Choroidal metastasis as late-onset of breast cancer

Metastases of breast cancer to the choroid are rare, but due to its vascular supply the choroid is the most common ocular site for intraocular metastatic disease. The majority of metastases originate from breast cancer in females and lung cancer in males. We present a case of a 73 year old woman with late distant recurrence eight years after primary diagnosis.

Patient concerns:

At the age of 65 years, the patient underwent neoadjuvant chemotherapy similar to NeoTEC study due to a hormone receptor positive, Her2 negative ductal invasive breast cancer. A subcutaneous mastectomy with axillary dissection was performed. Tumor stage after surgery: ypT2 (25 mm) ypN1a (2/17) cM0. Endocrine treatment was not specified. In 10/2018 she consulted her general practitioner due to bilateral amaurosis, starting in October 2018. Ophthalmological diagnostics and MRI imaging revealed suspicion for choroidal metastases. Retinal ablation was found with no evidence of brain metastases. Staging and a CT guided biopsy of the iliac crest proved bone lesions. Receptor status: ER: 12 PR: 0 Her2: positive.

Due to the tumor biology and receptor status chemotherapy was started with docetaxel, dual blockade of Her2 (CLEOPATRA) as well as radiation of both eyes and bone modifying therapy with denosumab. Follow up visits are pending.

Summary:

Choroidal metastases were the leading feature of the metastatic disease. This case indicates that even patients with hormone receptor positive breast cancer are likely to develop metastases beyond common sites. Also histological confirmation is necessary in case of tumor shift.