Intraocular metastasis from urothelial carcinoma : an unusua
The present case has been reported in BMJ. A 59-year-old woman with multiple sclerosis presented with blurred vision in the right eye, floaters and flashes of light for 2 weeks. She had right-sided optic neuritis which was treated 8 years prior. There was a 20 pack-year smoking history. Examination was remarkable for right-sided temporal field loss and a palpable breast lump.

Ophthalmological examination revealed right exudative retinal detachment, with ultrasonography demonstrating a choroidal mass with medium to high internal reflectivity. MRI was significant for a 14 mm intraocular metastasis. On further questioning, the patient described haematuria.

Urine cytology demonstrated large cells with high nuclear to cytoplasmic ratio, irregular nuclear borders and necrosis, all suggesting high-grade malignancy. Abdominal imaging revealed an ill-defined heterogeneously hypoenhancing infiltrative lesion of the right kidney within the mid and superior portions measuring 7.5×6.6×8.5 cm.

Biopsy of both the renal and breast masses confirmed urothelial carcinoma. Cells were immunoreactive for CK7, p63, GATA3 and uroplakin II and negative for CK20, PAX8, ER, PR and mammaglobin.

Learning points
• Choroidal metastasis presents as decreased visual acuity eventually progressing to retinal detachment. The patient will give a history of decreasing vision followed by flashers and floaters.

• Pre-existing eye disease is common with advancing age, however if the patient describes a history of haematuria, smoking, occupational exposure then further evaluation is warranted.

• If a choroidal lesion is found, the use of fine-needle aspiration is controversial, and a thorough search for a primary cancer should be undertaken.

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