Choroidal Metastasis from Colon Cancer Treated with Palliative Radiotherapy

Abstract

Choroidal metastasis from colorectal cancer is very rare and has not been reported before in Korea. We report a case of eye hyperemia and discomfort in a patient with advanced colon cancer. Orbit magnetic resonance imaging and positron emission tomography revealed an enhancing mass within the temporal side of the left orbit, suggestive of choroidal metastasis from the colorectal adenocarcinoma. The condition's rarity may be due to the long and distant pathway from the colon to the orbit. The presentation usually suggests extensive hematogeneous cancer dissemination and a poor prognosis. However, palliative radiotherapy may be an effective treatment for choroidal metastasis. (Korean J Med 2015;89:723-727) Keywords: Colorectal neoplasms; Choroid; Neoplasm metastasis; Radiotherapy 서 론 결장직장암은 전 세계에서뿐만 아니라 한국에서도 세 번 째로 발생률이 높은 암으로 최근 발생률이 지속적으로 증가 하고 있다. 결장직장암은 간, 폐, 뼈, 뇌로 흔히 전이되지만 맥락막으로 전이되는 경우는 매우 드물어 전 세계적으로 14 증례가 보고된 바 있고[1,2], 한국에서는 아직 문헌상 보고된 증례는 없다. 결장직장암의 맥락막전이가 드문 이유에 대해 서는 명확하게 밝혀진 바는 없으나 전이되기 위해 거쳐야 할 경로가 길고 해부학적 장벽이 많은 것이 원인일 것으로 추 정된다[3]. 우리는 결장직장암이 맥락막으로 전이되어 증상 을 일으킨 매우 드문 경우를 경험했기에 문헌고찰과 함께 보고하는 바이다. 증 례 환 자: 51세 여자 주 소: 안구충혈 및 이물감 현병력: 내원 27개월 전에 직장구불결장 이행부에 발생한 대장암을 진단받았고, 진단 시에 병기는 TNM staging에 따

Choroidal Metastasis as the Initial Presentation of Rectal Adenocarcinoma

“…The ocular symptoms in cases of choroidal metastasis include, but are not limited to, blurred vision, decreased visual acuity, visual field disturbance, double vision, eye pain, hyperaemia, glare and eye movement disorder, flashes and floaters. However, 9–11% of patients are asymptomatic, and lesions can be seen on routine ocular examination [ 1 , 2 ] . Choroidal metastases generally appear as a yellow subretinal mass associated with subretinal fluid but can also appear as an orange, brown-grey mass.…”

“…Magnetic resonance imaging is the most common method used for diagnosis. Biopsy is needed for confirmation but should be performed with consideration for the patient’s life expectancy due to the high risk of bleeding and blindness [ 2 ] . The current literature contains few recommendations regarding the appropriate treatment of choroidal metastasis from colorectal cancer, but an aggressive multidisciplinary approach is recommended.…”

“…If choroid metastasis is found, 47% of the primary cancers are breast cancer, 21% lung cancer, 4% gastrointestinal tract cancer, 2% skin melanoma, 2% renal cell carcinoma and 2% prostate cancer. Choroid metastasis from colorectal cancer is rare worldwide, possibly because of the long course through multiple vascular beds from the colorectal site to the eyeball with many anatomical barriers [ 2 ] . Due to the rarity of the condition, there is a paucity of succinct evidence-based data on demographic characteristics, treatment, duration of treatment and outcomes, with data limited to case reports.…”

Metastatic Intraocular Tumor Due to Colorectal Adenocarcinoma: Case Report and Literature Review

“…[6] We performed a literature review through a systematic search in PubMed and Google Scholar using an appropriate search strategy for each database (supplementary material 1) and reviewed the references of the reports included in the systematic search to increase the chances of identifying all reported cases of intraocular metastasis due to colorectal adenocarcinoma. We included 23 case reports and 1 case series (Table 1), accounting for 25 cases, for which 19 patients presented with metastasis only to the choroid, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] three with metastasis only to the retina, [24][25][26] one with metastasis to the retina and choroid, [27] one with metastasis to the sclera, retina, and optic nerve, [28] and one with metastasis to the choroid and optic nerve. [29] The average age was 55.2 years (ranging from 30 to 80 years), and 15 patients were men.…”