Choroidal metastasis from carcinoma of breast detected on F18-FDG PET CT scan: A case report and review of literature

Abstract

Intraocular choroidal metastasis is a very rare cause of blindness. Choroidal hemangioma and melanoma are other causes that may mimic the condition. Carcinoma of breast is the most common primary malignancy that accounts for choroidal metastasis in females and carcinoma of lung is the most common cause in males. Other primary neoplasms which can uncommonly metastasize to the choroid are testis, gastrointestinal tract, kidney, thyroid, pancreas, and prostate. Metastatic neoplasm to the eye outnumbers the primary tumors such as retinoblastomas and malignant melanoma. Sonography is usually the initial investigation after fundus examination to look for the architecture of the lesion. However, it lacks in specificity. We present a case of carcinoma of breast that had visual disturbances and wholebody F18-fluorodeoxyglucose, positron emission tomography-computerized tomography (FDG PET CT) revealed a choroidal lesion in addition to cerebral, pulmonary, and skeletal metastases. Choroidal metastasis from carcinoma of lung has been reported previously on FDG PET. To the best of our knowledge, this is the first case report of carcinoma of breast demonstrating choroid metastasis on F18-FDG PET CT scan.

Keywords: Distant metastasis; paranasal sinuses; thyroid neoplasms.

Figure 1

Ultrasonography of left eye shows a well-defined, echogenic lentiform-shaped lesion along the temporal aspect of the posterior coat of the globe associated with retinal detachment (►). A differential diagnosis of melanoma, metastasis was made

Figure 2

Magnetic resonance imaging shows a plaque-like lesion of uneven thickness along the posterolateral surface of the globe in close relation to the choroid (►) with associated retinal detachment. The lesion is hypointense on T2W study and hyperintense on STIR images

Figure 3

F18-FDG PET CT study: Maximum intensity projection image shows FDG-avid lesions in the brain (), lungs (), mediastinal-retroperitoneal lymph nodes, and skeleton (→)

Figure 4

F18 FDG PET CT: Transaxial section across the orbit shows intense focus of FDG activity in the left eye ball posteriorly—fusion image shows coregistration in the posterior choroid corresponding to the radiologic lesion seen in computerized tomogram (◄)