|Year : 2022 | Volume
| Issue : 6 | Page : 739-746
Ocular metastasis of primary gynecological malignancies, a rare but not insignificant entity: A systematic review
DE Vlachos, N Thomakos, D Haidopoulos, V Pergialiotis, V Theodoulidis, A Protopapas, A Rodolakis
Gynecologic Oncology Unit, 1st Department of Obstetricsa and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
|Date of Submission||23-Aug-2021|
|Date of Acceptance||25-Mar-2022|
|Date of Web Publication||16-Jun-2022|
Dr. D E Vlachos
80 Leoforos Vasilisis Sofias Str, 11526, Athens
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The genital system remains one of the most common sites of carcinogenesis in women. Advances in surgery, radiation treatment, and chemotherapy have increased their efficacy and many patients survive for many years after their initial diagnosis. The eye is a rare site of metastasis from gynecological cancer due to its distant location from the genitalia. In this systematic review, we retrieved all case reports of patients with ocular metastasis from gynecological neoplasms. The demographic, clinical, and treatment characteristics were retrieved and analyzed. A total of 70 case reports were included. Forty-eight of these reports concerned patients with a known malignancy that recurred in the eye and in 22 patients' ocular symptomatology accompanied the initial diagnosis of the gynecologic malignancy. 73.9% of these patients exhibited concomitant metastasis to other organs. The mean disease-free interval was found at 25.7 months and mean survival time after the eye metastasis was 13.5 months. Refractory disease was identified as the most important risk factor associated with mortality. Because eye metastasis has such a dismal prognosis, all gynecologists who treat oncological patients should be highly suspicious for reported eye complaints.
Keywords: Eye, gynecological malignancies, metastasis, orbit
|How to cite this article:|
Vlachos D E, Thomakos N, Haidopoulos D, Pergialiotis V, Theodoulidis V, Protopapas A, Rodolakis A. Ocular metastasis of primary gynecological malignancies, a rare but not insignificant entity: A systematic review. Niger J Clin Pract 2022;25:739-46
|How to cite this URL:|
Vlachos D E, Thomakos N, Haidopoulos D, Pergialiotis V, Theodoulidis V, Protopapas A, Rodolakis A. Ocular metastasis of primary gynecological malignancies, a rare but not insignificant entity: A systematic review. Niger J Clin Pract [serial online] 2022 [cited 2022 Jul 3];25:739-46. Available from: https://www.njcponline.com/text.asp?2022/25/6/739/347606
| Introduction|| |
According to the 2020 Global Cancer Observatory Annual Report, the genital tract is the second most frequent site of carcinogenesis in women with 1,398,601 newly diagnosed cases and 671,875 fatalities. Gynecological malignancies exhibit 3 patterns of spread: first, by local expansion to the adjuvant organs or the peritoneal cavity; second, by expansion to the locoregional lymph nodes; and third, by expansion via bloodstream to distal organs. The pattern of spread varies depending on the primary site of origin, the histological type, and the grade of a tumor. Hematogenous dissemination occurs frequently by poorly differentiated tumors in the liver, pleura, and lungs.
Ocular malignancies are rare, and the most common primary malignancies of the eye are uveal melanoma, vitreoretinal lymphoma, and rhabdomyosarcoma. Secondary malignant lesions to the orbit are more frequent than the primary. Two major surveys have reported that their incidence varies from 2%–7%, and they mainly originate from lung, breast, and prostate carcinomas. Choroidal metastasis is more common than the orbital (86% vs. 12%, respectively). The reported median survival after the identification of eye metastasis is 6.5 months.
In the international literature, there are sporadic case reports (CRs) and literature reviews on the metastasis of gynecological cancer to the eye. This paper represents a comprehensive systematic review of the literature presenting data regarding the dissemination of gynecological malignancies to the eye to analyze the patterns of the disease.
| Materials and Methods|| |
This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We performed an electronic database search for CRs of gynecological cancer patients (breast cancer patients excluded) who developed metastasis to the different anatomical parts of the eye and orbit. We searched PubMed using the terms “Eye,” “Uvea,” “Choroid,” “Iris,” “Ciliary Body,” “Retina,” “Sclera” and “Uterine Neoplasms,” “Endometrial Cancer,” “Endometrial Neoplasms,” “Cervical Cancer,” “Uterine Cervical Neoplasms,” “Ovarian Cancer,” “Ovarian Neoplasms,” “Choriocarcinoma,” and “Gestational Trophoblastic Neoplasia.” Scopus and Google Scholar were also searched using the same terms. All the articles that met or were presumed to meet the inclusion criteria were retrieved in full text. Also, the reference lists from the retrieved studies were utilized for retrieving similar reports. Full papers as well as abstracts were read [Figure 1].
