A 26-year-old man was referred to the Jules-Gonin Eye Hospital with loss of vision and a non-pigmented tumour in his left eye. In the previous two weeks, he had been diagnosed with a left testicular tumour and multiple metastases to the lung, brain, cerebellum, kidney, liver and spine. Histopathology following left radical orchiectomy had revealed a non-seminomatous testicular choriocarcinoma, positive for β-human chorionic gonadotropin (β-HCG) and pancytokeratin, slightly positive for α-fetoprotein (AFP) while negative for carcino-embryonic antigen (CEA). Serum levels were for β-HCG 271 052 U/l (normal < 3.0 U/l)), for AFP 0.9 ng/ml (normal < 10 ng/ml) and for LDH 1757 U/l (normal < 450 U/l). He was receiving chemotherapy with bleomycin, etoposide and cisplatin.
Visual acuity was 6/6 in the right eye and counting fingers (CF) in the left eye. The left posterior fundus showed a large amelanotic choroidal tumour associated with a hemorrhagic retinal detachment. On B-scan ultrasonography, thickness was 7 mm. In the right inferior choroid, a second non pigmented, flat lesion was also present, compatible with a diagnosis of bilateral choroidal metastases (Figure ).
Figure 1 Panoramic fundus pictures: Choroidal metastases from testicular choriocarcinoma at presentation: RE (Right Eye): a non pigmented, flat lesion is discovered in the inferior choroid. LE (Left Eye): a large amelanotic tumour with associated hemorrhagic retinal (more ...)
Chemotherapy was continued, with a total of 4 cycles over 3 months' time. Additionally, a stereotactic radiotherapy of the spine and head was performed, the latter including the posterior part of both eyes, using two lateral accelerated photon fields of 6 MV with a total dose of 30.80 Gy in 14 fractions.
After four years' follow-up, the patient is in remission without any evidence of metastases. All tumour markers are within normal ranges (β-HCG < 0.1 U/l; AFP 1.2 ng/ml; LDH 284 U/l). Visual acuity is 6/6 in the right and 6/9 in the left eye, both fundi showing a flat chorioretinal scar (Figure ).
Panoramic fundus pictures: Four years after chemo- and radiotherapy, both lesions have become flat chorioretinal scars. Despite the unfavourable localisation of the left scar near the fovea, visual acuity has recovered to 6/9.