Metastatic Neoplasms in the Optic Disc

Abstract

Background: Little information is available on metastatic tumors to the optic disc. Objective: To determine the clinical features and prognosis of patients with optic disc metastasis. Design: Retrospective chart review. Results: Of 660 consecutively evaluated patients with intraocular metastasis, 30 (4.5%) (31 eyes) had metastatic cancer to the optic disc; 24 (80%) were women and 6 (20%) were men. Mean age at the time of ocular diagnosis was 55 years. The primary neoplasm was in the breast in 13 patients (43%), in the lung in 8 (27%), in the intestine in 1 (3%), in the kidney in 1 (3%), and in the prostate in 1 (3%); the primary neoplasm was never determined in 6 patients (20%). The optic disc metastasis was unilateral in 29 patients (97%) and bilateral in 1 (3%). Ophthalmoscopically, the disc metastasis appeared as a diffuse enlargement of the optic disc in 26 eyes (84%) and as a distinct nodule in 5 (16%). There was an adjacent juxtapapillary choroidal component to the metastatic disc lesion in 23 eyes (74%), and the optic disc was involved without a retinal or choroidal component in 8 (26%). Other associated findings included some degree of secondary disc edema in all eyes, buried disc blood vessels in 23 (74%), and splinter hemorrhages in 13 (42%). Fine needle aspiration biopsy was useful in establishing the diagnosis in all 5 eyes in which it was performed. Mean survival was 13 months after diagnosis of the disc metastasis. Conclusions: Metastasis to the optic disc accounts for 5% of all intraocular metastases. It can occur as invasion from a juxtapapillary choroidal metastasis or as isolated optic disc metastasis. Breast and lung cancers are the most common primary neoplasms that account for metastasis to the optic disc. The primary site is never determined in 20% of patients. The characteristic clinical features of optic disc metastasis should help differentiate it from other causes of swollen optic disc. Patient prognosis is poor.

Case of metastatic pulmonary carcinoma in optic disc diagnosed from results of biopsy performed during vitrectomy surgery

“…FA findings of metastatic optic disc tumours commonly show gradual hyper-fluorescence beginning in the late venous phase [2,3], which is compatible with our case. Tortuous retinal veins and haemorrhages are also usually evident as a result of the space occupying lesion in the optic nerve.…”

“…Interestingly, brain metastasis is rarely present at the time optic disc metastasis is discovered [2,3,8]. In our case as well, multiple brain metastases were not noted until about 2 months later.…”

“…Optic disc metastasis is usually characterized by central swelling of and haemorrhage in the disc, with 84% of reported cases appearing as diffuse enlargement of the optic disc without a distinct nodule [2]. In contrast, the optic disc appearance in our case was striking and unique in regard to shape.…”

Case of metastatic pulmonary carcinoma in optic disc diagnosed from results of biopsy performed during vitrectomy surgery

“…FA findings of metastatic optic disc tumours commonly show gradual hyper-fluorescence beginning in the late venous phase [2,3], which is compatible with our case. Tortuous retinal veins and haemorrhages are also usually evident as a result of the space occupying lesion in the optic nerve.…”

“…Interestingly, brain metastasis is rarely present at the time optic disc metastasis is discovered [2,3,8]. In our case as well, multiple brain metastases were not noted until about 2 months later.…”

“…Optic disc metastasis is usually characterized by central swelling of and haemorrhage in the disc, with 84% of reported cases appearing as diffuse enlargement of the optic disc without a distinct nodule [2]. In contrast, the optic disc appearance in our case was striking and unique in regard to shape.…”

Optic disc and choroidal metastases secondary to breast cancer: A case report

“…7 In the literature, mean survival after diagnosis of disc metastasis is 13 months. 1 Our patient deceased only 6 weeks following the diagnosis of optic disc and choroidal metastases. In presence of poor vital prognosis, we addressed the patient urgently to her senologist for extension assessment.…”

“…Optic disc metastasis appeared in this case as a whitish cluster nodular infiltrate originating from the center of the optic disc and protruding into the vitreous cavity. It has been described by Shields et al 1 as "intensely white chalky infiltrates." This nodular appearance is reported in 16% of optic disc metastases.…”

Case of metastatic pulmonary carcinoma in optic disc diagnosed from results of biopsy performed during vitrectomy surgery

“…FA findings of metastatic optic disc tumours commonly show gradual hyper-fluorescence beginning in the late venous phase [2,3], which is compatible with our case. Tortuous retinal veins and haemorrhages are also usually evident as a result of the space occupying lesion in the optic nerve.…”

“…Interestingly, brain metastasis is rarely present at the time optic disc metastasis is discovered [2,3,8]. In our case as well, multiple brain metastases were not noted until about 2 months later.…”

“…Optic disc metastasis is usually characterized by central swelling of and haemorrhage in the disc, with 84% of reported cases appearing as diffuse enlargement of the optic disc without a distinct nodule [2]. In contrast, the optic disc appearance in our case was striking and unique in regard to shape.…”

Optic disc and choroidal metastases secondary to breast cancer: A case report

“…7 In the literature, mean survival after diagnosis of disc metastasis is 13 months. 1 Our patient deceased only 6 weeks following the diagnosis of optic disc and choroidal metastases. In presence of poor vital prognosis, we addressed the patient urgently to her senologist for extension assessment.…”

“…Optic disc metastasis appeared in this case as a whitish cluster nodular infiltrate originating from the center of the optic disc and protruding into the vitreous cavity. It has been described by Shields et al 1 as "intensely white chalky infiltrates." This nodular appearance is reported in 16% of optic disc metastases.…”

Case of metastatic pulmonary carcinoma in optic disc diagnosed from results of biopsy performed during vitrectomy surgery

“…FA findings of metastatic optic disc tumours commonly show gradual hyper-fluorescence beginning in the late venous phase [2,3], which is compatible with our case. Tortuous retinal veins and haemorrhages are also usually evident as a result of the space occupying lesion in the optic nerve.…”

“…Interestingly, brain metastasis is rarely present at the time optic disc metastasis is discovered [2,3,8]. In our case as well, multiple brain metastases were not noted until about 2 months later.…”

“…Optic disc metastasis is usually characterized by central swelling of and haemorrhage in the disc, with 84% of reported cases appearing as diffuse enlargement of the optic disc without a distinct nodule [2]. In contrast, the optic disc appearance in our case was striking and unique in regard to shape.…”

Optic disc and choroidal metastases secondary to breast cancer: A case report

“…7 In the literature, mean survival after diagnosis of disc metastasis is 13 months. 1 Our patient deceased only 6 weeks following the diagnosis of optic disc and choroidal metastases. In presence of poor vital prognosis, we addressed the patient urgently to her senologist for extension assessment.…”

“…Optic disc metastasis appeared in this case as a whitish cluster nodular infiltrate originating from the center of the optic disc and protruding into the vitreous cavity. It has been described by Shields et al 1 as "intensely white chalky infiltrates." This nodular appearance is reported in 16% of optic disc metastases.…”