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ARTICLE
Year : 1968  |  Volume : 16  |  Issue : 2  |  Page : 72-75

A case of metastatic carcinoma of choroid from breast


Eye Infirmary, Medical College Hospitals, Calcutta, India

Date of Web Publication22-Dec-2007

Correspondence Address:
S P Das
Eye Infirmary, Medical College Hospitals, Calcutta
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Das S P. A case of metastatic carcinoma of choroid from breast. Indian J Ophthalmol 1968;16:72-5

How to cite this URL:
Das S P. A case of metastatic carcinoma of choroid from breast. Indian J Ophthalmol [serial online] 1968 [cited 2020 Jul 3];16:72-5. Available from: http://www.ijo.in/text.asp?1968/16/2/72/37497

Cancer in general is quite com­mon, but metastatic intraocular tumour is very rare. BEDELL (1943) collected 250 cases of choroidal me­tastasis from the literature and re­marked, "few ophthalmologists ever encounter more than one case in their private practice". Carcinoma metastatises in the uvea much more frequently than sarcoma or malig­nant melanoma. This is explained by REESE (1963) as due to much higher incidence of carcinoma.

Only one case of metastatic carci­noma of choroid from breast cancer was detected in the Eye Infirmary, Medical College Hospitals, Calcutta over a period of 9 years (1950-1958).


  Case report Top


N.R., a 38-year old female, was admitted on 15th April, 1958 in the Eye Infirmary, Medical College Hos­pitals, Calcutta, with the presenting complaint of marked fall in vision in the right eye within a week. She gave a history that she had mastec­tomy done for her right breast in another hospital eight months back and she was treated with deep X-­ray therapy for her breast cancer six months back.

Eye Examination:

On admission, the visual acuity in the right eve was 3/60 which could not be improved with lenses. On fundus examination of the right eye there was a solid opaque detachment of the retina in the posterior region of the eye. The raised portion of the retina had a pinkish colour. There was slight hemorrhage and pigmentary change over the involved area. On repeated examinations, no hole could be detected in the fundus. The remainder of the fundus showed no significant change. Tension was 35 mm. Hg. (Schiotz). The detached re­tina was found dark on transillumi­nation.

The left eve was entirely normal and the vision was 6/6 without glass. Physical examination at the time of admission showed entirely negative findings except the marks of mastec­tomy operation over the right side of the body. X-ray of chest was done and no metastasis could be de­tected.

Laboratory Studies were as follows:

Wassermann reaction and Kahn test were negative. Tuberculin tests in 1/100,000 and 1/10,000 were ne­gative. Blood sugar was 80 mg. per cent.

Haemogram : Leukocytes, 6820 per c mm (neutrophils 70 per cent; lymp­hocyte 25 per cent; eosinophils 3 per cent; monocyte 2 per cent); haemo­globin 78 per cent; erythrocytes 3,880,000 per c. mm. The urine showed no gross abnormality.

The case was then presented to the hospital board. The final opinion of the board was that the lesion was a secondary detachment of choroid due to metastatic tumour coming from primary site of breast carcino­ma.

The retinal detachment increased gradually and on 1st June, the visual acuity was reduced to perception of light only. X-ray of chest was repeated and this time also there was no sign of metastasis.

On 3rd June, 1958, the patient was having severe pain in the right eye and the tension was then 70 mm. Hg. (Schiotz). On 4th June, 1958, the right eye had to be enucleated for severe pain. The enuclented right eye-hall was sent for histopathologi­cal examination.

Pathological Report

Gross : The specimen of right eye was of normal external appearance. On bisecting the eye, there was a diffuse mas in the right half of the choroid making it thickened. The posterior limit of the mass was up to the optic nerve. The mass was more prominent in the posterior por­tion of the choroid. There was a small amount of serous fluid bet­ween the tumour and the detached retina. The mass was soft in feel and pale pink in colour. The margins of the mass were irregular but it ap­peared to be well defined. The re­mainder of the eye showed no gross changes.

Microscopic : [Figure - 1],[Figure - 2],[Figure - 3]

The neoplasm in the choroid showed the picture of alveolar adeno­carcinoma. The alveoli were of va­rious shapes and sizes and consisted of round or polygonal cells. The cells had large vesicular nuclei with indis­tinct cytoplasm. Mitosis were abun­dant. There was no pigment in the tumour cells. The stroma between the alveoli consisted of dense fibrous tissue. Small multiple hemorrhages were present in the tumour indicat­ing degenerative changes. The tumour extended up to the optic nerve, but the nerve itself was not invaded by the tumour cells. The tumour was found in the right half of the choroid only. Other tissues of the eye were not invaded by the tumour cells.

Follow-up

The patient was asked to come to the hospital at the interval of 10 days. On 19th October, 1958, the patient died from generalised metas­tasis at home.


  Discussion Top


Metastatic carcinoma of the uveal tract is very rare. Only the present case of uveal metastatic tumour was detected in the Eye Infirmary Medi­cal College Hospitals, Calcutta, over a period of nine years, although car­cinoma in general is quite common as elsewhere. According to GIRL (1939) this is due to fact that metas­tasis are blood borne and that the ophthalmic artery arises from the in­ternal carotid artery at almost right angles and, therefore, cancer cells in the blood stream are swept past the ophthalmic artery and deposited in the brain and meninges. STALLARD (1933) estimated the incidence of metastatic carcinoma of the eye to 1: 140,000 from the records of Royal London Ophthalmic Hospital Clinic. GODTFREDSEN (1944) in the ana­lysis of 8,712 carcinoma patients noted only 6 cases with metastasis to the choroid. In his series he found 1,287, patients with carcinoma of the breast, of which 2 had choroidal metastasis. DUKE-ELDER (1940) suggested that metastases to the eye may be more frequent than would appear from the literature. He point­ed out that in most of the cases the patient is almost gravely ill, some­times more or less in moriband state and the clinical picture is dominated by the general condition while the patient himself or herself does not notice what may be a minor defect in one eye.

