Clinicopathological report: Bilateral choroidal metastases from papillary thyroid cancer

Abstract

Bilateral uveal metastases from papillary thyroid carcinoma are extremely rare. A 36-year-old woman with a 12-month history of papillary thyroid carcinoma presented with sudden loss of visual acuity and fields in the left eye. An examination and B-scan revealed a large, solid choroidal lesion in the left eye causing exudative retinal detachment. A small solid mass was also observed in the right eye fundus. Following left eye enucleation, immunohistopathology confirmed metastatic papillary thyroid carcinoma. The authors report the third known case of bilateral choroidal metastases.

Management of choroidal metastases

“…Among 131 I and EBRT in non iodine-avid tumors, 125 I brachytherapy or chemotherapy and bevacizumab, 131 I therapy only yielded transient efficacy. The total dose of radiotherapy varied from 20 Gy in 5 fractions, to 50 Gy in 25 fractions and so did the techniques [55][56][57]. The observed survival was less than a year and CM was predictive of very poor outcome.…”

Orbital metastasis as initial manifestation of a widespread papillary thyroid microcarcinoma

“…Regression of the mass and normalisation of thyroglobulin levels may take 1–2 years to occur 4. However, if possible, surgical excision is the treatment of choice for metastases of thyroid carcinomas to the eye 24. This may provide benefit in enhancing disease control 2.…”

“…EBRT is also indicated for unresectable, residual, or metastatic DTC that does not concentrate iodine-131 4. The other treatment options are brachyradiotherapy using iodine-125 episcleral radioactive plaque insertion,25 chemotherapy, and targeted therapy with monoclonal antibodies26 and small molecules 22 24Learning points

Although infrequent, thyroid carcinomas should be included in the differentials of patients with orbital metastasis even if examination of the neck is unremarkable.

Proptosis and diplopia are the most common symptoms of orbital metastasis from thyroid carcinomas.

Currently, there are no clear guidelines on the treatment of differentiated thyroid carcinoma (DTC) with orbital metastasis apart from surgical removal of the primary tumour followed by radioactive iodine-131 therapy ablation typical of all DTCs.

Surgical tumour debulking of orbital metastasis should be performed if presented with a very large orbital mass, with sudden decrease in vision and with intractable orbital pain.

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