Choroid plexus tumors are uncommon brain tumors that primarily occur in children. Most of these tumors originate from the intraventricular area, and the most common clinicalpresentation is increased intracranial pressure. Dissemination through the cerebrospinal fluid space is the inevitable natural course of the disease. Here, we present 2 rare cases of adult choroid plexus carcinoma (CPC), each with distinct clinical presentation and progression. The first case was a 40-year-old male who presented with multiple intraventricular masses. After surgical biopsy, radiation and intrathecal chemotherapy failed to elicit any response. The patient progressed with spinal cord dissemination and expired 1 year later. The second case presented with visual disturbance, and brain MRI revealed a large ovoid juxtaventricular mass with peritumoral edema. This 49-year-old female patient underwent craniotomy for what was thought to be a high-grade glioma; however, the mass was connected to the choroid plexus at the operative field. Her pathology specimen was diagnosed as CPC, and adjuvant systemic chemotherapy was administered. She has now been free of recurrence for 10 months. The description of the presentation and progression of these rare adult-onset CPC provides insight for the diagnosis and treatment of other rare instances of choroid plexus tumors.
Adult ; Biopsy ; Brain ; Brain Neoplasms ; Cerebrospinal Fluid ; Child ; Choroid Plexus Neoplasms ; Choroid Plexus ; Choroid ; Craniotomy ; Diagnosis ; Drug Therapy ; Edema ; Female ; Fourth Ventricle ; Glioma ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pathology ; Recurrence ; Spinal Cord

Metastatic tumors to the eye are probably the most common type of intraocular malignancies. The choroid is the most common site of involvement. Though the iris is a less common site of uveal involvement, metastases to the iris may occur and may produce a variety of clinical findings. The most common metastatic tumor to the eye is breast tumor and lung tumor is second, whereas the prompt most common metastatic tumor to the iris is lung tumor and breast tumor is second. The iris lesion may be the first presentation of the cancer and should make a search for the primary tumor. The diagnosis of metastatic tumor to the iris can be established by cytologic examination of aqueous. Local irradiation can spare the patient an enucleation and can preserve the eye for the generally few months of life that remain. Although the prognosis for vision is usually good, the prognosis for life is poor. The authors describe a 37 year old male patient having a metastasis from oat cell carcinoma of the lung to iris, which begins to respond to chemotherapy.
Adult ; Breast Neoplasms ; Carcinoma, Bronchogenic* ; Carcinoma, Small Cell ; Choroid ; Diagnosis ; Drug Therapy* ; Humans ; Iris* ; Lung ; Male ; Neoplasm Metastasis ; Prognosis

Gastric cancer with double metastasis to the orbit and duodenum is extremely rare. We report the case of a patient with gastric adenocarcinoma who presented with synchronous orbital and duodenal metastases at the time of initial diagnosis. A 60-year-old man presented with a 1-month history of visual disorder and pain in his right eye. He underwent ophthalmological examinations. The biopsy results suggested intraocular metastatic carcinoma. We conducted a systemic evaluation to identify primary malignancy. Finally, a diagnosis of advanced gastric adenocarcinoma with multi-organ metastasis was made. He planned to be treated with systemic chemotherapy.
Adenocarcinoma ; Biopsy ; Choroid ; Diagnosis ; Drug Therapy ; Duodenum ; Humans ; Middle Aged ; Neoplasm Metastasis ; Orbit ; Stomach Neoplasms ; Vision Disorders

PURPOSE: To report the first case of pigmented choroidal metastases without enucleation diagnosed with fine-needle aspiration biopsy. CASE SUMMARY: A 47-year-old male was referred to our clinic with a suspected diagnosis of choroidal melanoma in his left eye. Positron emission tomography-computer tomography used to evaluate systemic metastases revealed lung cancer. Pathology of the detected lung mass was primary lung neuroendocrine tumor. To differentiate choroidal metastasis and primary choroidal melanoma, we performed a fine-needle aspiration biopsy for choroidal tumors. The cytology showed results favoring metastatic atypical carcinoid and the patient was started on systemic chemotherapy. CONCLUSIONS: All pigmented choroidal tumors are not choroidal melanomas and choroidal metastases may be pigmented. The present case suggests that proper systemic evaluation and biopsy for suspected choroidal tumor could be helpful in diagnosis.
Biopsy ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Choroid* ; Diagnosis ; Drug Therapy ; Electrons ; Humans ; Lung ; Lung Neoplasms ; Male ; Melanoma* ; Middle Aged ; Neoplasm Metastasis* ; Neuroendocrine Tumors ; Pathology

We report 3 cases of circumscribed choroidal hemangioma (CCH) effectively managed with intravitreal bevacizumab. One patient (case 1) who had recurrent CCH (1.6 mm in thickness) with prior laser photocoagulation was treated with intravitreal bevacizumab alone. Two patients (case 2 and 3) who had CCH (2.4 mm and 2.2 mm in thickness, respectively) with recent visual impairment were treated with bevacizumab followed by photodynamic therapy (PDT). Ophthalmic evaluations included visual acuity, ophthalmoscopic examination, fluorescein angiography, ultrasonography, and optical coherence tomography. Patients were followed up for 6-9 months. After therapy, all patients showed improved visual acuity due to complete resorption of subretinal fluid and macular edema. Ultrasonography demonstrated a reduction of the thickness of CCH in case 1 and complete regression of the lesions in case 2 and 3. No patient showed tumor recurrence. Intravitreal bevacizumab, alone or in combination therapy with PDT, may be a useful alternative for the treatment of symptomatic CCH with subretinal fluid.
Angiogenesis Inhibitors/*administration & dosage ; Antibodies, Monoclonal/*administration & dosage ; Choroid Neoplasms/diagnosis/*drug therapy ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Hemangioma/diagnosis/*drug therapy ; Humans ; Injections ; Male ; Middle Aged ; Ophthalmoscopy ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factor A ; Vitreous Body

