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Photo Essay
October 1998

Solitary Choroidal Metastasis as the First Sign of Metastatic Lung Carcinoid

Arch Ophthalmol. 1998;116(10):1396-1397. doi:10.1001/archopht.116.10.1396

A 65-YEAR-OLD white man had a progressive loss of visual field in the superotemporal quadrant of his right eye. He had laser photocoagulation of a juxtafoveal choroidal neovascularization in his right eye 18 months ago and had a macular scar in his left eye due to exudative age-related maculopathy for 3 years. Visual acuity was 16/20 OD and 20/400 OS. On ophthalmic examination, his right eye showed a highly elevated, orange choroidal mass resembling choroidal melanoma in the inferonasal quadrant (Figure 1). The tumor demonstrated lower signal intensities on magnetic resonance imaging by T1compared with the signals expected for choroidal melanoma (Figure 2 and Figure 3). The lesion was not present 18 months earlier during laser photocoagulation. Thus, rapid tumor growth was assumed and metastasis was suspected. Computed tomography of the lung revealed a peripheral bronchial carcinoma (Figure 4), classified as a carcinoid by bronchoscopic biopsy. After a total dose of 40 Gy of ocular external beam irradiation and chemotherapy (3 courses of etoposide [VePesid, Bristol-Meyers Oncology Division, Bristol-Meyers Squibb Co, Princeton, NJ] and cisplatin [Platinol, Bristol-Meyers Oncology Division]), the metastasis completely regressed without deterioration of visual acuity (Figure 5). The patient demonstrated no recurrence in the eye, but developed brain metastasis after 6 months of follow-up.

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