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Metastatic tumours to the eye. Review of metastasis to the iris, ciliary body, choroid, retina, optic disc, vitreous, and/or lens capsule

Abstract

Metastasis to the eye can involve the choroid (90%), ciliary body (2%), iris (8%), and retina, optic disc, vitreous, and/or lens capsule (<1–4%). The mean number of uveal metastasis per eye (1.7), mean tumour base (11.6 mm) and thickness (3.2 mm), tumour colour (86% yellow), and presence of subretinal fluid (72%), are all clinical features suggestive of the diagnosis. Imaging with ultrasonography demonstrates an echodense mass (80%) and optical coherence tomography shows a “lumpy bumpy” choroidal surface (64%), both important diagnostic features. Uveal metastases typically emanate from primary cancer of the breast (37%), lung (27%), kidney (4%), gastrointestinal tract (4%), cutaneous melanoma (2%), lung carcinoid (2%), prostate (2%), thyroid (1%), pancreas (1%), and other sites (3%). Occasionally, fine needle aspiration biopsy is employed if the primary site is not known. In 16% of cases, the primary site remains unknown. Rarely, metastases affect the retina, vitreous, and lens capsule, most often originating from cutaneous melanoma and in patients previously treated with checkpoint inhibitor therapy. Kaplan–Meier analysis in a series of 1111 patients with uveal metastasis revealed 32% survival at 3 years and 24% at 5 years. Patients with uveal metastasis from carcinoid tumour showed most favourable survival at 5-years (92%), whereas pancreatic and kidney cancer demonstrated least favourable survival (0%). The 5-year survival was better for females (versus (vs.) males) (31% vs. 21%) and older adults (vs. children) (40% vs. 0%). In this review, we examine several large-cohort publications on the topic of ocular metastasis.

摘要

肿瘤可以转移至眼的脉络膜(90%), 睫状体(2%), 虹膜(8%)和视网膜, 视盘, 玻璃体和/或晶状体囊(<1–4%)等部位。每只眼脉络膜转移的平均数量为1.7, 平均肿瘤基底部的宽度为11.6 mm, 厚度为3.2 mm, 肿瘤颜色(86%黄色), 视网膜下积液(72%)这些临床特征都是诊断依据。超声成像提示有回声肿块(80%), 光学相干断层扫描(OCT)提示脉络膜表面有“块状隆起” (64%), 为重要的诊断特征。葡萄膜的转移性肿瘤通常来源于乳腺(37%), 肺(27%), 肾(4%), 胃肠道(4%), 皮肤黑色素瘤(2%), 肺类癌(2%), 前列腺(2%), 甲状腺(1%), 胰腺(1%)和其他部位(3%)。少数原发部位未明的眼部转移肿瘤可采用细针穿刺进行活检。在16%的病例中, 转移肿瘤的原发部位仍然未知。在极少数情况下, 转移肿瘤会侵犯视网膜, 玻璃体, 晶状体囊, 这些肿瘤多数来源于皮肤黑色素瘤和既往使用免疫检查点抑制剂治疗过的病人。对1111名有葡萄膜转移肿瘤的病人使用Kaplan-Meier生存分析, 结果提示3年生存率为32%, 5年生存率为24%。其中, 类癌葡萄膜转移的病人5年生存率最高(92%),而前列腺和肾脏来源的葡萄膜肿瘤生存率最低(0%)。女性(vs.男性)(31% vs.21%)和老年人(vs.儿童)(40% vs.0%)的5年生存率更好。在这篇综述中, 我们验证了一些以眼部转移肿瘤为主题的大型队列研究的成果。

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Fig. 1: Multinodular choroidal metastasis.
Fig. 2: Dome-shaped choroidal metastasis.
Fig. 3: Treatment of choroidal metastases.
Fig. 4: Iris metastasis.
Fig. 5: Retina metastasis.

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Martine J. Jager, Carol L. Shields, … Bertil E. Damato

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Funding

Support provided in part by the Eye Tumor Research Foundation, Philadelphia, PA (CLS). The funders had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data, and in the preparation, review or approval of the manuscript. CLS has had full access to all the data in the study and takes responsibility for the integrity of the data.

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CLS, NEK, MG, MS: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AL, AMVS, KA, SEL, JAS: Substantial contributions to the interpretation of data for the work; Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Carol L. Shields.

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Shields, C.L., Kalafatis, N.E., Gad, M. et al. Metastatic tumours to the eye. Review of metastasis to the iris, ciliary body, choroid, retina, optic disc, vitreous, and/or lens capsule. Eye 37, 809–814 (2023). https://doi.org/10.1038/s41433-022-02015-4

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