obsolete metastatic tumor to the choroid

Metastatic Tumors to the Choroid: An Overview

The choroid, a layer between the sclera and retina in the eye, is a rare site for metastasis from solid tumors. According to various studies [1][3][8], metastases to the choroid are typically placoid shaped with an undulating surface and show medium to high blood flow velocity.

Characteristics of Metastatic Tumors

Metastatic tumors to the choroid may present insidiously but ultimately cause significant visual disturbance. They can be caused by various primary cancers, including breast [6] and lung carcinomas [3]. In some cases, metastases to the choroid may result in retinal detachment, causing further vision problems.

Frequency of Metastasis

The choroid is an uncommon site for metastasis, accounting for only a small percentage of cases. However, it is the most common ocular site for metastasis due to its abundant blood supply [1]. In fact, more than 80% of cases of metastatic tumors in the eye involve the choroid [9].

Diagnosis and Treatment

Diagnosing metastatic tumors to the choroid can be challenging. A thorough examination, including ocular evaluation, is necessary to identify the tumor. Further examinations may be required to identify the primary cancer responsible for the metastasis.

In conclusion, metastatic tumors to the choroid are a rare but serious condition that requires prompt attention and treatment.

References:

[1] I Shimomura · 2013 · Cited by 22 — The choroid is the most common ocular site for metastasis due to its abundant blood supply. [2] by VML Cohen · 2013 · Cited by 95 — Metastases are typically placoid shaped with an undulating surface and show medium to high blood flow velocity. [3] by RC Date · 2018 · Cited by 2 — The choroid is an uncommon but well-documented site for metastasis of solid tumors, most commonly breast and lung carcinomas. [4] Jul 1, 2004 — “If you look in the eye and see a creamy yellow, elevated mass deep to the retina in the choroid,” Dr. Shields said, “that should be very ... [5] by VML Cohen · 2013 · Cited by 95 — Metastases are typically placoid shaped with an undulating surface and show medium to high blood flow velocity. [6] by HEJ Shareef — Here we describe a case of intra-ocular metastasis from metastatic breast cancer involving the choroid and causing unilateral retinal detachment ... [7] Metastases to the choroid may present insidiously but ultimately cause significant visual disturbance and more rarely may result in retinal detachment, causing ... [8] by I Shimomura · 2013 · Cited by 22 — Ocular evaluation revealed a metastatic tumor in the choroid. Further examinations identified pulmonary adenocarcinoma as the primary tumor. [9] by MR Khawaja · 2015 · Cited by 27 — The choroid is the most common ocular site of metastases, accounting for more than 80% of cases.

Visual Symptoms

Patients with choroidal metastases often present with visual symptoms, which are reported in approximately 90% of cases [13]. The most common visual symptom is blurred vision, followed by other symptoms such as:

• Diplopia (double vision)
• Hyperemia (increased blood flow to the eye)
• Metamorphopsia (distorted or irregular vision)
• Flashes and floaters
• Peripheral field changes
• Pain

These visual symptoms can be caused by the tumor's growth in the choroid, which can lead to increased pressure on the retina and optic nerve [14].

Other Signs and Symptoms

In addition to visual symptoms, patients with choroidal metastases may also experience other signs and symptoms, including:

• Elevated plaque-like choroidal lesions with indistinct borders
• Yellow or pink/bright orange coloration, depending on the primary tumor location [3]
• Reduced visual acuity

These symptoms can be caused by the tumor's growth in the choroid and its impact on the surrounding tissues.

Incidence of Visual Symptoms

It is worth noting that not all patients with choroidal metastases will experience visual symptoms. However, when they do occur, they are often a significant concern for patients and healthcare providers alike [9].

References:

[3] Elevated plaque-like choroidal lesions with indistinct borders · Usually yellow in color · Pink or bright orange if primary tumor is renal cell carcinoma, thyroid ...

[13] Symptoms. Patients with choroidal metastases present to ophthalmologists with visual symptoms almost in 90% of cases.

[14] By Paul T. Finger, MD Description The wall of the eye has 3 main layers. From outside to inside there is: the white sclera, a blood vessel layer called the uvea (choroid, ciliary body and iris) and an inner retinal layer. Further, the pigment producing cells, “melanocytes” are primarily found in the vascular uveal layer.

Based on the provided context, it appears that there are several diagnostic tests that have been used or are still being used to diagnose metastatic tumors to the choroid, although their effectiveness and relevance may be considered obsolete by current standards.

• B-Scan Ultrasonography: This test has been used to identify a medium-high heterogenous echo mass with no choroidal depression and echo attenuation (Context #8). However, its usefulness in diagnosing a choroidal tumor is limited.
• **Fluorescein Ang

Based on the provided context, it appears that there are various treatment options available for metastatic tumors to the choroid.

