Choroidal metastases were first reported by Perls in 1872. The choroid is the most common ocular site for metastatic disease due to the abundant blood supply. Bilateral lesions are commonly associated with breast carcinoma (4047%) and unilateral with lung (2129%). Treatment frequently depends on the patient status but includes observation, systemic chemotherapy, immunotherapy, hormone therapy, radiotherapy, plaque therapy, or photodynamic therapy. Neuroendocrine tumours (NETs) rarely metastasize to the choroid, however cavitating metastases from lung NETs have been reported in the literature. We report an asymptomatic 23 year old mother of three, who on a routine optician check was found to have bilateral choroidal lesions 5 years after curative right upper lobectomy for a Typical Carcinoid of the lung. Clinically these lesions were thought to be either dormant metastatic carcinoid or bilateral uveal melanocytic proliferation. Multimodal imaging available at that time including full body CT and Octreoscan, complemented by full NET biochemistry proved unremarkable, and the patient was closely monitored. At 2 years follow up these lesions increased in size and a chorioretinal biopsy was performed. Histology confirmed this to be a metastatic NET. Gallium scanning was requested and skeletal lesions suspicious of metastases were revealed. The patient was commenced on a somatostatin analogue (SSA), Lanreotide autogel 120 mg, deep subcutaneous injection every 28 days. Close monitoring revealed possible early regression followed by stabilization of the lesions for 6 months, deeming the SSA treatment successful. MEN 1 gene testing previously proved normal, as were pituitary and bone profiles, and the patient consented to entry into the 100, 000 genome project. Given the changing paradigm for management of lung NETs, further treatment options for progression would include targeted therapy or PRRT. Previous studies have reported success with SSA and PRRT. Access to gallium scanning for routine NETs is of importance in detecting metastases, which may not be picked up by other modalities. NETs can metastasise to the eyes, which highlights the significance of multidisciplinary collaboration. They need to be closely monitored as an increase in size may necessitate further evaluation and treatment. Choroidal biopsy may be useful in confirming the diagnosis.
04 Dec 2017
UK and Ireland Neuroendocrine Tumour Society