We extracted the following data from the collected CRs: age, primary or recurrent disease, number of recurrences until eye metastasis, affected side (left, right, bilateral), ocular symptoms, pain, fundoscopic findings, ocular pressure, affected part of the eye, main symptom, duration of the disease before the diagnosis of eye metastasis, histological type, grade, concomitant metastasis to the brain or the spinal cord, histological type and grade, diagnostic test utilized for the diagnosis, fundoscopic findings, treatment utilized for the eye metastasis, response to treatment, chemotherapy scheme that was utilized, and survival after the diagnosis of ocular involvement. The main summary measure was the overall survival of the patients.
The clinicopathological characteristics of each case report were tabulated in a Microsoft® Excel spreadsheet. The results were expressed as mean values (SD) or as median values (interquartile range). Qualitative variables were expressed as absolute and relative frequencies. Life table analyses were used to calculate cumulative survival rate (standard errors) for specific time intervals. The prognostic value of each variable for survival was assessed by the log-rank test, as well as the Cox proportional hazards regression analysis. Kaplan–Meier survival estimates for events were graphed over the follow-up period. All reported P values are two-tailed. Statistical significance was set at P < 0.05, and all analyses were conducted using SPSS statistical software (version 27.0) on a standard IBM personal computer.
| Results|| |
In [Table 1] and [Table 2], the demographic and the clinical characteristics of the patients are presented. As shown, a total of 70 CRs published between the years 1959–2021 in America (42.9%), Asia (32.9%), Australia (1.4%), Europe (20%), Japan (1.4%), and South Korea (1.4%) were included in the present analysis, with the mean age of patients being equal to 47.7 years (SD = 16.1 years).,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Most of the studies (68.6%) examined recurrence of malignancy, and in most of the examined CRs, 71.1% was the first recurrence. Overall, 46.4% of the patients were diagnosed with metastatic cancer on their left eye, and 39.1% of patients on the right eye. Choroid (54.3%) was the most frequent part of the eye diagnosed with metastatic cancer. Regarding the symptoms, loss of vision was reported in 35% and pain in 32.9% of the patients. Furthermore, 40.5% of the patients had impaired ocular movement, 47.3% of the patients had retinal detachment, 47.8% of the patients were diagnosed with elevated ocular pressure on the right eye, while 76.9% of the patients were diagnosed with elevated ocular pressure on their left eye.
As depicted in [Table 3] and [Table 4], 72.5% of the patients were diagnosed primarily at stage 4, and 66.7% of the patients were diagnosed with a grade 3 malignancy. Concomitant metastasis occurred in 73.9% of the patients, and the most frequent site was the lungs (47, 14%). As far as the response of the eye metastasis to the applied treatment, 58.8% of the patients presented complete response and 26.5% of the patients presented partial response; 43.2% and 29.7% of the patients presented complete and partial response, respectively. Ocular symptoms were predominant on 76.5% of the patients, while it was the initial symptom of recurrence on 60.9% of patients.
[Figure 2] and [Figure 3] summarize the overall survival, both in the total sample and the subgroups according to the type of disease and the diagnosis of another metastasis. During the follow-up period, 37/47 of the patients died (78.7%), and the mean survival time in the total sample was 13.5 months (95% CI = 8.2–18.9 months). No significant difference was observed according to the type of disease (P = 0.834) and the diagnosis of other metastasis (P = 0.285). Patients with refractory disease had 8.37 times greater hazard as compared to those with complete response, while the progression-free survival, stage, and grade were not found to be significantly associated with survival. The cumulative survival rate for the first 6 months was 38% (SE = 7.0%), for 1 year 31% (SE = 7.0%), for 2 years 25% (SE = 7.0%), and for 3 years 16% (SE = 7.0%) [Figure 2].