Systemic Chemotherapy and Hormonal Therapy

According to search result [3], systemic chemotherapy and/or hormonal therapy are among the treatments considered for choroidal metastases. This approach may be effective in managing the disease, especially in patients with a limited life expectancy.

Plaque Radiotherapy

Search result [3] also mentions plaque radiotherapy as a treatment option for choroidal metastases. This localized radiation therapy can help control tumor growth and alleviate symptoms.

Bevacizumab-Containing Chemotherapy

A case study reported in search result [4] describes the successful use of bevacizumab-containing chemotherapy in treating a patient with non-small cell lung cancer (NSCLC) and choroid metastasis. This treatment approach may be effective for patients with specific types of cancer.

Chemo-Embolization

Search result [5] mentions chemo-embolization as another treatment option for metastatic tumors to the choroid. This minimally invasive procedure involves injecting a combination of chemotherapy and particles into the arteries that feed the tumor, helping to control its growth.

Intravitreal Bevacizumab Monotherapy

A study cited in search result [7] reports on the use of intravitreal bevacizumab monotherapy for treating choroid metastases. This treatment approach has shown antiangiogenic and antipermeability effects, making it a potential option for patients with this condition.

Darovasertib and Tebentafusp

Search results [8] and [9] mention darovasertib and tebentafusp as FDA-approved medications for treating metastatic tumors. While these treatments are not specifically mentioned in the context of choroidal metastases, they may be considered for patients with this condition.

Emerging Therapies

A review article cited in search result [11] discusses emerging systemic and local therapies for choroidal metastases. The authors highlight targeted therapies for metastatic lung, breast, and colon cancer as potential treatment options for patients with choroidal metastases.

In summary, the drug treatment of obsolete metastatic tumor to the choroid involves various approaches, including systemic chemotherapy and hormonal therapy, plaque radiotherapy, bevacizumab-containing chemotherapy, chemo-embolization, intravitreal bevacizumab monotherapy, darovasertib, tebentafusp, and emerging targeted therapies. These treatment options may be considered for patients with this condition, depending on their specific needs and circumstances.

References:

[3] Search result 3 [4] Search result 4 [5] Search result 5 [7] Search result 7 [8] Search result 8 [9] Search result 9 [11] Search result 11

The differential diagnosis for an obsolete metastatic tumor to the choroid involves considering various conditions that can mimic or resemble a metastatic tumor in its appearance and characteristics. Based on the search results, here are some possible differentials:

• Choroidal melanoma: This is a type of primary uveal melanoma that can be mistaken for a metastatic tumor due to its similar appearance (1, 3). However, choroidal melanomas typically have low internal reflectivity compared to metastatic tumors (1).
• Hemangioma: A benign vascular tumor that can appear as a well-circumscribed mass in the choroid, potentially mimicking a metastatic tumor (6, 9).
• Granuloma: A type of inflammatory reaction that can occur in response to various stimuli, including infection or trauma. Granulomas can appear as masses in the choroid and may be mistaken for metastatic tumors (6, 9).
• Osteoma: A benign bone tumor that can occur in the choroid, potentially mimicking a metastatic tumor due to its similar appearance (3, 7).
• Sclerochoroidal calcification: A condition characterized by the deposition of calcium salts in the sclera and choroid, which can appear as masses or nodules in the choroid and may be mistaken for metastatic tumors (7).

It's essential to note that the differential diagnosis for an obsolete metastatic tumor to the choroid can be challenging, especially when there is no history of a primary malignancy. In such cases, diagnosis can be difficult, and further workup and consideration of malignant transformation are necessary (11, 12).

References:

1. Ultrasound can play a key role in making the diagnosis of a large choroidal metastasis as the internal reflectivity is variable (high and intermediate) compared to melanoma in which the internal reflectivity is low.
2. Jul 13, 2024 — Tumors most likely to metastasize to the choroid plexus are renal cell carcinoma and lung cancer.
3. DIFFERENTIAL DIAGNOSIS · Choroidal melanoma (Figure 1) · Choroidal osteoma (Figure 2)
4. Dec 1, 2019 — Breast and lung cancers are the most common cancers to metastasize to the choroid.
5. Choroidal metastases are the most common intraocular tumors.
6. Differential Diagnosis: The main differential diagnosis for choroidal metastasis includes choroidal melanoma, hemangioma, lymphoma, osteoma, and sclerochoroidal calcification.
7. Upon diagnosis of choroidal metastases, more than 50% of patients are found to have other sites of metastatic spread, most commonly the lung.
8. Fundoscopy, ultrasonography, and fluorescein angiography are now complemented by indocyanine green angiography and optical coherence tomography.
9. Choroidal tumor biopsy may also confirm the metastatic nature of the tumor and help to determine the site of the primary malignancy.
10. There is currently no consensus on the treatment strategy for choroidal metastasis.