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CASE SNIPPET
Year : 2012  |  Volume : 58  |  Issue : 2  |  Page : 153-154

Atypical presentation of lung carcinoma


Department of Ophthalmology, Kasturba Medical College, Manipal, Karnataka, India

Date of Web Publication14-Jun-2012

Correspondence Address:
Y S Kamath
Department of Ophthalmology, Kasturba Medical College, Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.97181

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How to cite this article:
Kamath Y S, Gupta P, Rao K A, Bhat S S. Atypical presentation of lung carcinoma. J Postgrad Med 2012;58:153-4

How to cite this URL:
Kamath Y S, Gupta P, Rao K A, Bhat S S. Atypical presentation of lung carcinoma. J Postgrad Med [serial online] 2012 [cited 2019 Dec 15];58:153-4. Available from: http://www.jpgmonline.com/text.asp?2012/58/2/153/97181


Choroidalmetastasis with symptoms of blurred vision may rarely be the initial presentation of lung carcinoma. [1],[2],[3] We report a case wherein a middle-aged patient presented to us with presbyopic symptoms, but was detected to have primary lung carcinoma with intraocular metastasis.

A 40-year-old farmer was evaluated in an eye camp, where he presented with a complaint of difficulty in reading small letters. Considering his age, presbyopia was initially suspected. However, a disparity in the visual acuity of both eyes prompted a detailed evaluation. His best corrected visual acuity was 20/20, N6 in his right eye, and 20/60, N12 in his left eye. Anterior segment evaluation was normal in his right eye but revealed a relative afferent pupillary defect in his left eye. His fundus examination at the base hospital showed a choroidal mass around 4 disc diameters in size with overlying serous retinal detachment in both eyes, with macular involvement in his left eye [Figure 1]. Systemic history of cough four months ago, occasional low-grade fever, but no significant weight loss or tobacco use was elicited. Mantoux test was negative and chest X-ray reported as normal. He was referred to the physician for evaluation of the cough but was lost to follow-up.
Figure 1: Fundus examination showing bilateral choroidal mass with overlying serous retinal detachment

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After a month, he reported with further deterioration of vision and cough. A fundus fluorescein angiogram [Figure 2], and repeat B-scan ultrasonography [Figure 3] showed an increase in size of lesions with features of choroidal metastasis. A chest computed tomography (CT) scan done showed a lung nodule with spiculated margins in the medial segment of the right middle lobe with metastatic lesions seen in the liver and lobular enhancing lymph nodal mass lesion in the carinal region and multiple enlarged mediastinal lymph nodes [Figure 4]. Bronchial brushing samples retrieved by fiberoptic bronchoscopy were detected to be smear-positive for non-small-cell lung carcinoma.
Figure 2: Fundus fluorescein angiography depicting hyperfluoresence of choroidal mass in both eyes

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Figure 3: B-scan ultrasonography showing bilateral choroidal thickening with overlying retinal detachment

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Figure 4: CT scan depicting a lung nodule with spiculated margins in the right middle lobe

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Choroidal metastasis is most common from breast carcinoma in women, and lung carcinoma in men. [4] In their case series, Shields et al., reported that of the patients presenting only with uveal metastasis without awareness of systemic cancer, 35% had the primary source in the lung. [4]

In the presence of a history of chronic cough in our middle-aged non-smoker, infectious etiology of tuberculosis was initially considered. Intraocular tuberculosis can present as a large choroidal mass called tuberculoma, which may cause visual disturbance if the macula is involved. [5] However in our case, the Mantoux test was negative and the fundus fluorescein angiogram revealed an early hyperfluoresence in the choroidal mass suggestive of metastasis.

Ocular metastasis of non-small-cell lung carcinoma has been reported to respond well to systemic chemotherapy and intravitreal bevacizumab therapy. [6],[7] The mean survival in patients with disseminated lung cancer and choroidal metastasis ranges from 1.9 months to 6 months. [8] Unfortunately, despite a diagnosis, the treatment could not be initiated as the patient was lost to follow-up.

To conclude, a disparity in presbyopic status in a peripheral camp was noted, evaluated due to a high index of suspicion and found to be a manifestation of a life-threatening problem.


 :: Acknowledgments Top


Mr. Suresh (Photographer, Department of Ophthalmology), Departments of Radiodiagnosis and Medicine, Kasturba Medical College, Manipal, India.

 
 :: References Top

1.Asteriou C, Konstantinou D, Kleontas A, Paliouras D, Samanidis G, Papadopoulou F, et al. Blurred vision due to choroidal metastasis as the first manifestation of lung cancer: A case report. World J Surg Oncol 2010;8:2.  Back to cited text no. 1
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2.John VJ, Jacobson MS, Grossniklaus HE. Bilateral choroidal metastasis as the presenting sign of small cell lung carcinoma. J Thorac Oncol 2010;5:1289.  Back to cited text no. 2
    
3.Herrag M, Lahmiti S, Yazidi AA, Le Lez ML, Diot P. Choroidal metastasis revealing a lung adenocarcinoma. Ann Thorac Surg 2010;89:1013-4; author reply 1014.  Back to cited text no. 3
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4.Shields CL, Shields JL, Gross NE, Schwartz GP, Lally SE. Survey of 520 eyes with uveal metastases. Ophthalmology 1997;104:1265-76.  Back to cited text no. 4
    
5.Gupta V, Gupta A, Rao NA. Intraocular tuberculosis: An update. Surv Ophthalmol 2007;52:561-87.  Back to cited text no. 5
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6.Kim SW, Kim MJ, Huh K, Oh J. Complete regression of choroidal metastasis secondary to non-small-cell lung cancer with intravitreal bevacizumab and oral erlotinib combination therapy. Ophthalmologica 2009;223:411-3.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Singh A, Singh P, Sahni K, Shukla P, Shukla V, Pant NK. Non-small cell lung cancer presenting with choroidal metastasis as first sign and showing good response to chemotherapy alone: A case report. J Med Case Reports 2010;4:185.  Back to cited text no. 7
    
8.Ascaso FJ, Castillo JM, García FJ, Cristóbal JA, Fuertes A, Artal A. Bilateral choroidal metastases revealing an advanced non-small cell lung cancer. Ann Thorac Surg 2009;88:1013-5.  Back to cited text no. 8
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
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