Suspicious choroidal mass – an interdisciplinary challenge

Purpose To highlight the importance of interdisciplinary work up based on a patient with presumed choroidal metastatic of unknown primary tumor. Methods Clinical-pathological case report. Results A 57 year old woman was referred to our clinic because of a progressive vision loss in her right eye for seven days. Loss of vision field and light flashes followed 3 days later. General medical history was inconspicuous and last general check-up including gynaecologic examination performed by general practitioner was apparently normal. At first presentation, a yellowish choroidal mass in the inferior part of fundus was found clinically. Further diagnostic exams like ultrasound, OCT, fluorescence angiography and MRI of the orbit were suspicious for a choroidal metastasis of unknown primary tumor. An immediate interdisciplinary work-up with gynaecologists and oncologist was performed; histology of a punch biopsy of the left mammae confirmed the suspected finding of a multiple low differentiated invasive growing ductal carcinoma. Furthermore, metastasis of the lung and axillary lymph nodes were found. Because of the multiple metastases, a combined chemotherapy and radiation therapy was initiated. Conclusion Choroidal mass is indicative for metastasis which requires immediate interdisciplinary work-up even in the absence of a positive medical history. Since biopsy of the choroidal mass should not be performed, the diagnosis was made by the biopsy of the primary tumor, showing a metastasized aggressive breast tumor. Thanks to efficient interdisciplinary work up, local and systemic therapy saved vision in her right eye and best palliative care was offered.