Blurred vision due to choroidal metastasis as the first manifestation of lung cancer: A case report
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Blurred vision due to choroidal metastasis as the first manifestation of lung cancer: A case report Christos Asteriou1*, Dimitrios Konstantinou2, Athanassios Kleontas1, Dimitrios Paliouras1, Georgios Samanidis1, Fani Papadopoulou1, Nikolaos Barbetakis1
Abstract Background: Reduction in visual acuity combined with blurred vision is rarely the first sign of lung cancer and very few cases have been announced globally. Case presentation: A case of a 46-year-old man who admitted with blurred vision is presented. His medical history, apart from a mild gastritis under treatment was negative. Ocular examination revealed a decrease in visual acuity due to a choroidal tumor. Further image body scans demonstrated a right lung lesion with dissemination to other organs. Diagnosis of a non-small cell lung cancer established after a VATS biopsy carried out. Conclusion: Blurred vision due to choroidal metastasis as the primary symptom of lung cancer is very uncommon. A great index of suspicion is essential when a choroidal lesion appears.
Background The incidence of ocular metastases from lung cancer is reported to be 2-7% according to the international literature [1,2]. The majority of cases involves end-stage patients. Choroidal metastases are metastatic lesions to the choroid layer of the eye. Decrease in optical acuity as the initial manifestation of lung cancer is infrequent. Case presentation A 46-year-old man noticed, three months ago, that for the past two weeks his left eye suffered from reduction in vision with a concomitant blurredness. He had no medical history apart from a mild gastritis under treatment. He was a heavy smoker (one and a half pack of cigarettes for the last 27 years), while he was a social drinker. Examination showed visual acuity of 2/20 in the left eye and normal in the right eye. Fundus examination revealed the presence of a choroidal tumor located superior to the optic nerve measuring 921 mm (Fig 1). An ultrasonographic evaluation of the eye demonstrated that the tumor had a height of 1.8 mm (Fig 2). Computed tomography of the chest, abdomen and brain were performed. A central lesion of the right upper lobe of the lung was detected. Both, a small pleural effusion * Correspondence: [email protected] 1 Cardiothoracic Surgery Department, Theagenio Cancer Hospital, Al Symeonidi 2, Thessaloniki, Greece, 54007
and several mediastinal enlarged lymph nodes were accompanying the aforementioned lesion. Moreover, small, bilateral adrenal masses were also present, while three brain metastases appeared. A bone scanning revealed multiple lesions. A transthoracic needle biopsy of the right upper lobe lung mass could not provide enough material to establish an accurate histopathological diagnosis. The patient experienced a Video Assisted Thoracic Surgical biopsy and the diagnosis of a low-grade squamous cell carcinoma was established (Fig 3). He was discharged after 5 days. The patient is currently receiving chemotherapy and radiotherapy.
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