Choroidal Metastasis Secondary to Lung Adenocarcinoma with an EGFR Exon 20 Insertion Mutation: A Case Report
Year: 2026
Type: article
Study design: Case Report
Abstract: Background: Choroidal metastases are rare ocular manifestations of systemic malignancies and usually occur in the context of advanced disease. Lung cancer represents the second most common primary tumor responsible for ocular metastases after breast cancer. We report a case of symptomatic choroidal metastasis occurring in the setting of advanced lung adenocarcinoma with an uncommon EGFR exon 20 insertion mutation. Case Presentation: A 45-year-old never-smoker man presented with a two- month history of right cervical lymphadenopathy. Cervical lymph node excision revealed metastatic moderately differentiated adenocarcinoma with thyroid transcription factor-1 (TTF-1) positivity, supporting the pulmonary origin of the adenocarcinoma. Molecular analysis identified an EGFR exon 20 insertion mutation (Ex20Ins). Staging assessment demonstrated a right upper lobe pulmonary mass with mediastinal lymphadenopathy and metastatic involvement of cervical lymph nodes, bones, and the brain. One week later, the patient developed sudden visual acuity impairment, a nasal visual field defect, and intermittent photopsia in the right eye. Ophthalmological examination revealed an elevated yellowish- white choroidal lesion involving the posterior pole, associated with exudative retinal detachment. Optical coherence tomography confirmed an underlying choroidal mass with retinal pigment epithelium elevation and subretinal fluid, consistent with choroidal metastasis. Systemic treatment was initiated, but the patient experienced rapid clinical deterioration and died one month later due to progressive brain metastatic disease. Conclusion: Choroidal metastasis is an uncommon but significant ocular manifestation of metastatic lung cancer. Its occurrence generally reflects extensive systemic disease and may be associated with poor prognosis. Early ophthalmological evaluation in patients presenting with visual symptoms is essential for prompt diagnosis and appropriate management. Molecular characterization, including identification of rare EGFR alterations, may provide additional information for therapeutic decision-making in advanced non-small cell lung cancer.
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7202177504
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