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Background: The reported incidence of metastatic uveal tumors has been increasing. The aim of this study is to report the clinical features, management, and prognosis of uveal metastatic tumors seen in a general oncology hospital., Methods: The records of 28 patients with uveal metastasis diagnosed between 1999 and 2006 were reviewed retrospectively., Results: Uveal metastatic tumours were detected in a total of 38 eyes, uveal involvement included the iris in 4 eyes and the choroid in 37 eyes. Ten patients (35.7%) had bilateral uveal involvement. The primary cancer site was the breast in 24 patients, the lung in 2 patients, the ovary in 1 patient, and the gastrointestinal tract in 1 patient. While the most common symptom was blurred vision, 14.2% of patients were asymptomatic. Choroidal metastases typically were creamy yellow in color, plateau or dome-shaped, and associated with secondary retinal detachment in 56.8% of eyes. The mean time interval between ocular and systemic diagnosis was 41.07 months. At the time of ocular diagnosis, 75% of patients had systemic metastasis. Eight eyes were treated with chemotherapy and hormone therapy, and external beam radiotherapy was applied to 30 eyes. Lesions commonly responded well to therapy, but 22 patients died as a result of disseminated systemic disease., Interpretation: Patients with uveal metastasis generally present to ophthalmologists with visual symptoms but may be asymptomatic in some cases. Local tumor control can be managed with current therapy, but systemic prognosis is generally poor because of the disseminated stage of the malignant disease.

Uveal metastasis from carcinoma is the most common cause of ocular malignancy in adults and represents an increasing problem in the context of an ageing population and enhanced survival of stage IV cancer patients. The reported prevalence of clinically evident uveal metastases in carcinoma patients ranges from 2% to 9%, with breast and lung cancer together accounting for between 71% and 92% of cases. Most patients (66-97%) have a known history of cancer and, although the majority have metastatic lesions elsewhere, up to 33% may present with an isolated ocular metastasis. These lesions may progress rapidly and are potentially sight-threatening. Early diagnosis and appropriate timely treatment are therefore of paramount importance to maintain patients' quality of life. The diagnosis is usually clinical and detailed descriptions of symptomatology and physical characteristics are provided. In 21-50% of patients, involvement is bilateral. External beam radiotherapy (EBRT), chemotherapy, hormone and biological therapies, brachytherapy, transpupillary thermotherapy, laser photocoagulation/photodynamic therapy and enucleation are therapeutic modalities described in the literature for the management of uveal metastases. The strongest evidence favours timely EBRT for the management of sight-threatening uveal metastases. The published evidence supporting EBRT for sight-threatening uveal metastases was given a grade B (strong support for recommendation). Newer alternative therapies are emerging and may have a role in selected patients; however, there are unfortunately few large studies examining such treatments for carcinoma metastatic to the eye. The role of these modalities will be further clarified with the results of larger comparative trials.

Context: Breast cancer is the most common malignancy in women, with increasing incidence in Europe and North America. The frequency of involvement of the eye and visual pathways is reported to be as high as 30% in patients with known metastatic disease. In some cases, ophthalmic involvement can be the first sign of metastatic spread. Metastasis occurs via the haematogenous route and predominantly involves the choroid. Metastases to other ocular structures, the orbit and the visual pathways have also been described. Paraneoplastic effects are rare but significant., Treatments: Different modalities are employed in the treatment of breast cancer and its metastases. These include chemotherapy and radiotherapy. The ocular adverse effects of these have been well described, but recently developed new treatment modalities, such as monoclonal antibodies, may have different side-effects. With the increasing incidence of breast cancer and the advent of new treatment strategies, the complications of the disease and the sequelae of therapy are highly relevant to both oncologists and ophthalmologists.

Purpose: Breast cancer is an increasingly important health problem in women and is the most common tumor to metastasize to the uvea. This study was designed to evaluate the clinical features, management, and prognosis of patients with uveal metastasis from breast cancer., Design: Retrospective interventional case series., Methods: We retrospectively reviewed 264 consecutive patients with uveal metastasis from breast cancer. We assessed the clinical features of the patient and tumor at the time of presentation, management, and prognosis. Kaplan-Meier survival estimates were used to analyze the probability of death as a function of time., Results: Uveal metastasis was the initial manifestation of breast cancer in seven patients (3%) and the first systemic metastatic site of previously diagnosed breast cancer in 43 (16%). Associated with uveal metastasis, optic disk metastasis was found in 13 patients (5%), eyelid metastasis in one patient (1%), and conjunctival and orbital in one patient (<1%). Of 264 patients with uveal metastasis, 225 (85%) had choroidal metastasis, eight (3%) iris metastasis, two (<1%) ciliary body metastasis, and 29 (11%) had metastasis in multiple uveal sites. In the 264 patients with uveal metastasis, the most common symptom was blurred vision in 197 patients (88%), floaters in 15 (5%), photopsia in 12 (5%), and 19 (7%) were asymptomatic. The uveal metastases were bilateral in 99 patients (38%) and unilateral in 165 (62%). In 55 (56%) of the 99 bilateral cases, a uveal metastasis was found in the asymptomatic fellow eye during follow-up examination. External beam radiotherapy was used in 137 patients with uveal metastasis (52%), providing tumor control in 116 patients (85%) at a mean follow-up of 21 months. Using Kaplan-Meier estimates, survival rates of all patients with uveal metastasis from breast cancer was 65% at 1-year, 34% at 3-year, and 24% at 5-year follow-up., Conclusions: Patients with uveal metastasis from breast cancer presented to ophthalmologists with visual symptoms in 93% of cases. However, asymptomatic metastases were commonly detected in the fellow eye. Local ocular tumor control was excellent with current therapies. However, systemic prognosis for all patients, including those who had been treated with different management options, was poor with survival rates of 65% at 1-year and 24% at 5-year follow-up.

