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

Abstract

Aim: To report an uncommon case of optic disc and multiple choroidal metastases secondary to breast cancer, assessed with swept source optical coherence tomography (SS-OCT), fluorescein (FA), and infracyanine (ICGA) angiographies. Methods: Observational case report. Case presentation: A 40-year-old woman with history of left breast carcinoma presented with blurred vision in her right eye (RE). Her visual acuity was 1/20 in the RE and 10/10 in the left eye. Fundus examination of the RE showed a large yellowish elevation of the posterior pole and a particular whitish nodular papillary cluster protruding from the optic disc into the vitreous. Infrared imaging enhanced the papillary nodular infiltrates. Characteristic findings of choroidal metastasis were noted within the macular lesion on SS-OCT and ICGA. SS-OCT showed specific “lumpy bumpy” irregularity of the anterior surface of the choroid and elevated hyperreflective nodular lesions of the optic disc associated to peripapillary subretinal fluid. The papillary lesions appeared as a bunch of hypofluorescent dots on both FA and ICGA, and ultra-wide field FA was helpful clearly delimiting the large macular lesion. Besides, comprehensive imaging and especially ICGA could detect two asymptomatic choroidal metastases in a systematic assessment of the fellow eye. Conclusion: Optic disc metastases are extremely rare. Their diagnosis can be easily done on fundus examination when presenting with characteristic whitish cluster nodular infiltrates of the optic disc. However multimodal imaging remains very useful for the assessment of the local extension of the lesion and for diagnosing associated asymptomatic choroidal lesions gone unnoticed at the fundus examination.

Posterior segment manifestations of ocular metastasis

“…FA displays a hyperfluorescent mass on the optic disc without signs of leakage [57]. ICGA demonstrated peripapillary hypocyanescence [4].…”

“…Fluorescein angiogram (FA) may show hypofluorescence in the early phase and diffuse staining in the late phase [30]. Dilated retinal capillaries with pinpoint leakage at the tumor border can also be found [4]. Lesions usually lack intrinsic vascularity, which helps differentiate them from other choroidal tumors, such as choroidal hemangioma or choroidal melanoma.…”

“…Among uveal metastases, the choroid is the most frequently involved (89%), followed by the iris (9%) and the ciliary body (2%) [3]. Although less common, the retina, vitreous, and optic disc are also affected by ocular metastases [4,5 ▪ ,6 ▪▪ ]. The most common primary sites associated with ocular metastases are breast cancer in women and lung cancer in men [7].…”

Posterior segment manifestations of ocular metastasis

“…FA displays a hyperfluorescent mass on the optic disc without signs of leakage [57]. ICGA demonstrated peripapillary hypocyanescence [4].…”

“…Fluorescein angiogram (FA) may show hypofluorescence in the early phase and diffuse staining in the late phase [30]. Dilated retinal capillaries with pinpoint leakage at the tumor border can also be found [4]. Lesions usually lack intrinsic vascularity, which helps differentiate them from other choroidal tumors, such as choroidal hemangioma or choroidal melanoma.…”

“…Among uveal metastases, the choroid is the most frequently involved (89%), followed by the iris (9%) and the ciliary body (2%) [3]. Although less common, the retina, vitreous, and optic disc are also affected by ocular metastases [4,5 ▪ ,6 ▪▪ ]. The most common primary sites associated with ocular metastases are breast cancer in women and lung cancer in men [7].…”

Posterior segment manifestations of ocular metastasis

“…FA displays a hyperfluorescent mass on the optic disc without signs of leakage [57]. ICGA demonstrated peripapillary hypocyanescence [4].…”

“…Fluorescein angiogram (FA) may show hypofluorescence in the early phase and diffuse staining in the late phase [30]. Dilated retinal capillaries with pinpoint leakage at the tumor border can also be found [4]. Lesions usually lack intrinsic vascularity, which helps differentiate them from other choroidal tumors, such as choroidal hemangioma or choroidal melanoma.…”

“…Among uveal metastases, the choroid is the most frequently involved (89%), followed by the iris (9%) and the ciliary body (2%) [3]. Although less common, the retina, vitreous, and optic disc are also affected by ocular metastases [4,5 ▪ ,6 ▪▪ ]. The most common primary sites associated with ocular metastases are breast cancer in women and lung cancer in men [7].…”

Posterior segment manifestations of ocular metastasis

“…FA displays a hyperfluorescent mass on the optic disc without signs of leakage [57]. ICGA demonstrated peripapillary hypocyanescence [4].…”

“…Fluorescein angiogram (FA) may show hypofluorescence in the early phase and diffuse staining in the late phase [30]. Dilated retinal capillaries with pinpoint leakage at the tumor border can also be found [4]. Lesions usually lack intrinsic vascularity, which helps differentiate them from other choroidal tumors, such as choroidal hemangioma or choroidal melanoma.…”

“…Among uveal metastases, the choroid is the most frequently involved (89%), followed by the iris (9%) and the ciliary body (2%) [3]. Although less common, the retina, vitreous, and optic disc are also affected by ocular metastases [4,5 ▪ ,6 ▪▪ ]. The most common primary sites associated with ocular metastases are breast cancer in women and lung cancer in men [7].…”