A 60-year-old male presented with a mass in his left parotid gland. He was diagnosed with pleomorphic carcinoma. After radiation therapy, he developed loss of vision in his left eye. Examination revealed a choroidal mass in his left eye. PET scan showed uptake in the left parotid gland and left eye, indicating metastasis of the parotid cancer to the choroid of the eye. Although rare, this case demonstrates that choroidal metastasis should be considered in patients with a history of salivary gland tumors.

1. 194 Indian Journal of Cancer | January-March 2012 | Volume 49 | Issue 1194
Letter to
Editor
Metastasis in the choroid
due to parotid malignancy
Sir,
A 60-year-old male presented with a history of a
mass in the left parotid area since six months. On
examination a 3 x 6 cm hard mass was felt near the left
ear lobule with restricted mobility and skin involvement
[Figure 1]. Fine needle aspiration cytology reported
pleomorphic carcinoma [Figure 2]. Chest X-ray and
other routine investigations were normal but due to pre-
existing cardiac morbidity surgery was not considered
and he was treated with external radiotherapy.
Figure 1: Clinical picture
Figure 2: Microscopic picture - cytology
Figure 4: Ultrasonogram showing choroidal mass
After 10 fractions of radiotherapy on an Elekta Synergy
linear accelerator, the patient complained of progressive
loss of vision in his left eye. He was advised an
ophthalmic evaluation which revealed a decreased acuity
of vision to 6/24 when compared to the right eye 6/12
and an in-field defect on perimetry. Fundus examination
[Figure 3] showed a choroidal mass inferior to the disc
with overlying depigmentation and an adjacent pocket
of exudative retinal detachment which was confirmed on
B scan [Figure 4].
We then requested for a PET (Positron Emission
Tomography) scan which showed multiple sites of
uptake in the body including the left parotid gland
[Figure 5] and uveal part of the left eye [Figure 6]. The
patient was subsequently advised systemic chemotherapy.
Figure 3: Fundus examination of left eye
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2. 195Indian Journal of Cancer | January-March 2012 | Volume 49 | Issue 1 195
Letter to Editor
Figure 5: PET-CT showing uptake in primary
Choroidal [uveal] metastases are the most common site
of intraocular metastases.[1]
The incidence of choroidal
metastases from various primaries has been reported
before in various literatures. A study by Soysal HG
showed the incidence of uveal metastases from various
primary sites as follows: breast (47%), lung (21%),
gastrointestinal tract (4%), prostate (2%), kidney (2%),
skin (2%), and other cancers (4%). In 17% of cases
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DOI:
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Figure 6: PET-CT showing choroidal uptake
the primary site was never established.[2]
The incidence
of distant metastases in head and neck cancers and
especially in salivary gland tumors is relatively low
in comparison to other malignancies. However, their
presence heralds a poor prognosis.
Although extremely rare, the possibility of choroidal
metastases should be considered in a patient with a
history of salivary gland tumor.
Ray DS, Patro KC1
, Muralikrishna V2
Department of Radiation Oncology, Apollo Gleneagles Cancer
Hospital, Kolkata, 1
Departments Radiation Oncology, 2
Surgical
Oncology, Mahatma Gandhi Cancer Hospital and Research
Institute, Visakhapatnam, Andhra Pradesh, India
Correspondence to:
Dr. Deepak Shankar Ray, E-mail: deepaksray@hotmail.com
References
1. Soysal HG. Metastatic tumors of the uvea in 38 eyes. Can J
Ophthalmol 2007;42:832-5.
2. Shields CL, Shields JA, Gross NE, Schwartz GP, Lally SE. Survey of
520 uveal metastases. Ophthalmology 1997;104:1265-76.
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