RESUMO
The aim of this study was to investigate the primary sites, clinical characteristics, and treatment outcomes of patients with metastatic tumors in the eye and ocular adnexa. This retrospective case series consisted of 42 patients diagnosed with intraocular metastasis (IM) or ocular adnexal metastasis (OAM) at a tertiary center between January 2001 and June 2023. The patients comprised 18 men and 24 women; 24 (57%) and 18 (43%) patients were diagnosed with IM and OAM, respectively. In the IM group, the primary tumors originated from the lungs (79%), followed by the breasts (17%). In the OAM group, the primary tumors originated from the breasts (33%). Previously, 57% of the patients had been diagnosed with cancer. In the IM group, 38% exhibited bilateral involvement. Only 6% of the patients with OAM had bilateral diseases. The 1-, 3-, and 5-year overall survival (OS) was 42%, 18%, and 7%, respectively. The median OS since metastasis diagnosis in the lungs and breast was 11.8 and 10.5 months, respectively. Lung cancer remains the predominant primary cancer in IM, whereas breast cancer is the major cancer in OAM. Despite poor OS, early detection will facilitate the prompt treatment of primary cancer and metastatic sites.
Assuntos
Neoplasias Oculares , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neoplasias Oculares/patologia , Neoplasias Oculares/terapia , Neoplasias Oculares/mortalidade , Neoplasias Oculares/secundário , Idoso , Estudos Retrospectivos , Adulto , Resultado do Tratamento , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Neoplasias da Mama/mortalidade , Idoso de 80 Anos ou mais , Metástase NeoplásicaRESUMO
Orbital and periocular metastatic tumors used to be considered very rare; however, with the constant updating of drugs and detection methods for cancer treatment, new chemotherapies and radiation treatments are being used. The life expectancy of cancer patients has become longer and periocular metastases are becoming easier to detect. Our knowledge of this rare disease of metastases also needs to be updated. This article reviews the incidence, symptomatic presentation, clinical features, diagnostic approaches and current treatment of metastatic tumors of the orbit and ocular adnexa in these patients.
Assuntos
Neoplasias Orbitárias , Humanos , Neoplasias Orbitárias/secundário , Neoplasias Orbitárias/terapia , Neoplasias Palpebrais/terapia , Neoplasias Palpebrais/patologia , Neoplasias Palpebrais/epidemiologia , Neoplasias Palpebrais/secundário , Neoplasias Oculares/secundário , Neoplasias Oculares/terapia , Neoplasias Oculares/patologiaRESUMO
BACKGROUND: Intraocular metastases arising from solid tumors are found in approximately 2% of patients with metastatic tumor diseases and are therefore more frequent than originally assumed. They often affect the uvea and are associated with a poor prognosis. Due to the difficult diagnosis and an inconsistent treatment regimen, ophthalmologists have a special responsibility here. OBJECTIVE: This article gives a summary of the various types of intraocular metastases with respect to clinical features, diagnostics, treatment and prognosis as well as recommendations for follow-up care. METHODS: A selective literature search was carried out on the topic of intraocular metastases using PubMed and Google Scholar. RESULTS: Intraocular metastases most frequently affect the uvea, specifically the choroid. In most cases the underlying disease is breast or lung cancer, but other rarer primary tumors have also been reported in the literature. Metastatic lesions can show very different morphological manifestations but can be distinguished based on the corresponding structure of manifestation in the eye and with the aid of targeted staging, thus providing valid information on the type of primary tumor. The treatment is partly experimental and usually depends on the primary tumor and leading symptoms of the patient. A differentiation between a curative or palliative treatment situation must always be made. CONCLUSION: Intraocular metastases are the most frequent intraocular tumor and are usually associated with a poor prognosis. Accurate diagnostics for finding the treatment as well as interdisciplinary collaboration and the presentation of the patient on the tumor board are essential.
