|Year : 1975 | Volume
| Issue : 4 | Page : 25-27
Chorionepithelioma of choroid
SP Dhir, IS Jain, DN Gangwar, GC Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
S P Dhir
Department of Ophthalmology, Postgraduate Institute of Medical Education & Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhir S P, Jain I S, Gangwar D N, Jain G C. Chorionepithelioma of choroid. Indian J Ophthalmol 1975;23:25-7
Metastatic tumours of the choroid are uncommon. Indeed they constitute only 0.6% of tumours of choroid(2).
Testicular tumours constitute less than 1% of all malignancies. Occurrence of chorionepithelioma in the testicle is rare and metastasis of such a tumour to eye is exceedingly rare. Chorionepitheloma also occurs in uterus of women and it is to be noted that the first three cases ever reported of choroidal metastasis of chorionepithelioma occured in women. About nine cases of chorionepithelioma of testicles metastasing to the choroid have been reported in the literature. There is no case report of such a case in India.
We report a case of metastatic tumour of the choroid from testicular choroinepithelioma in a male patient.
| Case Report|| |
T.N., a 40 year old male patient came to eye department with a complaint of sudden loss of vision in left eye from two days, He also had redness and pain in left eye of 7 days duration. No history of trauma was available. Patient was admitted to emergency ward with provisional diagnosis of total retinal detachment of left eye. Next day, detailed fundus examination of
left eye revealed choroidal tumour with secondary detachment.
Due to its peculiar pinkish colour, some metastatic lesion was thought of and systemic examination revealed enlarged right scrotum. On inquiry, patient gave history of painless, progressive enlargement of right scrotum of 11 years duration. There was associated history of loss of appetite and weight, of one month duration.
General Physical Examination
Patient was moderately built, cachexic and anaemic. No lymphadenopathy, cyanosis, jaundice or neck vein enlargement was found. Pulse, respiration and blood pressure were normal. Systemic examination was normal except for an enlarged scrotum.
Genito-Urinary System : There was enlargement of the scrotum on the right side [Figure - 1]. Swelling measured 12 x 5 cms in size. It was firm in consistency and testis could not be palpated separately. Testicular tenderness and fluctuations were absent. Vas was normal, transillumination of the swelling was negative. Left side testis did not reveal any abnormality. Inguinal and abdominal lymphnodes were not palpable.
Visual acuity in right eye was normal but reduced only to perception of light in the left eye. Eyes were straight and movement was full. Left eye ball was prominent than the right eye and exophthat mometery measurements revealed right eye 15 mm and left eye 19 mm. Examination of left eye showed conjunctival congestion and chemosis more marked on the nasal side. Anterior chamber was shallower than the right eye. Pupil showed sluggish reaction to light and was semi-dilated. A whitish reflex could be seen through the pupil. On ophthalmoscopic examination of left eye media was clear, optic disc could not be seen. A large orange coloured, solid looking mass extending from 7`o' Clock position was seen obscuring the disc. The mass was bulging forward and downward. The edges of the mass could not be defined. There were few haemorrhages over the retina covering the mass. There were two balloons of detached retina with folds in the lower part. Slit lamp examination revealed a pinkish mass underlying the retina. No cells were seen in the anterior chamber or the vitreous cavity. Intraocular pressure was raised (39 mm applanation). Retrobulbar resistance was raised. Trans illumination was absent in the upper and nasal quadrant. Right eye was normal.
Hb, 10.5 gm%; ESR, 60 mm, Ist hr., PCV : 30, TLC : 6600 per cumm., Blood sugar, 130 mgm., Blood urea, 30 mg., Acid phosphatase, 2.4 K.A., Alkaline phosphatase, 10.0 KAU Urine. Biological test for gonadotrophin was positive. X-ray chest showed multiple metastatic deposits in both lung fields [Figure - 2]. X-ray of the skull was normal.
Patient was diagnosed as a case ofmetastic tumour of the choroid from testis. As the eye was painful and blind it was enucleated and examined histopathologically. Gross examination of the enucleated eye ball did not reveal any extra-scleral extension. Gross section showed tumour mass filling half of the vitreous cavity and anteriorely extending into the cilliary body [Figure - 3]. Retinal detachment filled with fluid was seen in the lower part.
Microscopic examination showed necrotic and haemorrhagic tissue lying in the vitreous. There were clumps of tumour cells with some melanin pigment [Figure - 3]. A diagnosis of chorionepithelioma (Teratoma with trophoblastic differentiation was made).
Histological examination of the testis after orchidectomy performed in the surgical discipline confirmed the diagnosis of chorionepithelioma of the right testis. Patient was treated with Endoxan 200 mg. biweekly, Methotrexate 20 mg. weekly and prednisolone 30 mg. daily.
| Discussion|| |
The case presented here is the 10th to be reported in the literature and first from India. Youngest patient having testicular tumour metastasing to choroid reported is 5 years 7 month old child and eldest is 36 year old. The present case is of 40 years old.
This is the only case where right testicular tumour metastised to the left eye.
Cause of pain, shallow anterior chamber and raised tension was found to be due to extension of the tumour to the ciliary body, thus pushing the iris lens diaphragm forwards and occluding the angle of the anterior chamber. Metastasis were not wide spread in this case.
| Summary|| |
A case of metastatic tumour of the choroid from chorionepithelioma of the testis in a man aged 40 years is reported.
| References|| |
Duke-Elder, S. and Perkins, E.S., 1966, System of Ophthalmology, 9,
935, Henry Kimpton, London.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]