gms | German Medical Science

Purpose: To report a rare case of choroidal metastatic tumor of lung adenocracinoma, who successfully treated by osimertinib (Tagrisso).

Methods: A retrospective case review of a case of lung adenocarcinoma with choroidal metastatic tumor. Comprehensive ophthalmic examination including visual acuity measurement, intraocular pressure (IOP), slit-lamp biomicroscope, fundus examination, and optical coherence tomography (OCT) was done in a tertiary medical center.

Results: A 47-year-old female diagnosed with left lung adenocarcinoma with brain and bone metastases, T4N3M1c, stage IVB in 2022. She received erlotinib and bevacizumab as the first line therapy. However, progressive left visual field defect with blurred vision was noted after one year of treatment. Thus, she was presented to our clinic with visual acuity of right eye was 20/20, and visual acuity of left eye was 20/50. Slit lamp examination for anterior segment showed unremarkable finding. Fundus examination revealed lobulated subretinal fluid at lower peripheral retina of right eye, and choroid metastasis with subretinal fluid at macula area of left eye. OCT of macula demonstrated subretinal fluid at macula area of left eye. Due to progressive disease of lung cancer, wedge resection of right lower lung lobe was performed and further tissue pathology reported epidermal growth factor receptor (EGFR) exon19 del+ T790M. Second-line target therapy of osimertinib was started for progressive disease treatment. After 3 months of treatment, her visual acuity recovered to 20/20 of bilateral eye, and subretinal fluid decreased of both eye.

Conclusions: Choroidal metastatic tumors are one of the common intraocular malignancy, and the most common primary tumor including breast cancer and lung cancer. Early visual change in cancer patient can be the warning sign of disease progression and metastasis. Clinical physicians should raise awareness with cancer patients with visual complaint. Treatment of choroidal metastatic tumor depends on the primary cancer status, including systemic chemotherapy, radiotherapy, and target immunotherapy or hormonal therapy.