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Sir,

Metastatic tumours to the optic disc are rare. In a series of 660 patients with intraocular metastasis, only 30 (4.5%) had metastatic cancer of the optic disc.1 We report our case because it is, to our knowledge, both the first reported case of metastasis to the optic disc and choroid from the larynx, and also the first case of an adenoid cystic carcinoma that metastasised to the optic disc.

Case report

A 65-year-old man had a history of adenoid cystic carcinoma of the larynx that was managed by surgery and radiation therapy in February 1997. In August 1999, he noted a decrease of vision in his left eye and came to our hospital. Fundus examination of the left eye showed a hyperaemic optic disc that was elevated and appeared nodular (Figure 1). In addition, a brown choroidal mass extended up to the disc and surrounded the disc, and there were flame-shaped haemorrhages, venous congestion, and a serous cystic retinal detachment inferiorly. A relative afferent pupillary defect was detected in the left eye. The fundus of the right eye was normal. The anterior segments and intraocular pressure in both eyes were normal. Goldmann perimetry of the left eye revealed an enlargement of the blind spot and a marked constriction of the field that was consistent with the area of retinal detachment. Fluorescein fundus angiography of the left eye revealed hypofluorescence at the centre of the disc and hyperfluorescence at the margins of the disc in the arterial and early venous phase (Figure 2). There was a marked diffuse hyperfluorescence of the disc in the late phase.

Figure 1
figure 1

Fundus photograph of the left eye. The left optic disc is markedly hyperaemic, and there are flame-shaped haemorrhages and venous congestion. A choroidal mass extends up to the disc and surrounds the disc.

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Figure 2
figure 2

Fluorescein fundus angiography showing hypofluorescence at the centre of the left optic disc and hyperfluorescence at the margin of the disc in the arterial and early venous phase.

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Choroidal/optic disc metastasis was suspected and systemic work-up initiated. Magnetic resonance imaging in T1-weighted images showed no intracranial tumour other than the intraocular tumour. Haematologic studies and cerebrospinal fluid examination were unremarkable. X-ray of the chest showed an abnormal shadow in the right pulmonary hilum and mediastinum, and the subsequent CT scan of the chest revealed an enlargement of the mediastinal lymph node and bone metastasis. Both transbronchial lung biopsy and fine needle aspiration to the chest wall revealed class V, adenoid cystic carcinoma cells. The systemic status of the patient worsened rapidly from January 2000, and he died from systemic metastasis of the carcinoma in the following month. Unfortunately, the eyes could not be obtained for histopathology.

Comment

In 1999, Shields et al summarised that the most common primary tumours that metastasised to the optic disc were breast carcinoma (43%) and lung carcinoma (27%). A metastasis of a laryngeal cancer of the optic disc has not been reported, although adenoid cystic carcinomas of the larynx are pathologically very rare and account for only 0.2% of all larynx neoplasm. There are a few reports of choroidal metastasis of an adenoid cystic carcinoma, from the salivary gland2,3,4 and from the submandibular gland5, both of which are common sites for adenoid cystic carcinomas.

We reported a case of tumour of the optic disc extended to the choroid that metastasised from an adenoid cystic carcinoma of the larynx. This patient was also unique because the optic disc metastasis presented as the first sign of multiple metastases from a recurrent laryngeal cancer after a successful treatment.