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LETTER TO EDITOR
Year : 2013  |  Volume : 2  |  Issue : 2  |  Page : 86

Lung cancer presenting as visual impairment


1 Department of Pulmonary Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
2 Department of Pulmonary Medicine, Kolkata Medical College and Hospital, Kolkata, West Bengal, India
3 Department of Pulmonary Medicine, NRS Medical College and Hospital, Kolkata, West Bengal, India

Date of Web Publication15-Apr-2013

Correspondence Address:
Kaushik Saha
Department of Pulmonary Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-330X.110501

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How to cite this article:
Saha K, Basuthakur S, Jash D, Maji A. Lung cancer presenting as visual impairment. South Asian J Cancer 2013;2:86

How to cite this URL:
Saha K, Basuthakur S, Jash D, Maji A. Lung cancer presenting as visual impairment. South Asian J Cancer [serial online] 2013 [cited 2019 Oct 23];2:86. Available from: http://journal.sajc.org/text.asp?2013/2/2/86/110501

Sir,

Synchronous bilateral retinal detachment due to choroidal metastasis as a presenting sign is very rare in lung carcinoma. Ocular metastasis can occur in lung cancer but usually as a late sign. Here we report a case of a non-smoker, young male patient presenting with visual impairment due to bilateral retinal detachment as a result of choroidal metastasis. He also had metastasis to occipital lobe, liver and kidneys.

A 24-year-old young non-smoker male presented with headache, loss of vision in left eye with dimness of vision in his right eye for one week to a local eye clinic. His ophthalmological examination showed visual acuity in left eye PL (perception of light) positive with PR (projection of rays) defective and counting fingers at three feet in right eye. On indirect ophthalmoscopy, there was presence of bilateral retinal detachment (left > right). There was central mass-like lesion in left side near hilum with increase in size of the lesion compared to the previous chest x-ray [Figure 1]a and b. Computed tomographic (CT) scan of thorax with contrast showed left upper lobe mass with mediastinal lymph nodes and metastatic lesions in liver and kidneys [Figure 1]c and d. On slit lamp microscopy and fundus fluorescein angiography, there was presence of bilateral retinal detachment with findings suggestive of choroidal metastasis [Figure 2]b, c and d. On ultrasonography (USG) B scan of eye there was presence of bilateral choroidal metastasis [Figure 2]a. Magnetic resonance imaging (MRI) of brain showed metastasis at right occipital lobe and highly enhancing soft tissue (hypointense in T1, isointense in T2, hyperintense in FLAIR) deposit at posteromedial aspect of right eye ball and posterior aspect of left eye ball; suggestive of choroidal metastasis that resulted in retinal detachment [Figure 2]e and f. CT-guided trucut biopsy of lung mass revealed features suggestive of poorly differentiated adenocarcinoma [Figure 3]a and b. Immunohistochemistry confirmed the diagnosis of adenocarcinoma as tumour cells stained positive for epithelial membrane antigen, pancytokeratin, thyroid transcription factor 1, and cytokeratins 8 and 7. Patient was treated with chemotherapy (regimen consists of carboplatin and paclitaxel) with intraocular radiotherapy.
Figure 1: (a) Chest x‑ray PA view showing left hilar opacity at onset of chest symptoms and (b) increase in the same opacity after 4 weeks (c) CT scan of thorax with contrast showing left upper lobe mass with mediastinal lymph node and (d) hypo‑echoic lesions in liver and kidneys suggestive of metastasis

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Figure 2: (a) Eye investigations: USG‑B scan of left eye showing choroidal metastasis with retinal detachment; (b and c) Slit lamp microscopy of both eyes showing retinal detachment with choroidal lesions; (d) Fundus fluorescein angiography showing blocked fluorescence at optic disc due to hemorrhage‑associated retinal detachment; (e) MRI of brain with contrast showing choroidal highly enhancing soft tissue deposit at posteromedial aspect of right eye ball and posterior aspect of left eye ball and (f) MRI of brain with contrast showing eccentric solid lesion with peripheral rim enhancement metastasis

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Figure 3: (a) CT‑guided fine needle aspiration cytology from lung mass showing highly cellular smear of atypical epithelial cells with mild‑to‑moderate pleomorphism and hyperchromatic nuclei in cluster and papillae (×5 ×10) and (b) acini showing cells with nuclear hyperchomacia, nuclear pleomorphism, nuclear overlapping and prominent nucleoli suggestive of poorly differentiated adenocarcinoma (×5 ×40)

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Metastatic tumor, being the most common malignant tumor of the eye in men, presenting as the first sign of disseminated cancer is rare. [1] Metastatic ocular tumors more commonly involve the anterior segment of the eye (conjunctiva, choroid and uvea) than the posterior segment, orbit and optic nerve with a proportion of 7:1. [2] The occurrence of retinal detachments due to ocular metastasis is rare, which is reported in our case. [3] This case report underscores that choroidal metastases should be suspected in lung cancer patients with reduced vision. The median survival from lung cancer after the discovery of choroidal metastasis is reported to be 7.4 months (range 0.5 to 19 months). [4]

 
  References Top

1.Buys R, Abramson DH, Kitchin FD, Gottlieb F, Epstein M. Simultaneous ocular and orbital involvement from metastatic bronchogenic carcinoma. Ann Ophthalmol 1982;14:1165-71.  Back to cited text no. 1
    
2.Jakobiec F, Rootman J, Jones I. Secondary and metastatic tumors of the orbit. Clin Ophthalmol 1988;2:51-64.  Back to cited text no. 2
    
3.Mack HG, Jakobiec FA. Isolated metastases to the retina or optic nerve. Int Ophthalmol Clin 1997;37:251-60.  Back to cited text no. 3
    
4.Ferry AP, Font RL. Carcinoma metastatic to the eye and orbit II. A clinicopathological study of 26 patients with carcinoma metastatic to the anterior segment of the eye. Arch Ophthalmol 1975;93:472-82.  Back to cited text no. 4
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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