|Figure 3: Kaplan Meier curve of overall survival associated with the type of disease|
Click here to view
Twenty-four patients were diagnosed with ocular metastasis from malignancies of the uterine cervix. The median age of the patients was 48 years, and the most common histological type was squamous cell carcinoma (16/24 CRs). Most metastases were located at the orbit of the eye (14/24), followed by the choroid (8/124), and both sides were equally affected. Interestingly, in 8 patients, the eye symptoms were the initial symptoms of the disease. In the rest 16, the median disease interval was 24.88 months (range: 6–120 months). Fourteen patients with eye metastases showed metastases to other sites, primary to the lung and secondary to the paraaortic and supraclavicular lymph nodes. The median overall survival was 5.56 months.
Fifteen CRs concerning ovarian cancer patients were obtained during our literature review. Fourteen cases of epithelial ovarian cancer patients and 1 case of ovarian choriocarcinoma were included. The median age was 52.13 years (range: 28–80 years). Four of the cases had ocular metastases at the time of their primary diagnosis. In the 11 patients with recurrent ovarian cancer, the median interval from primary diagnosis to developing eye metastasis was 36.42 months (range: 8–120 months), and it developed during their first recurrence in the majority of the cases (7/11). The left eye was mostly affected (7/14 CRs). The choroid plexus was affected in 12/15 cases, and in the rest of the cases, the orbit was affected. Concomitant metastasis was found in 12 cases, mostly the lungs (5/12). Median survival after the diagnosis of the ocular metastasis was 14 months (range: 1–48 months).
We retrieved 14 CRs reporting metastases on endometrial carcinoma patients. The median age was 59.64 years (range: 31–87 years), and in most cases, the right eye was affected (8/14). Three CRs concerned newly diagnosed patients, and in 2 of the cases, the eye symptomatology was the initial symptom. Median duration of recurrence was 29.6 months (range: 3–108 months). In two CRs, the metastases affected the orbit and the retina, and in 7 CRs, the uvea was affected. No special predilection to the histological subtype was observed. The mean survival time after diagnosis of eye metastasis was 2 months.
Interestingly, 14 CRs of choriocarcinoma patients were retrieved. The patients had a mean age of 3 years (range: 17–43 years). In half of the CRs (7/14), eye metastasis was concomitantly diagnosed with the initial diagnosis of the primary disease. In recurrent cases, the relapse was diagnosed after a median of 17 months (range: 12–120 months). Choroid plexus was the most commonly affected site (13/14), and lungs (13/14) was the most common site of concomitant metastasis.
We retrieved 3 CRs of uterine sarcomas patients, involving 2 leiomyosarcoma and 1 low-grade endometrial stromal sarcoma patient. Median age was 57 years (range: 46–63 years). Two cases of orbital and 1 of choroidal metastasis were identified in the context of recurrence.
| Discussion|| |
The eye is a complex sensory organ that is composed of three layers: the corneoscleral coat, the uvea, and the retina. The cornea and sclera form the hard outer cover of the eye. The retina is the neurosensory layer of the eye responsible for eyesight, while the uvea consists mainly the choroid, i.e., the vascular layer responsible for the blood supply of the eye. The choroid plexus is created by the extensive branching of the retinal vessels after they penetrate the eyeball with the optic nerve.
Contrary to the orbit, the eye is devoid of lymphatic channels, and ocular metastatic lesions are of hematogenous spread., As with brain metastasis, the tight capillary network of the choroid plexus decelerates blood flow, thus, facilitating the implantation of circulating tumor cells. Macula and the paramacular area exhibit the densest capillary network of the retina, which explains the higher rates of metastasis in these regions. Iris metastasis is the most uncommon with reported rate of 7.8%, while the orbit and optical nerve are affected in 12.3% and 1.3% cases, respectively.
In our review, most of the cancer types had a predilection of metastasis to the choroid plexus, except cervical cancer. In our study, 38/70 (54.3%) of patients developed choroidal metastasis. Choriocarcinoma patients exhibited the biggest predilection in creating choroidal lesions. Although gestational trophoblastic neoplasia is a rare malignancy, we retrieved 14 relevant CRs. In all of the cases, there are multiple organs affected. This indicates the potential capability of these tumors for hematogenous dissemination. Interestingly, 14/24 (58.3%) cervical cancer patients developed orbital metastasis. We estimate that this is due to the enhanced intratumoral lymphangiogenesis of squamous cell carcinomas.