The posterior uvea is said to be more affected than the anterior uvea (DUKE-ELDER, 1940); REESE, 1963), DUKE-ELDER), reasons that majority of the embodi would natu­rally pass through 20 short posterior ciliary arteries than the two long posterior or the five or more anterior arteries. Another reason may be that carcinomatous metastasis is very rare in muscle, and ciliary body is composed of muscle tissue. SANDERS (1938) observed that choroidal in­volvement was more common than that of the iris and ciliary body in the ratio of 156: 17. In LEMOINE AND McLEOD's series (1936) of 229 cases of uveal metastasis, the choroid was involved in 156. In the present case, both macroscopically and mic­roscopically the choroid alone was found to be involved by the tumour mass.

CORDES (1944) in his review of literature found that the age group most commonly affected was between the ages of 40 and 49 years and lie could find only isolated cases which had been reported in patients young­er than 30 years or older than 70 years. The present case was 38 years of age.

The left eye is said to be most frequently affected than the right (DUKE-ELDER, 1940; REESE, 1963). But in the present case the primary tumour was in the right breast and the metastatic umour was in the right side of the choroid of the right eye.

The site of primary tumour is mostly the breast (DUKE-ELDER, 1940; REESE, 1963). USHER (1923 and 1926) gave the figure as 72 per cent, COHEN (1937) 70 per cent and GIRL (1939) 60 per cent. The inci­dence of carinoma of breast particu­larly the female breast as noted in this institution is as common as in other parts of the World, but only the present case of uveal metastasis from carcinoma of female breast was noted during the last nine years. SCHINZ (1939) noted only 3 cases of ocular metastasis in a series of 536 cases of breast carcinoma. The com­paratively higher incidence of metas­tasis to the eye from primary breast cancer has been explained by LE­MOINE AND McLEOD (1936) on the postulation that cancer cells of the breast have a special affinity for tiveal tissue. REESE (1963) thinks that in most cases of cancer, some of the tumour cells enter the blood stream whereas only rarely do the cells remain viable and grow at the implanted sites; the ability of various types of cancer cells to remain viable, away from their primary sites, varies greatly and may vary from time to time according to certain inconstant factors like resistance of the host; the cells of carcinoma of the breast are among the most rugged of all cancer cells and have the ability to survive and even propagate under circumstances unfavourable to other cancer cells.

The interval between the diagno­sis of primary tumour and the detec­tion of metastatic tumour in the uvea vary from weeks to years (REESE, 1963). In the present case, the in­terval was 8 months.

The treatment of choice in metas­tatic tumour of the eye is irradia­tion, because the lungs have already been involved and there must be implanted foci elsewhere particularly in the brain indicating the worst prog­nosis, at least so far as the life is con­cerned (DUKE-ELDER, 1940; REESE, 1963). In the present case, enucleation of the eye had to be per­formed because of the severe pain in the eye following secondary glau­coma.


  Summary Top


A case of metastatic carcinoma of the choroid from primary site of breast is reported. The primary tumour in the breast was on the right breast and the metastatic tum­our in the choroid was in the right side of the choroid of the right eye.[12]

 
  References Top

1.
BEDELL A. J.: Bilateral Metastatic Carcinoma of the Choroid. Arch. of Ophth. (Chicago) 30, 2.5 (1943).  Back to cited text no. 1
    
2.
COHEN M.: Bilateral Metastatic Car­cinoma of Choroid, Report of a case. Arch. of Ophth. (Chicago) 1S. 604, (1937).  Back to cited text no. 2
    
3.
CORDES F. C.: Bilateral Metastatic Carcinoma of the Choroid with Z-ray Therapy to one eye, Amer. J. Ophtli. 27, 1.355 (1944).  Back to cited text no. 3
    
4.
DUKE-ELDER W. S.: Text-hook of Ophthalmology Vol. III (1940) Henry Kimpton, London p. 2522.  Back to cited text no. 4
    
5.
GIRL D. V. as quoted in Schwiz med. Wehnochr. 20, 1069 (1939).  Back to cited text no. 5
    
6.
GODTFREDSEN E, as quoted in 8 Acta Ophthal. 22, 394 (1944).  Back to cited text no. 6
    
7.
LEMOINE A. N. and McLEOD J. Bilateral Metastatic Carcinoma of the Choroid. Successful Roentgen Treat­ment of one Eye. Arch. of Ophth 16, 804, (1936).  Back to cited text no. 7
    
8.
REESE A. B. Tumours of the Eye (second edit. 1963) Paul Hoeber lose. New York p. 514.  Back to cited text no. 8
    
9.
SANDERS T. E. Metastatic Carcinoma of the Iris. Amer. J. Ophth 21, 646 (1938).  Back to cited text no. 9
    
10.
SCHINZ H. R. as quoted in 8 Mill. Monats. of Augenh. 103, 425 (1939).  Back to cited text no. 10
    
11.
STALLARD H. B, as quoted in 4. Proc. Roy. Soc. Med. 26, 1042 (1933).  Back to cited text no. 11
    
12.
USHER C. H. Frequency of Metastatic Carcinoma of the Choroid Brit. J. Ophth. 10. 180 (1926).  Back to cited text no. 12
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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