Adenocarcinoma of Lung Presenting as Unilateral Blindness: A Case Report

Introduction: Lung cancer is the most common cause of death among cancers. Over 55% have distant metastasis at presentation. Intraocular metastasis is a rare site of spread. It is extremely unusual for lung cancer to present primarily with features of choroidal involvement before any respiratory symptoms are manifest.Case Report: A 53 year old lady presented with protrusion of the left eye followed by sudden unilateral painless loss of vision one month later. She was diagnosed to have a left retinal detachment due to a choroidal mass in the left eye. Enucleation was done and showed a metastatic carcinoma of unknown primary. Immunohistochemistry was suggestive of adenocarcinoma with primary in the lung. She had a right mid-lobe lesion for which biopsy was attempted but failed. She also had multiple skeletal metastases and small lesions in the liver. Mutation analysis on the enucleation specimen was positive for exon 19 mutation of EGFR gene and she was started on single agent oral gefitinib 250mg daily and bisphosphonates. Reassessment done 3 months showed reduction in the size of the primary lung lesion with resolution of the liver lesions. Skeletal lesions remained the same.Conclusion: This case of choroidal metastasis presenting with retinal detachment demonstrates a very rare initial presentation of adenocarcinoma of the lung and highlights the need to look for a primary in the lung in cases of choroidal metastasis