The symptoms of the affected patients depend on the location of the tumor and progress rapidly due to the fine histologic elements of the oculus and the orbital confined space. The patients usually complain of impaired vision, restriction of the visual field, and proptosis. The development of the tumor inside the retina can cause detachment of the retina and optic neuropathy. The development of a tumor inside the orbit can cause motility problems to the eye or even exophthalmos. Occlusion of the cilioretinal artery from metastatic tumor conglomerates can also lead to decreased vision or blindness. In our literature review, the most common symptom was partial or complete loss of vision; pain was referred only in 9 cases and proptosis in 6 cases.
The diagnosis of an ocular malignancy can be accomplished with several methods. Fundus photography helps to cartograph the lesions and measure their sizes. Ultrasound can measure the dimensions of a tumor and also differentiate between primary and secondary lesions based on the unique sonographic characteristics. Computed tomography (CT) can be utilized for the depiction of the eye and brain, while ocular computed tomography (OCT) creates cross-sectional images of the retina and can visualize the borders of the tumor as well as retinal disturbance. Lastly, magnetic resonance imaging (MRI) can be utilized, especially in cases of inadequate fundoscopy (e.g., cataract) and positron emission tomography to locate the primary tumor source and multvisceral involvement. In our literature review, CT was utilized in 24 cases, while MRI in 20 cases. Fluorescein angiography was also implemented in 10 cases to localize the lesion.
Biopsy of the tumor largely depends on the location of the lesion and can be accomplished either with fine needle biopsy or with surgical excision of the lesion. In our review, we found that, in 43/70 cases, biopsy could not be obtained. This is probably due to the distinctive imaging characteristics that malignant tumors exhibit in the eye and the fact that, in most of these cases (30/43), there was concomitant metastasis to other organs.
The treatment of these patients is modulated according to their findings. In 59 patients, multivisceral metastasis was diagnosed. Treatment of the ocular lesion is usually by means of radiation therapy or excision of the tumor or enucleation. In our review, most cases received radiation therapy (60/70) with or without chemotherapy (6/70). Fifteen patients received only chemotherapy due to the extent of their disease or the chemosensitivity of the tumors (9/15 patients with GTN). Ten patients underwent surgery. Ten patients were operated primarily, while 1 patient was operated due to failure of the other treatments.
The prognosis of the ocular metastases is dismal. Jeddi et al. reported that the mean life expectancy was 6.5 months. In our review, the mean survival time was 13.5 months. In 59 of our 70 retrieved cases, ocular metastasis was accompanied with metastasis to other organs too, especially lungs (32/70). This finding is anticipated because circulating tumor cells would reach the pulmonary circulation before reaching the eyes. Interestingly, we found only 9 CRs with brain metastases. The disease with the lowest mortality rate was ovarian cancer with a median survival of 16 months. The cases with the longest survival after the diagnosis of the ocular metastasis are patients suffering from choriocarcinoma. From our findings, it is obvious that patients with chemosensitive disease have longer survival intervals.
| Conclusion|| |
Gynecological malignancies have a high burden in our society. Because our population is constantly growing older and life expectancy is rising, it is expected that gynecological cancer cases will increase. Modern treatment modalities have improved the survival rates of oncologic patients, and rare sites of distant metastasis have become more frequent. It is crucial that oncologists treating gynecologic cancer patients be vigilant during their follow-ups because eye metastasis foreshadows an ominous clinical course. To date, risk factors of ocular metastases have not been discovered. However, it should be noted that given their rarity, it is important to establish a prospective international registry, which will help determine prognostic factors of survival.
Strengths and limitations
Our study summarizes for the first-time tumor characteristics and survival rates of patients with ocular metastases from gynecological tumors. Direct implications for clinical practice are impossible due to the high possibility of selection bias; however, it should be noticed that ocular metastases, even as single site lesions, are associated with dismal prognosis, thus, indicating the need for aggressive patient management.