Breast carcinoma is the most common primary tumor producing intraocular metastasis. Metastases to the iris and ciliary body are relatively rare. The authors report a case of a 61-year-old lady, operated for carcinoma of the left breast 3 years back, who presented with symptoms and signs of acute narrow-angle glaucoma in the right eye. A diffuse whitish plaque-like mass in the upper nasal quadrant of the iris with an episcleral nodule on the limbus in the corresponding area and all the signs of acute narrow-angle glaucoma were present in the right eye. Intraocular pressure was controlled medically. Fine-needle aspiration cytology from the episcleral nodule showed malignant cells. Histopathology of the excised nodule showed metastatic poorly differentiated carcinoma, and the cellular pattern was similar to the carcinoma of the breast. There was no other metastasis anywhere in the body. Fine-needle aspiration cytology from an external lesion of the eye is a less invasive and easier procedure than paracentesis to diagnose the metastatic nature of the lesions. The rare features in our case are the clinical presentation as acute glaucoma and the ocular structures being the first and only site of metastasis., (Copyright 2000 S. Karger AG, Basel)

We studied two cases of uveal metastasis from carcinoma of the breast in men. One patient was a 51-year-old man who developed ocular symptoms nine months after excision of a breast mass histologically diagnosed as an infiltrating ductal carcinoma. After the patient committed suicide, an autopsy disclosed metastatic lesions to the lungs, mediastinum, and chest wall. The second patient was a 49-year-old man who complained of ocular symptoms three years after undergoing mastectomy for breast carcinoma. One month after the onset of the ocular symptoms, his left eye was enucleated. Metastatic lesions were detected in the lungs and brain. More than one year after undergoing bilateral orchiectomy, and after whole-brain radiation therapy (4,500 rads) and chemotherapy, the patient has no neurologic symptoms. It appears that mammary carcinoma in men has a poorer prognosis than it does in women, probably because of two main factors: the advanced clinical stage of the disease when it is first detected and the more diffuse infiltrating character of the mass because of the scarcity of mammary tissue in men.

Simultaneous uveal and orbital spread of breast carcinoma occurred in a male patient. We believe that this case is unusual because of the rarity of ocular metastases from carcinoma of the breast in men and the extremely long interval (ten years) between detection of the primary tumor and appearance of metastatic disease.

Metastatic carcinoma is the most common form of intraocular malignancy. Metastatic carcinoma in the anterior segment is much less common than posterior involvement, and may be confused with uveitis of nonmalignant origin. Two cases of metastatic carcinoma to the iris, with diagnosis by a cytopathologic technique, are reported.

Breast carcinoma in males associated with ocular metastases is not often observed. A case is reported with review of the literature. Medical management is satisfactory in case of metastases and enucleation is suggested for severe pain.

Ocular metastases developed from breast carcinomas in two women 7 and 19 years after their mastectomies. They were both ciliary body metastases that had eroded through the root of the iris to present as unifocal globular, gelatinous (colloid) masses in the anterior chamber, and were amenable to local surgery. Histopathologically, small cellular clusters were widely separated in a sea of mucin; the tumor cells failed to display marked pleomorphism or mitotic activity. In each case, the distinction from a primary mucinous ciliary epithelial neoplasm had to be made both clinically and pathologically. For comparison, the authors also report a unique primary ciliary carcinoma that caused intractable glaucoma by spreading diffusely throughout the iris, ciliary body, and anterior chamber angle, and that necessitated enucleation. The tumor cells failed to produce hyaluronic acid but elaborated a mucosubstance which was histochemically indistinguishable from that of the metastatic carcinomas. This primary neoplasm, however, exhibited the following histologic differences from the metastases: more architectural variability, including garlands and festoons of cells not forming lumens that were suspended in a mucinous matrix; much more abundant intracellular mucin; foci of sheet-like and pleomorphic cellular proliferations with mitotic activity; and partial replacement of the ciliary processes by a comparatively benign-appearing mucinous columnar epithelium.

Cancer is a leading cause of death in America. Cancer to the eye is being diagnosed with increasing frequency. It is now considered the most common intraocular malignancy in adults. Although most ocular metastases do not require treatment, they have important prognostic implications for the patient's overall survival. Diagnostic errors leading to enucleation could be reduced if the incidence of metastatic tumors was always well considered. Presented here are two patients with metastatic tumors and a brief discussion of the nature of this ocular disease.