Assuntos
Neoplasias Oculares , Humanos , Neoplasias Oculares/secundário , Neoplasias Oculares/terapia , Neoplasias Oculares/patologia , Neoplasias Oculares/diagnóstico , PrognósticoRESUMO
Metastases of malignant diseases are the most frequent tumors diagnosed in the human eye. They occur in approximately 5-10% of patients with solid tumors during the course of the disease. Their frequency is particularly high in patients with breast and lung cancer. Many highly sensitive periorbital tissues can be affected by the localization of the metastatic lesions and pose a number of clinical challenges. The main goal of the therapy of ocular metastases consists of the control of tumor growth (including the control of other possible manifestations throughout the body), the preservation of the affected eye and the minimization of potential iatrogenic damage to adjacent tissues. Overall, the purpose of this strategy is also to maintain the quality of life and especially the eyes and vision of the patient. Furthermore, pain should be avoided or at least alleviated. Of special importance is the differentiation between a curative or palliative situation. Patients with ocular metastases usually undergo systemic treatment appropriate for the underlying tumor entity, which is often accompanied by concomitant or sequential radiotherapy. In addition to classical chemotherapy, targeted treatment, treatment with monoclonal antibodies and antibody-drug conjugates as well as immunotherapy with checkpoint antibodies are currently available for many cancer types. This review article gives an overview of the currently available treatment options for patients with ocular metastases of solid tumors.
Assuntos
Neoplasias Oculares , Estadiamento de Neoplasias , Humanos , Neoplasias Oculares/secundário , Neoplasias Oculares/terapia , Neoplasias Oculares/patologia , Imunoterapia/métodos , Terapia Combinada , Antineoplásicos/uso terapêuticoAssuntos
Carcinoma de Células Renais , Endoftalmite , Neoplasias Renais , Corpo Vítreo , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/diagnóstico , Diagnóstico Diferencial , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Neoplasias Oculares/diagnóstico , Neoplasias Oculares/secundário , Neoplasias Renais/patologia , Neoplasias Renais/diagnóstico , Corpo Vítreo/patologia , Corpo Vítreo/microbiologia , Corpo Vítreo/diagnóstico por imagemAssuntos
Melanoma , Recidiva Local de Neoplasia , Inoculação de Neoplasia , Neoplasias Uveais , Corpo Vítreo , Humanos , Masculino , Neoplasias Oculares/patologia , Neoplasias Oculares/secundário , Melanoma/secundário , Melanoma/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Uveais/patologia , Corpo Vítreo/patologia , Corpo Vítreo/diagnóstico por imagemAssuntos
Inibidores de Checkpoint Imunológico , Melanoma , Neoplasias Cutâneas , Humanos , Neoplasias Oculares/secundário , Neoplasias Oculares/tratamento farmacológico , Neoplasias Oculares/patologia , Inibidores de Checkpoint Imunológico/uso terapêutico , Melanoma/secundário , Melanoma/tratamento farmacológico , Melanoma/patologia , Melanoma Maligno Cutâneo , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/secundário , Corpo Vítreo/patologia , Feminino , Pessoa de Meia-IdadeRESUMO
Metastatic tumors to the eye and eyelid are generally seen in patients with disseminated metastases in the setting of advanced disease. Occasionally, they can present as the first sign of occult malignancy. The choroid is the most common site of intraocular metastases secondary to its dense vascular supply. Similar to the eye, metastatic tumors to the eyelid can present with a variety of clinical findings and are most often seen in patients with a known history of cancer. The most common skin malignancy that can spread to ocular structures is cutaneous melanoma, whereas the most common noncutaneous malignancy is breast cancer followed by lung cancer. In pediatric patients, metastatic disease to the eye is rare and can be seen in neuroblastoma and Ewing sarcoma. The overall prognosis of metastatic lesions involving the eye and eyelid is typically poor, with a mean survival of months. Ophthalmologists play an important role in the diagnosis of metastatic disease of the eye and eyelid; therefore, it is imperative for patients to undergo a complete ophthalmic examination and systemic workup if they have new-onset vision changes and a known history of cancer. Early diagnosis and management with systemic and local therapies can maximize quality of life and preserve vision.