Breast cancer is the most common primary source of orbital metastasis. Metastasis occurs through hematogenous spread and predominantly involves the choroid. We present a case of a metastatic subconjunctival mass associated with primary breast cancer. To our knowledge, this is the first reported case of its kind. A 41-year-old woman presented with complaints of conjunctival injection and a foreign body sensation in the left eye. She had a history of breast cancer and had been treated 2 years previously with modified radical mastectomy followed by adjuvant radiotherapy and chemotherapy. Slit-lamp examination showed a cystic mass under the temporal bulbar conjunctiva, associated with dilated overlying conjunctival vessels. An excisional biopsy revealed a poorly differentiated adenocarcinoma. Positron emission tomography examination for systemic malignancy revealed multiple systemic metastasis. Metastatic disease should be considered in the differential diagnosis of subconjunctival lesions, and ophthalmic manifestations can play an important role in the detection of metastatic spread of a known primary breast cancer.
Adenocarcinoma ; Adult ; Biopsy ; Breast Neoplasms* ; Breast* ; Choroid ; Conjunctiva ; Conjunctival Neoplasms ; Diagnosis, Differential ; Drug Therapy ; Female ; Foreign Bodies ; Humans ; Mastectomy, Modified Radical ; Neoplasm Metastasis ; Orbit ; Positron-Emission Tomography ; Radiotherapy, Adjuvant ; Sensation

Tumors of the central nervous system are the second most frequent neoplasm in children. In a review of 43 children with brain tumor under the age of 16 evaluated at a pediatric and neurosurgical department at Severance Hospital Yonsei University during a 61/2 year period, following results were obtained. 1. All 43 cases were diagnosed by pathological examination as well as brain CT scan. The sex ratio of male and female was equal. The age distribution was highest between 13-14 year of age and 7% of them were under 1 year of age. 2. There was a small preponderance of infratentorial tumors (51%) over supratentoral tumors (49%). 3. Among 43 verified brain tumors by pathological examination, glioma represented 75%, of which astrocytoma was the commonest neoplasm being 19 cases (45%) and remainder were medulloblastoma 10 cases (23%), choroid plexus droglioma 2 cases (5%), ependymoma 1case (2%). The rest were craniopharyngioma 6 cases (14%), choroid plexus papilloma 1 case (2%), neuroblastoma 2 cases (5%), pineal teratoma 1 case (2%), melanotic neuroectodermal turmor 1 case (2%). 4. The most common symptom was headache occuring 63% of the patients followed by vomiting, motor weakness, visual disturbance, gait distrubance, mental disturbance and seizure in order of trequency. Neurological signs showed positive Babinski sign, papilledema, cerebellar sign, 6th nerve palsy and facial weakness. 5. Plain skull X-ray changes were noted in 26 out of the 43 cases (61%). Those were suture separation of skull noted 35% of tumors followed in frequency by increased digital marking, sella changes and calcification. 6. In brain CT scan studies, the most common abnormal finding was solid mass shadow followed by cystic mass shadow, solid and cystic mass shadow. After contrast infusion, diffuse enhancement was the most common features. 7. 27 cases were treated by operation only, 15 by operation and radiotherapy, 1 by operation, radiation and chemotherapy. 8. Progonsis of brain tumor was very poor. 5 of 43 cases died within 1 month of diagnosis, 1 year survival rate was 19%, and 2 year survival rate was 16%. The survival rate was better in the group of patients in whom total or subtotal resection combined with radiotherapy was performed. 53% of cases were not able to follow-up or discharged anainst advice without proper treatment.
Abducens Nerve Diseases ; Age Distribution ; Astrocytoma ; Brain Neoplasms* ; Brain* ; Central Nervous System ; Child* ; Choroid Plexus ; Craniopharyngioma ; Diagnosis ; Drug Therapy ; Ependymoma ; Female ; Follow-Up Studies ; Gait ; Glioma ; Headache ; Humans ; Infratentorial Neoplasms ; Male ; Medulloblastoma ; Neural Plate ; Neuroblastoma ; Papilledema ; Papilloma, Choroid Plexus ; Radiotherapy ; Reflex, Babinski ; Seizures ; Sex Ratio ; Skull ; Survival Rate ; Sutures ; Teratoma ; Tomography, X-Ray Computed ; Vomiting

Choroidal osteoma is a benign ossified tumor that is found predominantly in healthy young women during their second and third decades of life. The lesions are white-to-cream or orange in color, are located in the peripapillary and macular areas, and are unilateral in most patients. The symptoms of choroidal osteoma include decreased visual acuity and metamorphopsia or scotoma corresponding to the location of the osteoma, but some patients have no symptoms. Prognosis of vision varies according to tumor location, retinal pigment epithelial and sensory retinal degeneration, subretinal fluid and hemorrhage, and development of a subretinal neovascular membrane.
Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Choroid Neoplasms/*complications/diagnosis ; Choroidal Neovascularization/diagnosis/*drug therapy/etiology ; Female ; Fluorescein Angiography ; Humans ; Intravitreal Injections ; Middle Aged ; Osteoma/*complications/diagnosis ; Photochemotherapy/*methods ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity