Título / Title

UNCOMMON OPHTHALMOLOGICAL INITIAL PRESENTATION OF METASTATIC LUNG CANCER

Introdução / Purpose

To report a case of mestastatic uveal lesion as a first presentation of a lung cancer.

Material e Método / Methods

Case report.

Resultados / Results

A 47-years-old man, caucasian, presents in the ER complaining about red and dry right eye (OD) 2 months after starting with right hemifacial paralysis. Ophthalmological and family history were unremarkable. Visual acuity was 20/25 on both eyes. External examination showed delay in the eyelid closure on the OD. Slit-lamp showed conjunctival hyperemia and superficial central punctate keratitis. Left eye (OS) was unremarkable. Eye movements were normal. Fundus examination on the OD was unremarkable and the OS presented slightly elevated yellowish choroidal lesion measuring approximately 4 disc diameter (DD) superiorly and 8 inferiorly besides a hyperpigmented lesion next to the superior lesion with 1 DD that had the aspect of a choroidal nevus (figure 1). Fundus fluorescein angiography showed pin points associated to light hyperfluorescence in late phase (figure 2). Optical coherence tomography revealed choroidal folds and increased thickness (figure 3). The lesions during ultrassonography presented as choroidal flat masses that during the A scan showed dense moderate reflectivity of the internal content with no signs of internal vasculature and thickness around 2,22 mm (figure 4).
In order to exclude the diagnosis of metastasis and to investigate the hemifacial paralysis we requested image exams and referred the patient to an oncologist. After screening, was diagnosed with small cell lung cancer and brain, spine and left eye metastasis. The treatment has been initiated with systemic chemotherapy alone.

Discussão e Conclusões / Conclusion

Metastatic uveal tumors is the most common type of intraocular or orbital malignant tumor in adults. The most common primary tumor sites that metasize to the choroid are lung in men and breast in women. It occurs usually between 40 and 70 years old, unilateral, more often in OS.

Palavras Chave

Uveal Neoplasms; Choroid Neoplasms; Neoplasm Metastasis.