Metastatic Choroidal Tumor

Metastatic Choroidal Tumor
SYMPTOMS Blurry vision, Metamorphopsia, Scotomas, Peripheral vision loss, Flashes, Floaters, Eye pain
SIGNS Usually isolated (Can be multifocal) | Usually unilateral (Can be bilateral) | Typically found in the posterior pole
Dome-shaped appearance as it breaks through Bruch’s membrane | Thickness is typically greater than 2mm | Subretinal fluid present with shaggy photoreceptor layer (Over 90% of cases present with SRF)
Accumulation of leopard skin spots (Macrophages containing lipofuscin and melanin granules) | Large basal diameter (usually greater than 7mm)
Documented increase in size | Absence of RPE halo and drusen | Typically associated with a serous retinal detachment (90% of the time)
WORK-UP Full eye exam with dilation | OCT | Fundus autofluorescence (Increase in AF due to leopard spots) | Fluorescein angiography (Hypofluorescence due to blockage of dye by tumor cells, followed by mottled hyperfluorescence and subsequent leakage) | ICG (Hypocyanescent without double circulation pattern) | Fundus photos | Infrared photos | B-scan ultrasound (Irregular mass with medium-high internal reflectivity)
TREATMENT Refer to an ocular oncologist/retinal specialist ASAP for treatment (plaque brachytherapy, etc.)
Refer to PCP/Oncology for additional testing to evaluate and treat cancer elsewhere
FOLLOW-UP Once retina/choroid is stable after treatment with no signs of active melanoma, carefully monitor every 4-6 months (Watch closely for radiation retinopathy)
ADDITIONAL LAB | TESTS CBC with differential | Liver enzyme panel | Renal function Urinalysis | CT or ultrasound of the abdomen and pelvis | CT or ultrasound of the liver | X-ray of the lungs | Mammography | MRI/CT of the orbit
Testing will most likely be ordered by ocular oncologist
ETIOLOGY Infiltration of the choroid by cancer cells from a primary site through the bloodstream
DIFFERENTIAL DX Choroidal amelanotic melanoma, Choroidal amelanotic nevus, Choroidal hemangioma, Choroidal osteoma, Choroidal granuloma
NOTES Typically associated with breast cancer in females and lung cancer in males
Patients with a metastatic choroidal tumor have a high mortality rate (100% in 10 years)