Shields J A, Shields C L, Eagle R C, Gündüz K, Lin B
Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Ophthalmic Surg Lasers. 1998 Jul;29(7):598-601.
A 68-year-old man with lung carcinoma and no systemic metastasis presented with a blind, painful right eye. Examination showed no perception of light in the affected eye, elevated intraocular pressure, marked epibulbar hyperemia, and a white placoid mass in the conjunctiva nasally. Although a cataract precluded a clear view of the fundus, ultrasonography disclosed a total retinal detachment and a diffuse thickening of the choroid. Metastatic carcinoma was suspected clinically and the eye was enucleated because of severe, intractable pain. Pathologic examination demonstrated extensively necrotic metastatic adenocarcinoma involving the conjunctiva, peripheral cornea, sclera, iris, ciliary body, choroid, optic nerve, subarachnoid space, and orbit. Metastatic disease usually affects a singular ocular tissue, and it is highly unusual for such widespread ocular involvement to be the first sign of systemic metastasis from a primary neoplasm.
一名68岁的肺癌患者，无全身转移，出现右眼失明且疼痛。检查发现患眼无光感、眼压升高、眼球表面明显充血，鼻侧结膜有白色斑块状肿物。尽管白内障妨碍了对眼底的清晰观察，但超声检查显示视网膜完全脱离和脉络膜弥漫性增厚。临床怀疑为转移性癌，因疼痛剧烈且难以控制，遂行眼球摘除术。病理检查显示广泛坏死的转移性腺癌累及结膜、周边角膜、巩膜、虹膜、睫状体、脉络膜、视神经、蛛网膜下腔和眼眶。转移性疾病通常累及单一眼部组织，如此广泛的眼部受累作为原发性肿瘤全身转移的首发症状极为罕见。
