Papillary Thyroid Carcinoma: Bilateral Choroidal Metastases with Extrascleral Extension
A 62-year-old man presented with a red and painful right eye. He had begun to experience visual problems 8 months earlier, which rapidly deteriorated in the last 2 months. He had undergone a total thyroidectomy for papillary carcinoma 4 years prior. Fifteen months later, metastatic disease was discovered in his sternum and he received iodine-131 therapy. His condition remained stable thereafter.\nUpon examination, his visual acuity was light perception in the right eye and 20 / 25 in the left eye. Microcystic corneal edema, a fixed and dilated pupil, and rubeosis iridis were found in the right eye. There was total serous retinal detachment and the intraocular pressure was 45 mmHg (applanation). Ocular ultrasonography demonstrated a single choroidal lesion with a basal diameter measuring 11 mm and a thickness of 6 mm in the right eye ().\nThe left eye was normal. The right eye was enucleated, as there were no prospects of recovering useful vision. A dark, well-encapsulated scleral nodule was noted over the enucleated globe (). A month later, the patient's visual acuity in the left eye decreased to 20 / 200 with the new development of a solitary, reddish-pink choroidal mass that measured 6 × 4.5 mm in basal dimensions and 1.5 mm in thickness, superior to the fovea and within the temporal vascular arcades (). There was minimal subretinal fluid over the lesion. This tumor was treated with a single session of transpupillary thermotherapy using a 0.5 mm spot size, 500 mW power, and 29 overlapping spots each lasting 45 seconds. Six weeks later, the tumor in the left eye totally disappeared without any improvement in the patient's visual acuity (). Evidence for widespread metastatic involvement of the lungs was confirmed a month later and he expired from respiratory complications.\nHistopathological examination of the eye revealed that the choroidal tumor was composed of papillary excrescences and cystic spaces (). The papillae were covered by columnar and cuboidal cells with eosinophilic cytoplasms. These cells had elongated nuclei and irregular nuclear contour. In one area, the sclera was eroded in full thickness and tumor cells gained access into the sub-Tenon's space. Immunohistopathological studies showed strong signals of thyroglobulin and thyroid transcription factor 1 ().