Case Report: Choroidal metastasis from lung cancer

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We report the case of a 61-year-old male with a history of renal stones who presented with a four-month history of progressive exertional dyspnea, dry cough, and declining visual acuity in the right eye. Imaging revealed a left hilar tumor with carcinomatous consolidation, bilateral parenchymal nodules, and left pleural effusion. Ophthalmologic evaluation showed choroidal lesions in the right eye, confirmed by orbital MRI as a subretinal intraocular lesion. Biopsies confirmed pulmonary SCC. The patient received six cycles of cisplatin and gemcitabine chemotherapy alongside choroidal radiotherapy. After four cycles, choroidal metastases regressed, and visual acuity improved. Post-treatment imaging showed complete resolution of the intraocular lesion and a 34% reduction in tumor burden per RECIST 1.1. This case underscores the efficacy of combined systemic and localized therapies in managing advanced metastatic pulmonary SCC." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-292/v1", "name": "Case Report: Choroidal metastasis from lung cancer" } } ] } Home Browse Case Report: Choroidal metastasis from lung cancer ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Karaborni B, Kamoun H, Rejeb H et al. Case Report: Choroidal metastasis from lung cancer [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :292 ( https://doi.org/10.12688/f1000research.162740.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Choroidal metastasis from lung cancer [version 1; peer review: 1 approved with reservations] Bochra Karaborni https://orcid.org/0009-0000-7980-3145 1 , Hela Kamoun https://orcid.org/0000-0003-4431-846X 1 , Hadhemi Rejeb 1 , Ines Akrout 1 , Hanene Smadhi https://orcid.org/0000-0002-6241-3842 1 , Leila Fekih 1 Bochra Karaborni https://orcid.org/0009-0000-7980-3145 1 , Hela Kamoun https://orcid.org/0000-0003-4431-846X 1 , [...] Hadhemi Rejeb 1 , Ines Akrout 1 , Hanene Smadhi https://orcid.org/0000-0002-6241-3842 1 , Leila Fekih 1 PUBLISHED 13 Mar 2025 Author details Author details 1 Pulmonology Department, Ibn Nefiss, Abderrahmane Mami Hospital, Ariana, Tunisia Bochra Karaborni Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Hela Kamoun Roles: Formal Analysis, Methodology, Supervision, Validation, Visualization Hadhemi Rejeb Roles: Formal Analysis, Methodology, Supervision, Visualization Ines Akrout Roles: Data Curation, Formal Analysis, Supervision Hanene Smadhi Roles: Formal Analysis, Supervision, Visualization Leila Fekih Roles: Supervision, Validation, Visualization OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Association for Cancer Immunotherapy collection. Abstract Pulmonary squamous cell carcinoma (SCC) is a common subtype of non-small cell lung cancer, often associated with metastatic spread at diagnosis. We report the case of a 61-year-old male with a history of renal stones who presented with a four-month history of progressive exertional dyspnea, dry cough, and declining visual acuity in the right eye. Imaging revealed a left hilar tumor with carcinomatous consolidation, bilateral parenchymal nodules, and left pleural effusion. Ophthalmologic evaluation showed choroidal lesions in the right eye, confirmed by orbital MRI as a subretinal intraocular lesion. Biopsies confirmed pulmonary SCC. The patient received six cycles of cisplatin and gemcitabine chemotherapy alongside choroidal radiotherapy. After four cycles, choroidal metastases regressed, and visual acuity improved. Post-treatment imaging showed complete resolution of the intraocular lesion and a 34% reduction in tumor burden per RECIST 1.1. This case underscores the efficacy of combined systemic and localized therapies in managing advanced metastatic pulmonary SCC. READ ALL READ LESS Keywords lung neoplasm ,Neoplasm Metastasis,Ophthalmology,Eye Neoplasms,Choroid Neoplasms Corresponding Author(s) Bochra Karaborni ( [email protected] ) Close Corresponding author: Bochra Karaborni Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Karaborni B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Karaborni B, Kamoun H, Rejeb H et al. Case Report: Choroidal metastasis from lung cancer [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :292 ( https://doi.org/10.12688/f1000research.162740.1 ) First published: 13 Mar 2025, 14 :292 ( https://doi.org/10.12688/f1000research.162740.1 ) Latest published: 13 Mar 2025, 14 :292 ( https://doi.org/10.12688/f1000research.162740.1 ) Introduction Pulmonary squamous cell carcinoma (SCC) is a common form of lung cancer, primarily affecting smokers. However, the presence of ocular metastases remains a rare and unusual presentation. Metastasis to the eye is commonly seen with melanoma or breast cancer, but it can occasionally be found in other solid tumors. This case report aims to describe a patient with plurimetastatic pulmonary SCC with a unique presentation of ocular metastasis. Case report A 61-year-old male, a 40-pack-year smoker currently not in cessation and working as a civil servant, presented to our hospital with progressive exertional dyspnea, dry cough, and a four-month history of general health deterioration. He had a history of surgically treated renal stones but no significant family history, particularly no history of cancer. Additionally, he reported gradual visual impairment in the right eye. On clinical examination, the patient was in good general condition with a performance status of 0. The examination revealed an intact neurological status, with no sensory-motor deficits, stable hemodynamic and respiratory parameters, and no abnormal lymph node palpation. Imaging findings A chest CT scan revealed a left hilar mass with associated lower lobar carcinomatous consolidation, trans-scisural lingular extension, bilateral parenchymal nodules, and left pleural effusion with pleural nodules. Further staging work-up included an abdominal-pelvic CT, which showed enlarged left gastric and retroperitoneal lymph nodes. A brain CT showed no secondary lesions in the brain. Ophthalmological examination revealed a reduction in visual acuity to light perception in the right eye, while the left eye was unaffected. Fundus examination revealed two choroidal lesions in the right eye. Orbital MRI demonstrated a subretinal intraocular lesion, measuring 11×5 mm, located in the posterior-medial and superior region of the right eye, with intermediate signal intensity on T1-weighted imaging and hypointensity on T2-weighted imaging (Please see Figure 1 , Figure 2 and Figure 3 ). Figure 1. T1-weighted MRI axial orbital section showing a subretinal intraocular lesion in the right eye. Figure 2. T1-weighted MRI axial orbital section demonstrating the lesion's posterior-medial and superior location. Figure 3. T1-weighted MRI sagittal orbital section highlighting the lesion's dimensions. Histopathology and diagnosis A bronchoscopy with biopsy was performed, revealing histopathological features consistent with moderately differentiated squamous cell carcinoma of pulmonary origin. The clinical and radiological findings confirmed the diagnosis of plurimetastatic pulmonary SCC with ocular involvement. Treatment and outcome The patient was treated with a combination of cisplatin and gemcitabine chemotherapy (six cycles) and localized radiotherapy for the choroidal metastases. After four cycles of chemotherapy, ophthalmological examination showed regression of the choroidal lesions and improvement in visual acuity. Orbital MRI after treatment showed complete resolution of the posterior-superior ocular wall thickening with no detectable intraocular mass. A follow-up thoracic-abdominal-pelvic CT scan showed a partial response, with a 34% reduction in tumor burden according to RECIST 1.1 criteria. Discussion Ocular metastases are rare in lung cancer, found in 0.7 to 12% of lung cancer patients. 1 , 2 The choroid is the most commonly affected ocular site, with choroidal metastases representing 88% of all ocular metastases in the study by Shields et al. 3 The hematogenous spread of the primary cancer, particularly via the posterior ciliary arteries, explains the preferential location of these metastases in the postero-supero-lateral choroid, a highly vascularized region. 1 , 4 Choroidal metastases are primarily seen in breast and lung cancers, with lung cancer being the leading cause of choroidal metastases in the male population. 5 They are rarely isolated and typically form part of a broader metastatic disease. In our case, pulmonary and pleural metastases were also identified. 6 , 7 Choroidal metastases are often asymptomatic, and orbital metastasis is rarely the first sign of lung cancer. 8 , 9 The most common clinical sign is exophthalmos, which can develop rapidly but often remains subtle in 66% of cases. 