Retinal metastases as the initial presentation of advanced lung adenocarcinoma
Introduction: Most lung cancers are diagnosed at an advanced stage. Common metastatic sites include the brain, bone, liver and adrenal glands. Ocular metastases, however, are extremely rare. We present a case of advanced lung adenocarcinoma presenting exclusively with photopsias attributable to reti...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SMC MEDIA SRL
2023-12-01
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| Series: | European Journal of Case Reports in Internal Medicine |
| Subjects: | |
| Online Access: | https://www.ejcrim.com/index.php/EJCRIM/article/view/4190 |
| _version_ | 1797361019046068224 |
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| author | Catarina Oliveira-Silva Maria Manuel Pereira Catarina Ferreira Eduardo Macedo Marta Mendes Ana Rita Marques Ilídio Brandão |
| author_facet | Catarina Oliveira-Silva Maria Manuel Pereira Catarina Ferreira Eduardo Macedo Marta Mendes Ana Rita Marques Ilídio Brandão |
| author_sort | Catarina Oliveira-Silva |
| collection | DOAJ |
| description | Introduction: Most lung cancers are diagnosed at an advanced stage. Common metastatic sites include the brain, bone, liver and adrenal glands. Ocular metastases, however, are extremely rare. We present a case of advanced lung adenocarcinoma presenting exclusively with photopsias attributable to retinal metastases.
Case description: We describe a woman in her fifties, a lifetime non-smoker with an unremarkable medical and family history, who presented to the emergency department with photopsias for a week. Ophthalmology evaluation revealed decreased visual acuity bilaterally, and a fundus examination disclosed lesions suggestive of bilateral retinal metastases. A comprehensive evaluation diagnosed a stage IVb lung adenocarcinoma with exon 19 mutation on epidermal growth factor receptor gene. Subsequently, she developed complaints of headaches and dizziness. She received frontline osimertinib 80 mg daily, preceded by upfront whole-brain radiation therapy with partial orbital inclusion for symptomatic ocular and brain metastases. After ten radiation therapy sessions, her complaints were resolved and an ophthalmology revaluation revealed improvement in visual acuity and resolution of photopsia complaints. The patient is currently on osimertinib and preserves an ECOG score of 0.
Conclusion: Retinal metastases usually indicate advanced disease, so presenting with isolated ocular symptoms is exceedingly rare. Especially in cases of uncommon metastases, a multidisciplinary approach is fundamental for a prompt diagnosis and timely treatment, impacting prognosis and quality of life. |
| first_indexed | 2024-03-08T15:47:56Z |
| format | Article |
| id | doaj.art-9fce3359511f445da0984c4b8ea96173 |
| institution | Directory Open Access Journal |
| issn | 2284-2594 |
| language | English |
| last_indexed | 2024-03-08T15:47:56Z |
| publishDate | 2023-12-01 |
| publisher | SMC MEDIA SRL |
| record_format | Article |
| series | European Journal of Case Reports in Internal Medicine |
| spelling | doaj.art-9fce3359511f445da0984c4b8ea961732024-01-09T09:32:11ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942023-12-0110.12890/2023_0041903725Retinal metastases as the initial presentation of advanced lung adenocarcinomaCatarina Oliveira-Silva0Maria Manuel Pereira1Catarina Ferreira2Eduardo Macedo3Marta Mendes4Ana Rita Marques5Ilídio Brandão6Department of Nephrology, Hospital de Braga, Braga, PortugalDepartment of Oncology, Hospital de Braga, Braga, PortugalDepartment of Oncology, Hospital de Braga, Braga, PortugalDepartment of Internal Medicine, Hospital de Braga, Braga, PortugalDepartment of Internal Medicine, Hospital de Braga, Braga, PortugalDepartment of Internal Medicine, Hospital de Braga, Braga, PortugalDepartment of Internal Medicine, Hospital de Braga, Braga, PortugalIntroduction: Most lung cancers are diagnosed at an advanced stage. Common metastatic sites include the brain, bone, liver and adrenal glands. Ocular metastases, however, are extremely rare. We present a case of advanced lung adenocarcinoma presenting exclusively with photopsias attributable to retinal metastases. Case description: We describe a woman in her fifties, a lifetime non-smoker with an unremarkable medical and family history, who presented to the emergency department with photopsias for a week. Ophthalmology evaluation revealed decreased visual acuity bilaterally, and a fundus examination disclosed lesions suggestive of bilateral retinal metastases. A comprehensive evaluation diagnosed a stage IVb lung adenocarcinoma with exon 19 mutation on epidermal growth factor receptor gene. Subsequently, she developed complaints of headaches and dizziness. She received frontline osimertinib 80 mg daily, preceded by upfront whole-brain radiation therapy with partial orbital inclusion for symptomatic ocular and brain metastases. After ten radiation therapy sessions, her complaints were resolved and an ophthalmology revaluation revealed improvement in visual acuity and resolution of photopsia complaints. The patient is currently on osimertinib and preserves an ECOG score of 0. Conclusion: Retinal metastases usually indicate advanced disease, so presenting with isolated ocular symptoms is exceedingly rare. Especially in cases of uncommon metastases, a multidisciplinary approach is fundamental for a prompt diagnosis and timely treatment, impacting prognosis and quality of life.https://www.ejcrim.com/index.php/EJCRIM/article/view/4190retinal metastaseslung canceregfr mutation |
| spellingShingle | Catarina Oliveira-Silva Maria Manuel Pereira Catarina Ferreira Eduardo Macedo Marta Mendes Ana Rita Marques Ilídio Brandão Retinal metastases as the initial presentation of advanced lung adenocarcinoma European Journal of Case Reports in Internal Medicine retinal metastases lung cancer egfr mutation |
| title | Retinal metastases as the initial presentation of advanced lung adenocarcinoma |
| title_full | Retinal metastases as the initial presentation of advanced lung adenocarcinoma |
| title_fullStr | Retinal metastases as the initial presentation of advanced lung adenocarcinoma |
| title_full_unstemmed | Retinal metastases as the initial presentation of advanced lung adenocarcinoma |
| title_short | Retinal metastases as the initial presentation of advanced lung adenocarcinoma |
| title_sort | retinal metastases as the initial presentation of advanced lung adenocarcinoma |
| topic | retinal metastases lung cancer egfr mutation |
| url | https://www.ejcrim.com/index.php/EJCRIM/article/view/4190 |
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