J Korean Ophthalmol Soc.  2010 Mar;51(3):458-462.

A Case of Modified Photodynamic Therapy in the Management of Choroidal Metastasis of Breast Cancer

• Cho YJ
• Park SP

Abstract

PURPOSE
To report a case of choroidal metastasis of breast cancer that was treated with modified photodynamic therapy.
CASE SUMMARY
A 45-year-old woman visited our clinic with blurred vision of the right eye, which began 1 month before. The patient previously suffered from a low back pain for 1 year. The best corrected visual acuity was 20/20 in both eyes. Fundus examination revealed an elevated yellowish mass-like lesion at the superonasal area in the right eye. Ultrasonography of the right eye showed a highly echogenic choroidal mass with moderate to high internal reflectivity. Fluorescein angiography showed hypofluorescence during the prearterial and arteriovenous phase, and well circumscribed hyperfluorescence during the venous phase. Radiologic examination was performed upon suspicion of metastasis. The examination revealed breast cancer with lung, spine and ovary metastasis. Subsequently, biopsy of the breast mass revealed an invasive ductal carcinoma. Based on these results, the patient was diagnosed with choroidal metastasis from breast carcinoma. The patient received systemic chemotherapy, and modified photodynamic therapy (PDT) was performed on the metastatic choroidal mass. Six days after modified PDT, the mass size was unchanged, and serous retinal detachment developed at the macula and inferior retina. However, 22days after treatment, the mass size markedly decreased and the serous retinal detachment was improved.

Keyword

Breast cancer; Choroidal metastatic tumor; Photodynamic therapy

MeSH Terms

Biopsy
Breast
Breast Neoplasms
Carcinoma, Ductal
Choroid
Eye
Female
Fluorescein Angiography
Humans
Low Back Pain
Lung
Middle Aged
Neoplasm Metastasis
Ovary
Photochemotherapy
Retina
Retinal Detachment
Spine
Triazenes
Vision, Ocular
Visual Acuity
Triazenes

Figure

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  Figure 1. The fundus photography of the right eye shows elevated mass-like lesion superonasal to the optic disc.

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  Figure 2. Ultrasonography of the right eye revealed a highly echogenic choroidal mass with moderate to high internal reflectivity.

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  Figure 3. Fluorescein angiography shows generalized hypofluorescence with pinpoint hyperfluorescence during the prearterial and arteriovenous phase (Top) and hyperfluorescence during the venous phase (Bottom) due to leakage.

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  Figure 4. The 99m Tc bone scan revealed multiple active bone lesions in the thoracic spine and the ribs on both sides.

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  Figure 5. Pathology of primary breast cancer. The invasive ductal carcinoma infiltrating into the adjacent stromal tissue.

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  Figure 6. The diameter of the treatment spot is calculated based on the lesion size measured on the pretreatment fluorescein angiogram. Fundus drawing demonstrating photodynamic therapy of the choroidal tumor using three overlapping spot (yellow circles). The greatest linear dimension of the retinal lesion is 12,500 μm. And each treatment spot size is 8,000 μm.

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  Figure 7. At 6 days after photodynamic therapy, atrophic change started on the tumor surface. And serous elevated lesion appeared surrounding the macula and inferior retina.

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  Figure 8. At 22 days after photodynamic therapy, the fundoscopy shows resolution of serous retinal detatchment and marked tumor shrinkage.

Reference

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