Iris metastasis as the initial presentation of metastatic esophageal cancer diagnosed by fine needle aspiration biopsy
| Autor: | Naoki Horiuchi, Hiroko Ozawa, Kazuo Tsubota, Yoji Takano, Yoshihiko Usui, Toshihide Kurihara, Lois E.H. Smith, Tohru Kuribayashi, Yohei Tomita |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
squamous cell carcinoma medicine.medical_specialty Intraocular pressure Esophageal Neoplasms genetic structures Anterior Chamber medicine.medical_treatment Biopsy Fine-Needle Visual Acuity Administration Oral Iris Metastasis Fatal Outcome secondary glaucoma Biopsy fine needle aspiration biopsy medicine Humans Clinical Case Report esophageal cancer Iris Neoplasms Neoplasm Metastasis Iris (anatomy) Carbonic Anhydrase Inhibitors Intraocular Pressure radiotherapy Aged Neovascularization Pathologic medicine.diagnostic_test business.industry Chemoradiotherapy General Medicine Esophageal cancer medicine.disease iris metastasis eye diseases Acetazolamide Radiation therapy Fine-needle aspiration medicine.anatomical_structure Carcinoma Squamous Cell Ocular Hypertension sense organs Radiology business Uveitis Research Article |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 0025-7974 |
| DOI: | 10.1097/md.0000000000026232 |
| Popis: | Rationale: Metastasis of neoplasms to the eye is quite uncommon. In this case report, we describe a patient where primary esophageal cancer was diagnosed by fine needle aspiration biopsy (FNAB) of an iris tumor. Patient concerns: A 70-year-old male complained of redness and discomfort in the right eye. Diagnosis and interventions: The patient's right eye was diagnosed as idiopathic uveitis, and a topical steroid was administered. As vitreous opacities were observed even after topical therapy, oral prednisolone was administered. On slit-lamp examination of the right eye, an iris mass with neovascularization was seen in the anterior chamber. A metastatic tumor was suspected, and FNAB was performed. Histology revealed squamous cell carcinoma. Systemic workup revealed esophageal cancer with several metastases. Best-corrected visual acuity decreased to 20/400, and intraocular pressure was 40 mmHg in the right eye. Two iris tumors with neovascularization were present extending into the anterior chamber with posterior iris synechiae and 360 degree peripheral anterior synechiae. Intraocular pressure in the right eye was medically managed with hypotensive eye drops and oral acetazolamide. Iris metastases were treated with 40 Gray of radiation therapy and concurrent chemotherapy. Outcomes: The tumor regressed, but intraocular pressure was refractory to treatment because of 360 degree goniosynechial closure. The right eye lost light perception six months after treatment commenced, and the patient died 9 months after the onset of therapy due to multiple systemic metastases. Lessons: This is a rare case of masquerade syndrome without systemic symptoms in which FNAB of an iris tumor led to a diagnosis of metastatic esophageal squamous cell carcinoma. Although the patient lost his sight due to uncontrollable ocular hypertension, systemic chemotherapy, and radiation therapy were initially effective in the treatment of the metastatic iris tumor. As the prognosis of patients with metastatic iris tumors is poor, it is important for ophthalmologists to consider such diagnoses and conduct systemic investigations when necessary. |
| Databáze: | OpenAIRE |
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