Retinal metastases as the initial presentation of advanced lung adenocarcinoma
  • Catarina Oliveira-Silva
    Department of Nephrology, Hospital de Braga, Braga, Portugal
  • Maria Manuel Pereira
    Department of Oncology, Hospital de Braga, Braga, Portugal
  • Catarina Ferreira
    Department of Oncology, Hospital de Braga, Braga, Portugal
  • Eduardo Macedo
    Department of Internal Medicine, Hospital de Braga, Braga, Portugal
  • Marta Mendes
    Department of Internal Medicine, Hospital de Braga, Braga, Portugal
  • Ana Rita Marques
    Department of Internal Medicine, Hospital de Braga, Braga, Portugal
  • Ilídio Brandão
    Department of Internal Medicine, Hospital de Braga, Braga, Portugal

Keywords

Retinal metastases, lung cancer, EGFR mutation

Abstract

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.

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    Published: 2023-12-13
    Issue: 2024: Vol 11 No 1 (view)

    How to cite:
    1.
    Oliveira-Silva C, Pereira MM, Ferreira C, Macedo E, Mendes M, Marques AR, Brandão I. Retinal metastases as the initial presentation of advanced lung adenocarcinoma. EJCRIM 2023;11 doi:10.12890/2023_004190.