Choroidal Metastasis Differs in Patients from Mexico

In Patients with choroidal metastasis who are from Mexico, both the primary cancer sites and clinical features differ from other studied populations, according to research published in Clinical Ophthalmology. These differences should be taken into account when evaluating Mexican patients living abroad, investigators reported. 

Researchers conducted a retrospective, observational, multi-center study using data collected from 6 ophthalmology hospitals in Mexico. Medical records of adults with choroidal metastasis diagnosed between 2000 and 2018 were reviewed. 

The study cohort included 78 patients (55.1% women; mean age, 57.6 years) with choroidal metastasis. Primary cancer sites included breast, lung, gastrointestinal, renal, testicular, ovarian, prostate, and thyroid., In 8 cases, the primary cancer site was unknown. By age, the oldest patients had breast, lung carcinoid, and gastrointestinal tract cancers; the youngest patients had testicular, breast, and gastrointestinal tract cancers. 

Primary cancer sites and clinical features of choroidal metastasis in Mexican patients show similarities and differences from other populations, the study found. Although breast and lung are the predominant sites in this population, the research shows a higher proportion of gastrointestinal and renal cancer, as well as a higher incidence of ovarian and testicular cancer in comparison with other studies.

Solitary lesions were found in 71.7% of patients; 28.2% presented with multiple lesions. When segmented by primary cancer type, solitary lesions were predominant in all groups except testicular cancer. Unilateral metastasis was most common (70.5% of patients), with cancer type segmentation indicating overall more unilateral lesions, except in testicular cancer. 

Records from 48 patients included a description of tumor color: 62.5% had white-creamy lesions, 25% had yellow lesions, and 12.5% had orange-red lesions. The most common symptoms at patient presentation were decreased visual acuity (79.4% of patients), floaters (11.5%), scotoma (5%), and pain (3.7%). Choroidal metastasis shapes were varied, and included dome, flat, round, spots, mushroom, multilobulated, and unilobulated. Location also varied, although most were found in the nasal posterior segment. 

Eight patients had choroidal metastases as their first manifestation of cancer. Median time between cancer diagnosis and choroidal metastasis diagnosis was 12 months (range, 1.25 months to 36 months). 

Study limitations include the retrospective nature of the analysis, and the availability of a limited amount of “sometimes incomplete” data. Additionally, most patients were lost to follow-up, which prevented investigators from analyzing histopathology, treatments, and survival rates. In the future, larger, multinational surveys can help determine if these trends are generalizable to other similar populations. 

“[The] primary cancer sites and clinical features of choroidal metastasis in Mexican patients show important differences from other populations previously studied, mainly the presence of a higher proportion of gastrointestinal and renal cancer,” the research says. “These types of cancer, although not as common as breast or lung, need to be taken into account when studying Mexican patients living abroad.” 

Reference

Salcedo-Villanueva G, Medina-Andrade AA, Moreno-Paramo D, et al. Primary cancer sites and clinical features of choroidal metastasis in Mexican patients. Published online December 1, 2020. Clin Ophthalmol. doi: 10.2147/OPTH.S285250