10 Frequent early indicators include diplopia, metamorphopsia, and visual acuity decline. 1 , 11 In our case, the patient reported progressive visual acuity loss in the right eye. Diagnosing the etiology of a choroidal mass can be challenging, with differential diagnoses including metastasis, melanoma, or choroidal hemangioma. 12 The definitive diagnosis is based on biopsy, guided by imaging, with immunohistochemical analysis. 13 In our case, the orbital biopsy was not performed, and the diagnosis was made based on the characteristic CT findings suggestive of a secondary origin, confirmed by histological confirmation of the pulmonary primary via bronchial biopsies. Management requires a multidisciplinary approach involving ophthalmologists, pulmonologists, and oncologists. The reference treatment is radiotherapy, with doses ranging from 30 to 40 Gy over two weeks, leading to tumor regression in most cases. 11 For our patient, the palliative treatment approach included chemotherapy and orbital radiotherapy. The prognosis for orbital metastases remains poor, with survival rarely exceeding one year. Only 27% of patients survive beyond two years. 11 Conclusion Although choroidal metastases are the most frequent ocular metastases, they remain rare. The diagnosis relies on a combination of clinical and paraclinical evidence. Radiotherapy, often combined with chemotherapy, remains the cornerstone of treatment for choroidal metastases. This case underscores the critical role of collaboration between pulmonologists, ophthalmologists, and oncologists in managing choroidal metastases from lung cancer. Informed consent Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. The patient was informed that all personal identifying information would be removed to ensure confidentiality and anonymity. The patient acknowledged that the case details and images could be freely available online and publicly accessible. Data and software availability No data are associated with this article. References 1. Raobela L, Rafanomezantsoa R, Ratovondrainy W, et al. : Ocular metastasis as a revealing sign of lung cancer. Rev. Anesth. Réanim Med. Urgence. 2015; 7 (1): 15–17. 2. Konoglou M, Zarogoulidis P, Porpodis K, et al. : Exophthalmos as a first manifestation of small cell lung cancer: a long-term follow-up. Case Rep. Ophthalmol. 2011; 2 (3): 360–366. PubMed Abstract | Publisher Full Text | Free Full Text 3. Shields JA: Metastatic neoplasms in the optic disc: the 1999 Bjerrum Lecture: part 2. Arch. Ophthalmol. 2000; 118 (2): 217–224. Publisher Full Text 4. Weaver M, Dhall N, Desai K, et al. : A choroidal mass: rare presentation of a metastatic disease. J. Clin. Oncol. 2018; 36 (15): 1500–1505. 5. Shields CL, Shields JA, Gross NE, et al. : Survey of 520 eyes with uveal metastases. Ophthalmology. 1997; 104 (8): 1265–1276. PubMed Abstract | Publisher Full Text 6. Battikh MH, Ben Yahia S, Ben Sayah MM, et al. : Choroidal metastases as the first manifestation of bronchogenic adenocarcinoma and their regression under chemotherapy. Rev. Pneumol. Clin. 2004; 60 (6): 353–356. PubMed Abstract | Publisher Full Text 7. Shields JA, Shields CL, Kiratli H, et al. : Metastatic tumors to the iris in 40 patients. Am. J. Ophthalmol. 1995; 119 (4): 422–430. PubMed Abstract | Publisher Full Text 8. Rached S, Mesri K, Koricki M, et al. : Bilateral choroidal metastases revealing bronchopulmonary cancer in a pregnant woman. J. Société Marocaine D’Ophtalmologie. 2023; 31 : 31–34. 9. Chaudhuri T, Yadava K: Orbital and infratemporal fossa metastasis: an unusual initial presentation of adenocarcinoma of the lung. Indian J. Med. Paediatr. Oncol. 2013; 34 (2): 132–133. PubMed Abstract | Publisher Full Text 10. Cornelis F, Mejdoubi M, Dousset V: Bilateral orbital extension of metastatic carcinoma from breast cancer. J. Radiol. 2007; 88 (5): 684–686. PubMed Abstract | Publisher Full Text 11. Munakomi S, Chaudhary S, Chaudhary P, et al. : Case report: orbital metastasis as the presenting feature of lung cancer. F1000Res. 2017; 6 : 430. PubMed Abstract | Publisher Full Text | Free Full Text 12. Kreusel KM, Wiegel T, Stange M, et al. : Choroidal metastasis in disseminated lung cancer: frequency and risk factors. Am. J. Ophthalmol. 2002; 134 (3): 445–447. PubMed Abstract | Publisher Full Text 13. Yarovoy AA, Bulgakova ES, Shatskikh AV, et al. : Core needle biopsy of orbital tumors. Graefes Arch. Clin. Exp. Ophthalmol. 