular pressure of 52 mm Hg (normal range, 11 to 21 mm Hg). Her right eyeball was enucleated. Histopathologic and immunohistochemical findings were consistent with choroidal metastases from a bronchial typical carcinoid with stage IV (M1c) (Fig. 3). She was still alive after enucleation.
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      Figure 1Histopathologic and immunohistochemical findings of the primary bronchial typical carcinoid in 2008. (A) Hematoxylin and eosin section (original magnification ×200). Immunohistochemically, the tumor cells revealed immunoreactivity for CK8 (B, original magnification ×200) and thyroid transcription factor 1 (C, original magnification ×200). Magnified images (original magnification ×400) of the black squared areas were shown in the bottom right corner, respectively.
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      Figure 2Images of the bronchial typical carcinoid and choroidal metastases. (A) Chest computed tomography depicted a mass invading the right pulmonary hilus (white arrow) and pleura (black arrow) in 2014. A nonfunctioning metallic bronchial stent (arrowhead) was found within the invaded right intermediate bronchus. (B,C) A large orange, dome-shaped mass (arrowhead) under the retina (white arrow) involving the optic nerve (black arrow) of the right eye on fundoscopy (B) and ultrasonography (C) in 2016.
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      Figure 3Histopathologic and immunohistochemical findings of the choroidal metastasis in 2016. (A) Hematoxylin and eosin section (original magnification ×200). (B,C) Immunohistochemically, the tumor cells revealed immunoreactivity for CK8 (B, original magnification ×200) and thyroid transcription factor 1 (C, original magnification ×200).
      Choroidal metastasis constitutes the most common intraocular malignant tumor.
      • Lim H.H.
      • Choi S.Y.
      • Yoo H.J.
      • et al.
      Choroidal metastasis of small cell lung cancer.
      The most frequent primary sites are lung in males and breast in females.
      • Shields C.L.
      • Shields J.A.
      • Gross N.E.
      • et al.
      Survey of 520 eyes with uveal metastases.
      • Shah S.U.
      • Mashayekhi A.
      • Shields C.L.
      • et al.
      Uveal metastasis from lung cancer: clinical features, treatment, and outcome in 194 patients.
      However, there are few published reports of choroidal metastasis from bronchial typical carcinoid given that it is a rare and low-grade lung neuroendocrine neoplasm and ocular screening is not routinely performed.
      • Harbour J.W.
      • De Potter P.
      • Shields C.L.
      • et al.
      Uveal metastasis from carcinoid tumor. Clinical observations in nine cases.
      However, an ophthalmologic evaluation is indicated in the presence of ocular symptoms in patients with bronchial carcinoid. Timely diagnosis and treatment might be helpful in preserving the eyeballs and improving the quality of remaining life.

      Acknowledgments

      This work was supported by grants from the following sources to Dr. Heindl: German Research Foundation (FOR 2240 “[Lymph-] Angiogenesis and Cellular Immunity in Inflammatory Diseases of the Eye”); HE 6743/2-1 and HE 6743/3-1, GEROK-program University Hospital of Cologne, and German Cancer Aid.

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