Korean J Ophthalmol.  2013 Jun;27(3):215-218. 10.3341/kjo.2013.27.3.215.

Papillary Thyroid Carcinoma: Bilateral Choroidal Metastases with Extrascleral Extension

• Kiratli H
• Tarlan B
• Soylemezoglu F

• KMID: 1798062
• DOI: http://doi.org/10.3341/kjo.2013.27.3.215

Abstract

Here, we present the case of a patient with bilateral choroidal metastases with extraocular extension in one eye. Metastasis of papillary thyroid carcinoma to the uvea is extremely rare, with only 6 patients reported in the literature. A 62-year-old man with a prior history of papillary thyroid carcinoma suffered the rapid loss of vision in his right eye. He had neovascular glaucoma, total retinal detachment, and a solitary choroidal mass. A month later, his left visual acuity also decreased because of a small macular choroidal mass. The right eye was enucleated and a nodular lesion over the sclera representing extraocular extension was observed. This tumor and the intraocular lesion were composed of papillary excrescences and cystic spaces and stained positively for thyroid transcription factor 1 and thyroglobulin, all confirming the diagnosis of metastatic papillary thyroid carcinoma. The tumor in the left eye was successfully treated with diode laser transpupillary thermotherapy. The patient expired within a month as a result of widespread pulmonary metastases. Papillary thyroid carcinoma may metastasize to the uvea bilaterally, cause rapid visual function loss, erode the sclera, and may extend outside the globe similar to choroidal melanoma. This aggressive ocular involvement was associated with a dismal prognosis in our patient.

Keyword

Choroid; Neoplasm metastasis; Papillary carcinoma; Thyroid gland; Transpupillary thermotherapy

MeSH Terms

Carcinoma/*pathology/therapy
Choroid/*pathology
Choroid Neoplasms/*secondary/therapy
Humans
Hyperthermia, Induced
Lung Neoplasms/secondary
Male
Middle Aged
Sclera/*pathology
Thyroid Neoplasms/*pathology/therapy

Figure

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  Fig. 1 (A) B-scan ultrasonogram of the right eye before enucleation shows the intraocular tumor with orbital shadowing which probably corresponds to the extraocular extension. (B) The enucleated right eye had a pigmented scleral nodule on the superior part.

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  Fig. 2 (A) Mid-phase fluorescein angiogram of the left fundus showing the relatively well-delineated lesion above the fovea with patchy areas of hyperfluorescence, before transpupillary thermotherapy. (B) Post-treatment early mid-phase fluorescein angiogram demonstrates the almost complete resolution of the lesion.

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  Fig. 3 Histopathological view of the specimen showing (A) papillary excrescences typical of papillary thyroid carcinoma (H&E, ×40) and (B) strong thyroid transcription factor 1 signals (×40).

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