D.-E.V.: Guarantor, Data collection, drafting of the manuscript; N.T.: conception and design, data interpretation; DH critical revision of the manuscript; V.P.: acquisition and data, analysis and interpretation of data, statistical analysis; V.T.: Data collection and statistical analysis; A.P.L: data analysis, data interpretation; A.R.: conception and design, critical revision of the manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Nagarkatti-Gude N, Wang Y, Ali MJ, Honavar SG, Jager MJ, Chan C-C. Genetics of primary intraocular tumors. Ocul Immunol Inflamm 2012;20:244-54.
Shields JA, Shields CL. Intraocular Tumors: A Text and Atlas. 4th
ed. WB Saunders; 1992.
Amemiya T, Hayashida H, Dake Y. Metastatic orbital tumors in Japan: A review of the literature. Ophthalmic Epidemiol 2009;9:35-47.
Barondes MJ, Hamilton AM, Hungerford J, Rustin GJ. Treatment of choroidal metastasis from choriocarcinoma. Case report. Arch Ophthalmol 1989;107:796-8.
McCulley TJ, Yip CC, Bullock JD, Warwar RE, Hood DL. Cervical carcinoma metastatic to the orbit. Ophthalmic Plast Reconstr Surg 2002;18:385-7.
Wadhwani M, Phuljhele S, Kumar R, Shameer A. Cervical carcinoma leading to orbital apex syndrome and blindness. BMJ Case Rep 2019;12:e226587.
Smith SH, Arudra SKC, Mullen MM, Palisoul M, Dahiya S, Kumar Rao P, et al
. A rare case of endometrial cancer metastatic to the uveal choroid. Gynecol Oncol Rep 2018;23:24-7.
Kodama M, Kawaguchi H, Komoto Y, Takemura M. Coexistent intramedullary spinal cord and choroidal metastases in ovarian cancer. J Obstet Gynaecol Res 2010;36:199-203.
Singh RP, Tullis S, Hatton M, Rubin PA. Orbital metastasis from ovarian carcinoma in a patient with BRCA-2 mutation. Ophthalmic Plast Reconstr Surg 2006;22:298-9.
Sareen P, Blandon RE, Binder NR, Wallace DL. Metastasis of squamous cell cervical carcinoma to the orbit of the eye. Gynecol Oncol Case Rep 2012;2:83-6.
Nair AG, Asnani HT, Mehta VC, Mehta SV, Pathak RS. Metastatic adenocarcinoma of the cervix presenting as a choroidal mass: A case report and review of literature of cervical metastases to the eye. Indian J Ophthalmol 2015;63:674-8.
] [Full text]
Krohn-Hansen D, Strom EH, Charles SJ, Bakken KE. Carcinoma of the ovary with primary presentation in the choroid. Acta Ophthalmol Scand 1999;77:713-6.
Ghourab SA, Abu el-Asrar AM. Bilateral choroidal metastases as the first sign of metastatic gestational choriocarcinoma. Eye (Lond) 1999;13:697-9.
Flam F, Kock E. Metastatic choroidal choriocarcinoma. Acta Obstet Gynecol Scand 1996;75:688-9.
Inoue K, Numaga J, Kaji Y, Toda J, Kato S, Sakurai M, et al
. Bilateral choroidal metastases secondary to uterocervical carcinoma of the squamous cell type. Am J Ophthalmol 2000;130:682-4.
Pham Lagler CN, Siracuse-Lee DE. Metastatic choriocarcinoma to the choroid with concurrent optic nerve involvement: A case report and review of the literature. Retin Cases Brief Rep 2012;6:313-6.
Ahamed NA, Sait K, Anfnan N, Farwan K, Nizamuddin SH, Baeesa SS. Gestational choriocarcinoma presenting with lacrimal gland metastasis: A first reported case. Case Rep Obstet Gynecol 2015;2015:879538.
Garcia Vasquez A, Thomassiny Bautista G, Sarda Ramirez MJ, Moheno Lozano JA, Solorzano Enriquez O, de la Rosa Jaime E. Choroid metastasis in a patient with squamous cell carcinoma of the uterine cervix: A case report. Case Rep Ophthalmol 2020;11:630-8.
