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LETTER TO EDITOR
Year : 2012  |  Volume : 49  |  Issue : 1  |  Page : 194-195
 

Metastasis in the choroid due to parotid malignancy


1 Department of Radiation Oncology, Apollo Gleneagles Cancer Hospital, Kolkata, India
2 Department of Radiation Oncology, Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, Andhra Pradesh, India
3 Department of Surgical Oncology, Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, Andhra Pradesh, India

Date of Web Publication25-Jul-2012

Correspondence Address:
D S Ray
Department of Radiation Oncology, Apollo Gleneagles Cancer Hospital, Kolkata
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.98953

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How to cite this article:
Ray D S, Patro K C, Muralikrishna V. Metastasis in the choroid due to parotid malignancy. Indian J Cancer 2012;49:194-5

How to cite this URL:
Ray D S, Patro K C, Muralikrishna V. Metastasis in the choroid due to parotid malignancy. Indian J Cancer [serial online] 2012 [cited 2020 Jun 4];49:194-5. Available from: http://www.indianjcancer.com/text.asp?2012/49/1/194/98953


Sir,

A 60-year-old male presented with a history of a mass in the left parotid area since six months. On examination a 3 x 6 cm hard mass was felt near the left ear lobule with restricted mobility and skin involvement [Figure 1]. Fine needle aspiration cytology reported pleomorphic carcinoma [Figure 2]. Chest X-ray and other routine investigations were normal but due to pre-existing cardiac morbidity surgery was not considered and he was treated with external radiotherapy.

After 10 fractions of radiotherapy on an Elekta Synergy linear accelerator, the patient complained of progressive loss of vision in his left eye. He was advised an ophthalmic evaluation which revealed a decreased acuity of vision to 6/24 when compared to the right eye 6/12 and an in-field defect on perimetry. Fundus examination [Figure 3] showed a choroidal mass inferior to the disc with overlying depigmentation and an adjacent pocket of exudative retinal detachment which was confirmed on B scan [Figure 4].
Figure 1: Clinical picture

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Figure 2: Microscopic picture - cytology

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Figure 3: Fundus examination of left eye

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Figure 4: Ultrasonogram showing choroidal mass

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We then requested for a PET (Positron Emission Tomography) scan which showed multiple sites of uptake in the body including the left parotid gland [Figure 5] and uveal part of the left eye [Figure 6]. The patient was subsequently advised systemic chemotherapy.
Figure 5: PET-CT showing uptake in primary

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Figure 6: PET-CT showing choroidal uptake

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Choroidal [uveal] metastases are the most common site of intraocular metastases. [1] The incidence of choroidal metastases from various primaries has been reported before in various literatures. A study by Soysal HG showed the incidence of uveal metastases from various primary sites as follows: breast (47%), lung (21%), gastrointestinal tract (4%), prostate (2%), kidney (2%), skin (2%), and other cancers (4%). In 17% of cases the primary site was never established. [2] The incidence of distant metastases in head and neck cancers and especially in salivary gland tumors is relatively low in comparison to other malignancies. However, their presence heralds a poor prognosis.

Although extremely rare, the possibility of choroidal metastases should be considered in a patient with a history of salivary gland tumor.

 
  References Top

1.Soysal HG. Metastatic tumors of the uvea in 38 eyes. Can J Ophthalmol 2007;42:832-5.  Back to cited text no. 1
[PUBMED]    
2.Shields CL, Shields JA, Gross NE, Schwartz GP, Lally SE. Survey of 520 uveal metastases. Ophthalmology 1997;104:1265-76.  Back to cited text no. 2
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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