Assuntos
Neoplasias da Mama , Neoplasias Palpebrais , Melanoma , Neoplasias Cutâneas , Feminino , Humanos , Neoplasias da Mama/patologia , Neoplasias da Coroide/secundário , Neoplasias Oculares/secundário , Neoplasias Palpebrais/secundário , Neoplasias Pulmonares/patologia , Melanoma/patologia , Neuroblastoma/secundário , Neuroblastoma/patologia , Prognóstico , Sarcoma de Ewing/patologia , Neoplasias Cutâneas/patologiaRESUMO
This case report describes iris neovascularization secondary to vitreous metastasis of a cutaneous melanoma in a man aged 75 years who presented with elevated intraocular pressure.
Assuntos
Neoplasias Oculares , Melanoma Maligno Cutâneo , Neovascularização Patológica , Neoplasias Cutâneas , Corpo Vítreo , Humanos , Iris/patologia , Melanoma Maligno Cutâneo/patologia , Neoplasias Cutâneas/patologia , Corpo Vítreo/patologia , Neoplasias Oculares/secundárioRESUMO
The incidence of ocular metastases in patients with disseminated breast cancer is increasing. This study aimed to investigate the clinical features, treatment, and prognosis of breast cancer patients with ocular metastases. For this purpose, a total of 16 patients were diagnosed with ocular metastases. Demographic, treatment, and other clinical data were obtained from patients' charts. The estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) statuses of the patients were obtained from the histopathologic reports. Demographic features were analyzed through descriptive statistics, and the Kaplan-Meier method was used for survival analysis. The results showed that among the 16 patients (median age: 41 years), 10 had ER-positive, 8 had PR-positive, and 3 had HER2-positive disease. The choroid was the most commonly involved structure (n = 8). Nine (56%) patients had blurred vision. Treatments for these patients included systemic therapy (six patients), radiotherapy (three patients), and combined therapy (seven patients). The median time from the diagnosis of breast cancer to the diagnosis of ocular metastasis was 52.9 months, and the median time from the diagnosis of metastatic breast cancer at any other site to the diagnosis of ocular metastasis was 21.3 months. The median overall survival (OS) was 136.5 months (95% confidence interval, 40.6-232.4 months), and the median survival duration after ocular metastasis was 32.4 months (95% confidence interval, 20.1-44.7 months). The OS of patients with unilateral eye involvement and bilateral eye involvement did not differ significantly (P = 0.573), nor did the OS of those diagnosed before 2000 and in 2000 or later (P = 0.409). In general, a breast cancer patient with ocular metastasis can have a good prognosis after therapy. However, large-scale clinical studies are needed to confirm our findings.
Assuntos
Neoplasias da Mama , Neoplasias Oculares , Adulto , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Neoplasias Oculares/diagnóstico , Neoplasias Oculares/secundário , Neoplasias Oculares/terapia , Feminino , Humanos , Receptor ErbB-2/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Estudos Retrospectivos , Análise de SobrevidaRESUMO
OBJECTIVE: To evaluate the clinicopathologic characteristics of metastatic cutaneous melanoma to the eye and identify potential distinguishing characteristics from the more common primary uveal melanoma; particularly, tumour location within the eye, cytomorphology and immunohistochemical/specific molecular genetic features. METHODS: A retrospective observational case series using surgical enucleation and diagnostic vitrectomy cytologic specimens from seven patients with suspected intraocular melanoma, eventually diagnosed as metastatic melanoma, was conducted. Haematoxylin and eosin-stained sections of tumour and immunohistochemical (IHC) stains for BRAFV600E and Ki-67 were critically reviewed; BAP1 IHC was also evaluated in cases where additional tissue was available. Clinical imaging studies and medical records were reviewed. RESULTS: The majority of patients (86%) with metastatic melanoma have primary vitreoretinal (not uveal) involvement and epithelioid, highly malignant cytomorphology (100%); many (50%) harbour BRAFV600E mutations, a finding not seen in large cohorts of primary uveal melanoma. CONCLUSIONS: Characteristics favouring or defining metastatic intraocular melanoma over primary uveal melanoma include high-grade epithelioid cytology, predominant involvement of the vitreous cavity and/or retina, and presence of positive immunostaining for BRAFV600E.
