Mushroom–Shaped Choroidal Metastases: Three Clinicopathologic Case Reports

Abstract

Abstract: : Purpose: To provide three clinicopathologic case reports of metastatic choroidal tumors that displayed mushroom–shaped configurations. These eyes, misdiagnosed clinically as choroidal melanomas because of the growth pattern of the tumor, were enucleated. Methods: Pathologic examination of the three enucleated globes. Results: Light microscopy of the mushroom–shaped choroidal tumor of an 85–year–old man showed a papillary arrangement of neoplastic cells, immunopositive for keratin (KAE 1–3) and prostatic specific antigen. The ocular tumor was histopathologically similar in appearance to that of the original prostate tumor. A pathologic diagnosis of prostatic adenocarcinoma metastatic to the choroid was made. In the case of the 54–year–old man, the mushroom–shaped tumor consisted of basophilic cells, immunopositive for Cam 5.2, KAE 1/3, and vimentin. A pathologic diagnosis of poorly–differentiated carcinoma with basaloid features, metastatic to the choroid, was made. Systemic evaluation resulted in the discovery of a primary esophageal basaloid squamous cell carcinoma consistent with patient's social risk factors ( heavy alcohol and tobacco abuse). The enucleated globe of a 72–year–old man contained a peripapillary mushroom–shaped choroidal mass. Histopathologly revealed neoplastic cells, immunopositive for thyroglobulin, TTF1 and CK–7, consistent with a diagnosis of metastatic thyroid carcinoma. Subsequent ultrasonography of the thyroid gland demonstrated a nodule in the right lobe and pulmonary metastases were detected on body CT. Conclusions: While mushroom–shaped choroidal masses are considered typical of melanomas, they may rarely represent a metastatic lesion. Since choroidal metastasis may be the presenting sign of a systemic malignancy, its proper diagnosis and differentiation from choroidal melanoma may lead to the discovery and initiation of therapy for the primary tumor. Choroidal metastases should be considered in patients with a history of systemic neoplasm, high risk factors for cancer, or in cases where the choroidal tumor shows sonographic or other clinical features atypical for melanoma.

Keywords: choroid • pathology: human • melanoma