Unusual Orange-Colored Choroidal Metastases
A 49-year-old Caucasian man was referred for deterioration of vision of 2 months’ duration. He had been diagnosed with high-grade small cell neuroendocrine carcinoma involving the larynx and oropharynx one year earlier; multiple massive regional lymph nodes and visceral metastases had failed to respond to cisplatin and etoposide combination chemotherapy. The patient had been a heavy smoker for over 25 years.\nVisual acuity was 20/30 in the right eye and counting fingers in the left one. The significant finding on ophthalmic examination was the presence of bilateral multiple orange-colored solid choroidal masses. There were four lesions on the right side, one partially involving the fovea and two larger masses in the left eye, one involving the macular area associated with exudative retinal detachment (A).\nUltrasonography demonstrated dome- shaped choroidal lesions of various thickness which appeared acoustically echogenic on B-scan without choroidal excavation (B), and with moderate to high internal reflectivity on A-scan.\nFluorescein angiography of the left macular tumor showed very faint fluorescence 22 seconds after dye injection. Fluorescence of these masses however did not show a significant increase during subsequent phases of the angiogram, reaching maximum fluorescence at 5 minutes (A, B, and C). The patient passed away two weeks after the ocular examination from advanced metastatic brain disease.