Objective:To evaluate the clinicopathological features of uveal metastatic carcinoma.Methods:This retrospective study analyzed data from 52 patients diagnosed with uveal metastatic carcinoma at the Department of Pathology,Eye and ENT Hospital of Fudan University,between 2005 and 2023.Key variables analyzed included age,gender,history of systemic malignancy,ocular manifestations,imaging studies,histopathological morphologies,immunophenotypes,and survival outcomes.Results:The cohort consisted of 34 males and 18 females,aged 20 to 74 years(mean,55.8±12.6).Primary carcinomas originated from various sites,including the lung(27 cases),breast(7 cases),gastrointestinal tract(5 cases:3 in the stomach,2 in colon),kidney(4 cases),uterus(2 cases),and liver(1 case).The primary site was unknown in 6 patients.One patient exhibited no detectable primary cancer after systemic evaluation and a 61-month follow-up period.Ocular diagnosis preceded the diagnosis of systemic cancer in 22 cases(42％).The duration of symptoms ranged from 0.3 to 24 months(mean 3.0±4.0).For 14 patients with lung cancer,the interval between primary cancer diagnosis and uveal metastasis was 0.5 to 72 months(mean,13.0±17.5),and for 7 patients with breast cancer,it was 36 to 120 months(mean,68.6±37.1).Fifty patients underwent enucleation;one patient had orbital evisceration due to extensive orbital involvement.Another patient underwent evisceration due to Acanthamoeba keratitis and endophthalmitis,with occasional micrometastasis being observed histopathologically.The choroid was involved in 46 cases(32 involving the posterior pole),the ciliary body in 12 cases,and the iris in 9 cases.Decreased vision was reported by 49 patients,with best-corrected visual acuity below 20/400 in 39 patients and no light perception in 21.Ocular pain or headache was reported by 27 patients,and two were asymptomatic.Retinal detachment was noted in 44 cases,and secondary glaucoma in 24.Two patients presented with masquerade syndrome.B-scan ultrasonography was employed in 48 cases,revealing hollowing or choroidal excavation in 10 cases and a mushroom-shaped tumor in 3 cases.Among the 25 patients enrolled in our study,MRI examinations revealed that 16 patients exhibited varying degrees of tumor enhancement within their ocular lesion.Initial clinical diagnoses included intraocular metastasis(24 cases),uveal melanoma(14 cases),intraocular occupation(7 cases),choroidal hemangioma(1 case),and corneal ulcer with endophthalmitis(1 case).Histopathological and immunohistologic findings were consistent with the primary cancer in all patients for whom the primary sites was known.Specifically,the primary cancers included lung adenocarcinoma(20 cases),lung squamous carcinoma(4 cases),lung neuroendocrine tumors(3 cases),invasive breast ductal carcinoma(7 cases),clear cell renal cell carcinoma(4 cases),gastrointestinal adenocarcinoma(4 cases),gastric neuroendocrine carcinoma(1 case),endometrial cancer(1 case),choriocarcinoma(1 case),and liver cancer(1 case).For the 6 patients with unknown primary sites,the histopathological diagnosis was adenocarcinoma in all cases.Among patients with follow-up data,28 ultimately succumbed to systemic metastases.The survival times ranged from 5 to 104 months(mean,19.3±20.1).Conclusions:The lung is the most common origin of uveal metastases,followed by the breast,gastrointestinal tract,and kidney.The choroid is the most frequently involved site in the eye.Ocular diagnosis may occasionally precede the detection of systemic cancer.The primary cancer remains unidentified in some cases.The nonspecific clinical and radiological characteristics can lead to misdiagnosis.Overall,the prognosis for patients with uveal metastasis is poor.
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