Assuntos
Neoplasias Oculares , Melanoma , Proteínas Proto-Oncogênicas B-raf , Neoplasias Cutâneas , Diagnóstico Diferencial , Neoplasias Oculares/diagnóstico , Neoplasias Oculares/genética , Neoplasias Oculares/secundário , Humanos , Melanoma/diagnóstico , Melanoma/genética , Melanoma/secundário , Proteínas Proto-Oncogênicas B-raf/genética , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Neoplasias Uveais/diagnóstico , Neoplasias Uveais/genética , Neoplasias Uveais/patologia , Melanoma Maligno CutâneoRESUMO
ABSTRACT: The prognosis of patients with postmenopausal breast cancer (PBC) could be improved by the early detection of intraocular metastases (IOMs). However, serum biomarkers for IOMs in PBC remain elusive. In the current study, we investigated patients with PBC, and compared serum parameters in an IOM and a non-IOM group, and then differentiated the risk factors related to IOMs. A comparison between an IOM and a non-IOM (NIOM) group was performed using Student t-test and a Chi-Squared test. After constructing a Poisson regression model to identify risk factors, we plotted receiver operating characteristic curves to evaluate the predictive value of significant risk factors in detecting IOMs. The incidence of IOMs in PBC was 1.16%. The histopathology results were not significantly different between the 2 groups. The levels of serum carbohydrate antigen 125 (CA-125), carbohydrate antigen 15-3 (CA15-3) and alkaline phosphatase were significantly elevated in IOMs compared with NIOMs (P = .082, Pâ<â.001, and Pâ<â.001, respectively). Compared with NIOMs, age, carbohydrate antigen 19 to 9, hemoglobin, calcium, total cholesterol, low-density lipoprotein (LDL) and apolipoprotein A1 were remarkably lower in IOMs (P = .038, Pâ<â.001, Pâ<â.001, P = .032, P = .041, Pâ<â.001, and P = .001, respectively). Poisson regression suggested that CA-125, CA15-3 and LDL were contributing to IOMs in PBC as risk factors (OR = 1.003, 95% CI: 1.001-1.005; OR = 1.025, 95% CI: 1.019-1.033; OR = 0.238, 95% CI: 0.112-0.505, respectively). A receiver operating characteristic curve revealed that the cut-off values for CA-125, CA15-3 and LDL were 16.78 0âU/mL, 63.175âU/mL, and 2.415âmmol/L, respectively. The combination of CA-125 and CA15-3 showed significant diagnostic value (area under the curve [AUC] = 0.982, Pâ<â.001). Our investigation suggests that CA-125, CA15-3 and LDL remarkably predict IOMs in PBC as risk factors, and the combination of CA-125 and CA15-3 shows considerable diagnostic value.
