This document presents the case of a 57-year-old female who presented with sudden inferior vision loss in her right eye. Examination revealed an inferior field defect in the right eye and fundus photography showed a choroidal mass with exudative retinal detachment. Further workup revealed metastatic breast cancer involving the lungs, liver, bones, and brain. The patient was diagnosed with a choroidal metastasis from breast cancer. She received palliative whole brain radiation which provided some tumor shrinkage and stabilization of vision. Her prognosis remained poor given her age and characteristics of the choroidal lesion.

1. Michele Todman, MD November 3, 2009 Grand Rounds

4. Fundus Photography

5. Fundus Photography

6. FA 23 sec 34 sec 1:30 1:32 3.51 4.13

7. Ultrasound A-scan: Medium to high internal reflectivity B-scan: Acoustic solidarity

8. Differential Diagnosis?

9. A-scan: Low internal reflectivity with reduction in amplitude. High amplitude Spike = break in Bruch’s membrane. B-scan: Solid mass with mushroom shape

10. A-scan: High internal reflectivity B-scan: Highly reflective plate-like lesion with orbital shadowing beyond lesion FA can help distinguish if CNV

11. A-scan: High internal reflectivity B-scan: Solid elevated mass

12. B-scan: Thickening of the retina, choroid and sclera with fluid beneath Tenon’s capsule and squaring of optic nerve shadow

13. A-scan: Medium to high internal reflectivity B-scan: Acoustic solidarity

18. Primary Sites of Choroidal Mets Breast 1% Kidney <1% Others 4% Skin 1% Skin 4% GI 2% Prostate 6% Others 4% Kidney 6% Unknown 12% GI 9% Lung 12% Unknown 29% Breast 68% Lung 40% Females (N=287) Males (N=137)

22. Survival Rates for Uveal Mets from Breast CA

26. Before Radiation Therapy After completion of 18 day course of radiation therapy but prior to chemotherapy Mass slightly smaller with regularly arranged pigment clumping on tumor surface

27. Before radiation therapy After Radiation Therapy

30. Before radiation therapy After radiation therapy