Su GW, Hong SH. Leiomyosarcoma of the uterus with sphenoid bone and orbital metastases. Ophthalmic Plast Reconstr Surg 2007;23:428-30.
Hertzanu Y, Vellet AD, Fain BA, Ferreira MM, Ninin DT. Eye metastases in carcinoma of the cervix. A case report. S Afr Med J 1987;71:53-4.
Anjana S, Rekha S, Rathinam SR. Metastatic carcinoma masquerading as lens matter. Indian J Ophthalmol 2019;67:2046-7.
] [Full text]
Carle MV, Boyer DS. A new choroidal mass in a patient with known metastatic leiomyosarcoma: Importance of fine-needle aspirate biopsy in diagnostic certainty and treatment planning. Retin Cases Brief Rep 2014;8:292-4.
Ino K, Mitsui T, Nomura S, Kikkawa F, Mizutani S. Complete remission of gestational choriocarcinoma with choroidal metastasis treated with systemic chemotherapy alone: Case report and review of literature. Gynecol Oncol 2001;83:601-4.
Lee HM, Choo CT, Poh WT. Orbital metastasis from carcinoma of cervix. Br J Ophthalmol 1997;81:330-1.
Uhrinak AN, Tierney KE, Duncun KL, Matsuo K. Intraocular metastasis from primary cervical cancer: A case report and review of the literature. Gynecol Oncol Rep 2015;12:61-3.
Hazan A, Katz MS, Leder H, Blace N, Szlechter M. Choroidal metastases of choriocarcinoma. Retin Cases Brief Rep 2014;8:95-6.
Aswani Y, Thakkar H, Hira P. Disseminated gestational choriocarcinoma presenting with hepatic and uveal metastases, hook effect, and choriocarcinoma syndrome. Indian J Radiol Imaging 2016;26:482-6.
] [Full text]
Keates RH, Billig SL. Metastatic uveal choriocarcinoma. Report of a case with improvement after chemotherapy. Arch Ophthalmol 1970;84:381-4.
Lawrence SD, Netland PA, Morris WR, Smiley L, Wilson MW. Uterine papillary serous carcinoma metastatic to the choroid. Retin Cases Brief Rep 2010;4:62-4.
Seker MM, Uslu AU, Ozer H, Seker A, Kacan T, Babacan N, et al
. Orbital metastasis of endocervical stromal sarcoma: A rare tumor and an uncommon metastasis. Prz Menopauzalny 2014;13:356-8.
Hauksson A, Bynke H, Trope C. A serious ovarian cystadenocarcinoma metastatic to both eyes. Acta Obstet Gynecol Scand 1987;66:187-8.
Dhrami-Gavazi E, Lo C, Patel P, Galic V, Pareja F, Kazim M. Gestational choriocarcinoma metastasis to the extraocular muscle: A case report. Ophthalmic Plast Reconstr Surg 2014;30:e75-7.
Akahira J, Konno R, Ito K, Sato S, Yajima A. Choroidal metastasis presented as the initial symptom of the recurrence from ovarian endometrioid adenocarcinoma: A case report. Gynecol Oncol 2000;77:219-21.
Malviya VK, Blessed W, Lawrence WD, Deppe G. Retroorbital metastases in ovarian cancer. Gynecol Oncol 1989;35:120-3.
Kim JE, Lee AC. Choroidal metastases from a primary ovarian mucinous cystadenocarcinoma. Retina 2003;23:240-2.
Gangadharan VP, Prakash NP, Chitrathara K, Sasidharan K, Ramachandran K. Ocular metastasis of choriocarcinoma. Br J Radiol 1999;72:1216-7.
Saxena S, Jain A, Ramindar Sharma S, Meyer CH. Three-dimensional spectral domain optical coherence tomography of retina in choroidal metastasis due to uterine endometrial carcinoma. BMJ Case Rep 2012;2012:bcr2012006599. doi: 10.1136/bcr-2012-006599
Spraul CW, Grossniklaus HE, Giles JT. Mullerian mixed tumor metastatic to the iris and ciliary body. Arch Ophthalmol 1997;115:122-3.
