Unusual presentation of metastatic carcinoma to the eye

Purpose: To describe four patients with an unusual presentation of metastatic carcinoma to the eye, diagnosed by histopathologic and immunohistochemical evaluation of vitrectomy material. Methods: Retrospective case series of four patients with metastatic carcinoma to the retina/vitreous. The New York Eye and Ear Infirmary database was searched to identify patients with metastatic carcinoma to the retina or vitreous diagnosed from 1995 to 2006. Diagnoses were established through histopathologic and immunohistochemical evaluation of vitreous fluid obtained via pars plana vitrectomy. Results: The New York Eye and Ear Infirmary Pathology database search resulted in 19,149 vitrectomy specimens, 4 of which were positive for metastatic carcinoma. The diagnosis was clinically unsuspected in three patients. The oncologic work-up revealed the origin of metastases to be from the breast in two patients and from the lung in two patients. Conclusion: Metastatic carcinoma to the eye can present with clinically innocuous metastases, masquerading as epiretinal membrane and macular hole, central serous chorioretinopathy, rhegmatogenous retinal detachment, retinal granuloma, and endophthalmitis. These findings suggest that submission of vitrectomy specimens for pathologic evaluation should be considered in patients with an oncologic history or in those with atypical clinical presentation.