Assuntos
Neoplasias da Mama/patologia , Antígeno Ca-125/sangue , Neoplasias Oculares/secundário , Lipoproteínas LDL/sangue , Mucina-1/sangue , Pós-Menopausa/fisiologia , Fatores Etários , Idoso , Biomarcadores Tumorais , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Curva ROCRESUMO
OBJECTIVE: Renal cell carcinoma is prone to early metastasis. In general, intraocular metastasis (IOM) is not common. In the present study, we studied the relationship between different biochemical indicators and the occurrence of IOM in renal cancer patients, and identified the potential risk factors. METHODS: A retrospective analysis of the clinical data of 214 patients with renal cell carcinoma from October 2001 to August 2016 was carried out. The difference and correlation of various indicators between the two groups with or without IOM was analyzed, and binary logistic regression analysis was used to explore the risk factors of IOM in renal cancer patients. The diagnostic value of each independent related factor was calculated according to the receiver operating curve (ROC). RESULTS: The level of neuron-specific enolase (NSE) in renal cell carcinoma patients with IOM was significantly higher than that in patients without IOM (P<0.05). There was no significant difference in alkaline phosphatase (ALP), hemoglobin (Hb), serum calcium concentration, α fetoprotein (AFP), carcinoembryonic antigen (CEA), CA-125 etc. between IOM group and non-IOM (NIOM) group (P>0.05). Binary logistic regression analysis showed that NSE was an independent risk factor for IOM in renal cell carcinoma patients (P<0.05). ROC curve shows that the factor has high accuracy in predicting IOM, and the area under the curve (AUC) is 0.774. The cut-off value of NSE was 49.5 U/l, the sensitivity was 72.2% and the specificity was 80.1%. CONCLUSION: NSE concentration is a risk factor for IOM in patients with renal cell cancer. If the concentration of NSE in the patient's body is ≥49.5 U/l, disease monitoring and eye scans should be strengthened.
Assuntos
Biomarcadores Tumorais/sangue , Carcinoma de Células Renais/sangue , Neoplasias Oculares/sangue , Neoplasias Renais/sangue , Fosfopiruvato Hidratase/sangue , Adulto , Idoso , Carcinoma de Células Renais/secundário , Neoplasias Oculares/secundário , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de RiscoRESUMO
Lung cancer is one of the leading causes of cancer related mortality worldwide. Currently, it is the third most common cancer behind prostate and breast cancer. Approximately 85% of all lung cancers are non-small-cell lung cancers (NSCLC). Adenocarcinoma and squamous cell carcinoma are the most common subtypes, accounting for 50% and 30% of NSCLC cases, respectively. Lung cancer is often initially found on chest x-rays and diagnosed via biopsy of the lesion. It is often diagnosed at the time of advanced or metastatic disease. The majority of lung cancers metastasize to locations such as bone, brain, adrenal glands and liver. Multiple case reports have been reported with ocular metastases, such as the choroid, iris and retina. We present a 87-year-old women whose initial emergency department presentation of squamous cell type lung cancer was an intraocular mass. To our knowledge this is the first reported case of this presentation and diagnosis within the emergency department setting.
Assuntos
Carcinoma de Células Escamosas/secundário , Neoplasias Oculares/secundário , Neoplasias Pulmonares/patologia , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Serviço Hospitalar de Emergência , Neoplasias Oculares/diagnóstico , Feminino , Humanos , Neoplasias Pulmonares/diagnósticoRESUMO
Several neoplastic processes can involve the eye, either primarily or secondary to a systemic malignancy. The most common primary tumors of the eye include conjunctival and uveal melanoma, retinoblastoma, conjunctival and intraocular lymphoma, and ocular surface squamous neoplasia. Metastatic spread from systemic malignancies, especially of the breast and lung, also can involve the eye. A combination of ophthalmologic examination, ancillary testing, and cytologic/histopathologic evaluation leads to accurate diagnosis. Management consists of surgery, radiotherapy, chemotherapy, and immunotherapy delivered in various forms.
