Retinal Metastasis Simulating Cytomegalovirus Retinitis

Abstract

A 62-year-old man with lung cancer presented with a 2-week history of decreased vision and clinical features of cytomegalovirus retinitis. The patient was empirically treated for viral retinitis, but microbiological testing of the vitreous fluid was negative. Based on the suspicion for retinal metastasis, the patient underwent pars plana vitrectomy with retinal biopsy. Surgical techniques included the use of a chandelier illumination to enable bimanual manipulation of the retinal tissue, creation a focal retinal detachment with a 41-gauge subretinal cannula, diathermy demarcation of the biopsy site, localized retinectomy with vertical scissors, endolaser, and long-acting gas tamponade. Histopathologic examination revealed sheets of tumor cells with pleomorphic nuclei and positive staining for cytokeratins consistent with metastatic adenocarcinoma. The patient subsequently underwent external beam radiation and was alive 10 months after presentation. This surgical technique may be valuable in select patients with retinal metastasis for diagnostic, therapeutic, and counseling purposes.

Retinal metastasis from unknown primary: diagnosis, management, and clinicopathologic correlation

“…Of these, the primary site could be identified in 26 patients: 9 from gastrointestinal tract, 9 from lung cancer, 7 from breast adenocarcinoma, and 1 from the genitourinary tract. [1][2][3][4] There are only 3 previous reported cases of retinal metastasis from unknown primary, and these present a diagnostic and therapeutic challenge. 1-2 Unlike choroidal metastases, retinal metastases rarely present with bilateral or multifocal lesions.…”

“…[1][2][3][4] Of these, no primary site could be identified in 3 cases. [1][2] Many other entities, including vascular occlusions, infectious retinitis, and lymphoproliferative disorders can masquerade as retinal metastasis, making this entity a diagnostic challenge, especially in patients with no prior history of cancer or in patients in whom no primary tumor can be found.…”

Diagnostic Vitrectomy for Infectious Uveitis

“…147 In the case reports of metastasis masquerading as anterior uveitis, aqueous sampling for cytology has led to the diagnosis in the few reports it was performed 137–142 with the remaining cases diagnosed with suggestive history and imaging. In patients undergoing diagnostic vitrectomy for uveitis of unknown cause, metastasis was rarely identified directly from vitrectomy cytology results 2–4 with only 1 case reported in each of these series despite uveal metastasis being the most common cause of intraocular malignancy in adults.…”

“…In case reports of patients with the extremely rare occurrence of tumor metastatic to the retina and vitreous, these conditions present as intermediate uveitis, vitreous hemorrhage, or retinal vasculitis with vitreous cytologic sampling and retinal biopsy assisting in diagnosis if no primary malignancy is identified. 113, 147, 148 …”

Multimodal imaging of retinal metastasis masquerading as an acute retinal necrosis

“…Subretinal fluid, vitreous seeds, and retinal or vitreous hemorrhage are the most common fundus findings. However, due to the rarity of retinal metastases, misdiagnosis for inflammatory or infectious retinitis has occurred in different institutions [ 3 – 5 ].…”