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J.Y. Choi, D.S. Bardenstein, J.S. Lewin, M.R. Levine; Ophthalmic Manifestations of Metastatic Prostate Carcinoma (MPC): Spectrum of Findings and Sources of Misdiagnosis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1589.
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Purpose: Prostate carcinoma is one of the 3 most common metastatic lesions to the eye and orbit but is still very rare. Its unique biologic properties, i.e. osteotropic metastasis and induced tissue changes, cause clinical and radiologic ophthalmic manifestations which can be mistaken for more common entities and lead to an unappreciatedly high rate of misdiagnosis. We present a series of MPC cases which demonstrates the broad spectrum of these manifestations and identify pitfalls in MPC diagnosis. Methods: Charts of Ocular Oncology Service (OOS) patients were retrospectively reviewed. Seven patients with MPC were identified. Clinical, radiologic and pathologic disease features were reviewed, and all radiologic studies were re-evaluated to identify the distribution of metastases. Results: Six patients with ophthalmic manifestations of MPC were identified. Two-thirds of patients were known to have prostate carcinoma. The spectrum of ophthalmic manifestations ranged from decreased vision due to choroidal masses, diplopia from mass effect, diplopia from extra-orbital cranial nerve palsy (CN 4 and 6), ptosis, exophthalmos, headache and visual loss from optic nerve compression. Half the patients were misdiagnosed initially by subspecialists. Misdiagnoses were radiologic (osteoblastic lesion misdiagnosed as meningioma) in 1/3 of these cases and clinical (ptosis misdiagnosed as Bell's palsy, diplopia as temporal arteritis) in 2/3. Correct diagnosis was made on the OOS, clinically in three cases and by fine needle aspiration biopsy in two. Visual outcomes ranged from no light perception to 20/25. Blindness was always associated with metastasis to the optic canal with optic nerve compression. Conclusion: MPC can cause a diverse array of ophthalmic manifestations. The same findings can result from both intra- and extra-orbital disease sites. While uncommon, recognition of these features of MPC, especially in patients with a history of prostate carcinoma, is critical for accurate diagnosis and effective treatment.
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