First Author: A.Arora UK
Co Author(s): V. Papastefanou J. Hungerford V. Cohen 0 0 0 0 0 0 0 0 0
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To demonstrate that a Choroidal metastases may masquerade as a choroidal haemangioma
Ocular Oncology Service, London
A 56-year old lady presented with a seven-year history of deteriorating visual acuity in the left eye. Patient had a 15-year history of sarcoidosis associated with recurrent uveitis. Posterior segment examination revealed an elevated lesion inferotemporally to the macula of the left eye measuring 6.5 x 6.8 mm, pale orange in colour and difficult to discern clinically from the surrounding retina. FFA indicated early hyperfluorescence. Doppler B-scan ultrasound demonstrated high internal reflectivity measuring 2.7 mm in elevation with internal blood flow. Clinical appearance was typical of a circumscribed choroidal haemangioma. No ocular treatment was performed pending ongoing investigations for a thyroid gland mass discovered on a routine CT scan of the neck and chest. Thyroid gland biopsy proved the mass was a follicular cell carcinoma of the thyroid and systemic staging revealed stage 4 disease. Following radioactive treatment of the thyroid gland the visual acuity reduced to counting fingers. Fundus examination indicated a dramatic change in the appearance of the lesion from an orange, dome shaped elevated mass to a flat fibrosed scar of pale-greenish colour. This change was attributed to radioactive iodine uptake and prompted the diagnosis of a secondary metastatic lesion masquerading as a choroidal haemangioma.
Choroidal metastases are the most common intraocular tumour. Metastases to the choroid are typically pale yellow in colour with the exception of thyroid, renal cell and carcinoid metastases, which are known to have an orange appearance. Hence an isolated choroidal metastasis from thyroid gland carcinoma can appear similar to a circumscribed choroidal haemangioma. In this case, the dramatic change in appearance of the choroidal mass following treatment for stage 4 follicular cell carcinoma indicated that the mass was a metastatic deposit. This dramatic, rapid fibrosis of a choroidal metastasis has, to our knowledge, not been described previously following I-131ablation treatment of follicular cell carcinoma of the thyroid gland. Following a review of the literature, 6 cases of follicular carcinoma metastatic to the choroid have been described. In all cases, including the present case, patients presented with coexisting metastases in bone or lung; therefore the eye is not an early metastatic site. In summary, metastatic thyroid cancer to the choroid can appear similar to circumscribed choroidal haemangioma. Response to systemic treatment with radiolabeled iodine was dramatic and produced complete regression of the choroidal lesion within 3 months. No local ocular treatment was required.