Mendia A, Shah CP, Grajo JR, Yachnis A, Yeung A, Cardenas-Goicoechea J, et al
. Orbital metastasis of squamous cell cervical cancer: A case report and review of literature. Gynecol Oncol Rep 2021;35:100689.
Frank KW, Sugar HS, Sherman AI, Beckman H, Thoms S. Anterior segment metastases from an ovarian choriocarcinoma. Am J Ophthalmol 1979;87:778-82.
Kushner DM, Zak RD, Lurain JR, Fishman DA. Ovarian carcinoma metastatic to the choroid of the eye. Gynecol Oncol 1997;65:517-9.
Walrath JD, Lelli GJ Jr, Engelbert M, Kazim M. Metastatic endometrial carcinoma resulting in orbital apex compression. Ophthalmic Plast Reconstr Surg 2007;23:250-1.
Theodossiadis P, Rouvas A, Nakopoulou L, Halvatziotis P, Magkou C, Vergados I. Epithelioid trophoblastic tumor. Ophthalmology 2007;114:1421.
Arthur A, Horo S, Balasubramanian DA, Peter J, Ram TS, Peter JV. Orbital metastasis of cervical carcinoma-Case report and review of literature. J Clin Diagn Res 2016;10:ND01-2.
Shibeeb O, Athanasiov P, Simon S, Gilhotra J. Cervical carcinoma manifesting as progressive bilateral visual loss. Case Rep Ophthalmol Med 2014;2014:757261.
Char DH, Moretto JC, Barakos JA. Cystic orbital metastasis from endometrial carcinoma. Orbit 2007;26:75-7.
Duke JR, Walsh FB. Metastatic carcinoma to the retina. Am J Ophthalmol 1959;47:44-8.
Kagusa H, Mizobuchi Y, Nakajima K, Fujihara T, Bando Y, Takagi Y. Metastatic tumor to the orbital cavity from a primary carcinoma of the uterine cervix: A case report. J Med Invest 2019;66:355-7.
Park TW, Theuerkauf I, Morakkabati N. Orbital metastases of unknown origin: HPV typing identifies the primary tumor. Acta Obstet Gynecol Scand 2005;84:702-4.
Nash S, Bartels H, Pemberton J. Metastatic cervical adenocarcinoma to the orbital subperiosteal space. Can J Ophthalmol 2017;52:e60-2.
Parija J. Vitreous humor metastasis in squamous cell carcinoma of cervix. Indian J Gynecol Oncol 2017;15:31.
Palled S, Nihanthy DS, Tiwari R, Goyal S. Unilateral isolated choroidal metastasis secondary to squamous cell carcinoma of uterine cervix. J Case Rep 2016;2:38-41.
Wiegel T, Kleineidam M, Schilling A. [Choroid metastasis in a patient with adenocarcinoma of the cervix. A case report]. Strahlenther Onkol 1995;171:539-42.
Thomakos N, Galaal K, Georgopoulos G, Nagaraju L, Hemming D, Naik R. Choroidal eye metastases from (recurrent) primary peritoneal carcinoma: Case report and review of the literature. Int Semin Surg Oncol 2009;6:3.
Conlon MR, Collyer RT, Joseph MG, Siebert LF. Metastatic choroidal choriocarcinoma: A clinicopathological study. Can J Ophthalmol 1991;26:321-4.
Kim YH, Park IK, Min GE, Jin KH, Shin JH. A case of orbital metastasis of uterine leiomyosarcoma with intracranial extension presenting with proptosis. Ophthalmic Plast Reconstr Surg 2016;32:e51-2.
Durán-Cruz M, Ramírez MA, Sánchez-López M. Choroidal metastasis in advanced adenosquamous endometrial cancer. Gac Mex Oncol 2019;18:56-9.
Kuo IC, Sambuelli RH, Bono J, Smith RJ, Reviglio VE. Progression of choroidal metastasis of ovarian serous cystoadenocarcinoma after intravitreal bevacizumab treatment. Rare Tumors 2013;5:e5.
Heerema A, Sudilovsky D. Mucinous adenocarcinoma of the ovary metastatic to the eye: Report of a case with diagnosis by fine needle aspiration biopsy. Acta Cytol 2001;45:789-93.