Assuntos
Neoplasias Oculares , Neoplasias Oculares/diagnóstico , Neoplasias Oculares/patologia , Neoplasias Oculares/secundário , Neoplasias Oculares/terapia , Humanos , Linfoma/patologia , Melanoma/patologia , Prognóstico , Retinoblastoma/patologia , Neoplasias Cutâneas/patologiaAssuntos
Câmara Anterior/patologia , Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Oculares/secundário , Neoplasias Pulmonares/patologia , Inibidores da Angiogênese/administração & dosagem , Câmara Anterior/diagnóstico por imagem , Câmara Anterior/efeitos dos fármacos , Antineoplásicos Imunológicos/administração & dosagem , Bevacizumab/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Oculares/diagnóstico por imagem , Neoplasias Oculares/tratamento farmacológico , Humanos , Injeções Intraoculares , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular , Fotografação , Lâmpada de Fenda , Microscopia com Lâmpada de Fenda/instrumentação , Resultado do Tratamento , Carga TumoralRESUMO
Lymphomatoid granulomatosis (LYG) is a rare variant of an angioinvasive T-cell lymphoproliferative disorder that primarily affects the lungs, with common sites of metastasis including the skin and subcutis. In humans, it is a B-cell lymphoproliferative disorder associated with Epstein-Barr virus infection. Our case is a 7-y-old, spayed female, domestic longhair cat that decompensated and was euthanized following an initial diagnosis of angioinvasive lymphoma from a skin biopsy. Autopsy revealed nodules in the lungs and subcutis, and corneal thickening and cloudiness. Histologic examination of cutaneous nodules, lungs, and eye showed similar angioinvasive cellular infiltrates and pattern to that of the original skin biopsy, consistent with a diagnosis of LYG. The neoplastic cells displayed CD3-positive immunoreactivity in the skin, eye, and lung, and PCR for antigen receptor rearrangement (PARR) showed T-cell clonality in all tissues tested. This is the third case of LYG to be reported in cats and is the only case in which PARR analysis and immunophenotyping immunohistochemical staining was performed. LYG with ocular involvement has not been reported previously in cats, to our knowledge. Our case demonstrates the necessity for considering LYG when presented with a cat with respiratory signs in conjunction with subcutaneous nodules and ocular lesions.
Assuntos
Doenças do Gato/diagnóstico , Neoplasias Oculares/veterinária , Neoplasias Pulmonares/veterinária , Granulomatose Linfomatoide/veterinária , Metástase Neoplásica/diagnóstico , Neoplasias Cutâneas/veterinária , Animais , Doenças do Gato/patologia , Gatos , Neoplasias Oculares/diagnóstico , Neoplasias Oculares/secundário , Feminino , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Granulomatose Linfomatoide/diagnóstico , Granulomatose Linfomatoide/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/secundárioRESUMO
BACKGROUND: Metastatic disease to the eye most commonly involves choroid followed by orbit leading to varied ocular manifestations. By comparison, it is relatively rarer than primary malignancies of eye as well as metastasis in other parts of the body. AIM: The aim of this study is to evaluate the common eye and orbital structures involved in secondary ocular and metastatic disease, to describe its clinical manifestations and outline the management done. METHODS: A retrospective study of newly diagnosed cases of ocular metastasis in last 2 years conducted in our recently established department of ocular oncology at a tertiary eye care hospital in Nepal. Demography, age and sex distribution were noted. The patients were segregated into those with secondary or metastatic ocular malignancies. Detail study on the metastatic disease to eye was made in regards to presenting symptoms, signs, primary site of cancer, and the treatment done. Details of the investigations done, like biopsy and imaging were also recorded. RESULTS: There were a total of 28 patients, whose age group ranged from 9 years to 69 years with median age of 43 years. Females constituted 46% of total patients. Both the eyes were involved in 9 patients (32%). Eye was secondarily involved by paranasal sinus tumors and Non Hodgkin lymphoma (7 patients each). Ocular metastasis was commonly seen from broncogenic carcinoma in four and breast carcinoma in three patients. Simultaneous metastasis to other parts of the body was also seen in 61% of our patients. Diminution of vision in 49% was the most common presenting feature followed by proptosis in 16% and palpable mass in 14% of patients. Orbit in 43% cases is the commonest ocular structure involved. Histopathologic diagnosis was done in 32% only while rest was based on imaging alone. The most common treatment done was chemotherapy in 57% patients. CONCLUSION: Ocular metastasis can display a wide variety of clinical and imaging features and therefore a high degree of suspicion is required. It is often associated with simultaneous metastasis to other parts of the body as well, hence the importance of earlier diagnosis and metastatic workup.