2013; 251 (8): 2057–2061. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 13 Mar 2025 ADD YOUR COMMENT Comment Author details Author details 1 Pulmonology Department, Ibn Nefiss, Abderrahmane Mami Hospital, Ariana, Tunisia Bochra Karaborni Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Hela Kamoun Roles: Formal Analysis, Methodology, Supervision, Validation, Visualization Hadhemi Rejeb Roles: Formal Analysis, Methodology, Supervision, Visualization Ines Akrout Roles: Data Curation, Formal Analysis, Supervision Hanene Smadhi Roles: Formal Analysis, Supervision, Visualization Leila Fekih Roles: Supervision, Validation, Visualization Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 13 Mar 2025, 14:292 https://doi.org/10.12688/f1000research.162740.1 Copyright © 2025 Karaborni B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Karaborni B, Kamoun H, Rejeb H et al. Case Report: Choroidal metastasis from lung cancer [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :292 ( https://doi.org/10.12688/f1000research.162740.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 13 Mar 2025 Views 0 Cite How to cite this report: Su PL. Reviewer Report For: Case Report: Choroidal metastasis from lung cancer [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :292 ( https://doi.org/10.5256/f1000research.178991.r404743 ) The direct URL for this report is: https://f1000research.com/articles/14-292/v1#referee-response-404743 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 Sep 2025 Po-Lan Su , The Ohio State University College of Medicine, Columbus, Ohio, USA Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.178991.r404743 This is a interesting case report regarding a patients with lung squamous cell carcinoma and choroidal metastasis, with optimal tumor shrinkage after chemotherapy and localized radiotherapy. The manuscript is well-written but it would be better to address following points: ... Continue reading READ ALL This is a interesting case report regarding a patients with lung squamous cell carcinoma and choroidal metastasis, with optimal tumor shrinkage after chemotherapy and localized radiotherapy. The manuscript is well-written but it would be better to address following points: 1.Please provide the formal ophthalmologic visual field test result to support the improvement of patient's symptom 2.Please add relevant paragraph to discuss the efficacy of immunotherapy in choroidal metastasis Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Single cell transcriptomics/proteomics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Su PL. Reviewer Report For: Case Report: Choroidal metastasis from lung cancer [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :292 ( https://doi.org/10.5256/f1000research.178991.r404743 ) The direct URL for this report is: https://f1000research.com/articles/14-292/v1#referee-response-404743 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 13 Mar 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 13 Mar 25 read Po-Lan Su , The Ohio State University College of Medicine, Columbus, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Su P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 Sep 2025 | for Version 1 Po-Lan Su , The Ohio State University College of Medicine, Columbus, Ohio, USA 0 Views copyright © 2025 Su P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a interesting case report regarding a patients with lung squamous cell carcinoma and choroidal metastasis, with optimal tumor shrinkage after chemotherapy and localized radiotherapy. The manuscript is well-written but it would be better to address following points: 1.Please provide the formal ophthalmologic visual field test result to support the improvement of patient's symptom 2.Please add relevant paragraph to discuss the efficacy of immunotherapy in choroidal metastasis Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Single cell transcriptomics/proteomics I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Su PL. Peer Review Report For: Case Report: Choroidal metastasis from lung cancer [version 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :292 ( https://doi.org/10.5256/f1000research.178991.r404743) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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