Gosslee JM, Misra RP, Langford MP, Vekovius B, Byrd WA, Flynn SB. Orbital metastasis of keratinizing squamous cell cervical carcinoma with giant cells. A case report. Int Ophthalmol 2009;29:39-44.
Kurosawa A, Sawaguchi S. Iris metastasis from squamous cell carcinoma of the uterine cervix. Case report. Arch Ophthalmol 1987;105:618.
Vidyadevi M, Palaksha D. A rare case report of unilateral choroidal metastasis s econdary to cervical adenocarcinoma. J Evid Based Med Healthc 2015;2:1710-13.
Singh K, Kumar V, Bhasker S, Mohanti BK. Carcinoma cervix with metastasis to the orbit: A case report and review of literature. J Cancer Res Ther 2011;7:357-8.
Grendys EC, Tang RA, Gershenson DM. Choroidal metastasis from primary ovarian carcinoma. Gynecol Oncol 1992;46:251-4.
Capeans C, Santos L, Sanchez-Salorio M, Forteza J. Iris metastasis from endometrial carcinoma. Am J Ophthalmol 1998;125:729-30.
Cormio G, Martino R, Loizzi V, Resta L, Selvaggi L. A rare case of choroidal metastasis presented after conservative management of endometrial cancer. Int J Gynecol Cancer 2006;16:2044-8.
Voykov B, Guenova E. Images in clinical medicine. Diagnostic finding in the iris. N Engl J Med 2009;361:e22.
Planten JT. Iridic metastasis of a uterine carcinoma. Ophthalmologica 1981;182:55-8.
Yoon A, Verma S, Birnbaum A. Exudative retinal detachment caused by metastatic choriocarcinoma to the choroid. J Emerg Med 2013;44:617-9.
Bomanji J, Glaholm J, Hungerford JL, Mather SJ, Granowska M, Britton KE, et al
. Radioimmunoscintigraphy of orbital metastases from ovarian carcinoma. Clin Nucl Med 1990;15:825-7.
Yoon KC, Oh HJ, Park SW, Lee KH, Lee JH. Bilateral iris metastasis from endometrial carcinoma. Jpn J Ophthalmol 2007;51:234-5.
Ortiz JM, Esterman B, Paulson J. Uterine cervical carcinoma metastasis to subconjunctival tissue. Arch Ophthalmol 1995;113:1362-3.
Tunio MA, AlAsiri M, Riaz K, Abdulmoniem R. Optic nerve metastasis from squamous cell carcinoma of the uterine cervix. J Coll Physicians Surg Pak 2015;25:694-5.
Kiel JW. The ocular circulation. Colloquium Series on Integrated Systems Physiology: From Molecule to Function 2011;3:1-81. doi: 10.4199/c00024ed1v01y201012isp012.
Bloch RS, Gartner S. The incidence of ocular metastatic carcinoma. Arch Ophthalmol 1971;85:673-5.
Eichler AF, Chung E, Kodack DP, Loeffler JS, Fukumura D, Jain RK. The biology of brain metastases-translation to new therapies. Nat Rev Clin Oncol 2011;8:344-56.
Takahashi Y, Kakizaki H. Orbital decompression for compressive optic neuropathy in patients with a metastatic orbital tumor from breast carcinoma. Orbit 2015;34:137-41.
Sobottka B, Kreissig I. Ultrasonography of metastases and melanomas of the choroid. Current opinion in ophthalmology Curr Opin Ophthalmol 1999;10:164-7.
Vishnevskia-Dai V, Zur D, Yaacobi S, Moroz I, Newman H, Neudorfer M. Optical coherence tomography: An adjunctive tool for differentiating between choroidal melanoma and metastasis. J Ophthalmol 2016;2016:9803547.
Kwee TC, Basu S, Cheng G, Alavi A. FDG PET/CT in carcinoma of unknown primary. Eur J Nucl Med Mol Imaging 2010;37:635-44.
Rusňák Š, Hecová L, Kasl Z, Sobotová M, Hauer L. Uveal melanoma biopsy. A review. Cesk Slov Oftalmol 2020;76:247-52.
Jeddi A, Bouguila H, Mezlini A, Daghfous F, Kaoueche M, Ben Ayed F, et al
. [Choroid metastases]. J Fr Ophtalmol 1994;17:657-63.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]