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Case report
Iris metastasis from prostate carcinoma: A case report and review of the literature Métastase à l’iris d’un cancer de prostate : cas clinique et revue de la littérature V. Martin a , X. Cuenca a,∗ , S. Lopez a , A.-F. Albertini b , P. Lang a , J.-M. Simon a , C.-G. Hémery a , L. Feuvret a , J.-J. Mazeron a a b
Radiation Oncology, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l’Hôpital, 75651 Paris cedex 13, France Pathology Department, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l’Hôpital, 75651 Paris cedex 13, France
a r t i c l e
i n f o
Article history: Received 11 June 2014 Received in revised form 15 December 2014 Accepted 24 December 2014 Keywords: Prostate carcinoma Iris Metastasis Uveal tumor Radiation therapy
a b s t r a c t Despite the high incidence of prostate carcinoma, metastases of the uvea are very rare and the iris localization is even more. Only a few cases worldwide have been described so far. We report here the case of a 66-year-old man diagnosed with a metastatic prostate carcinoma. Nine months later, he developed brain and skin metastases. A couple of weeks later, the metastatic lesion appeared on his left iris. He has received whole brain radiation therapy including the iris lesion in the radiation fields. Through this case report and a literature review, we discuss the incidence, the different clinical presentations and the impact on the survival prognosis of this uncommon metastatic site. © 2015 Published by Elsevier Masson SAS on behalf of the Société française de radiothérapie oncologique (SFRO).
r é s u m é Mots clés : Cancer de prostate Iris Métastase Tumeur uvéal Radiothérapie
Malgré l’incidence élevée du cancer de la prostate, les métastases à l’uvée sont très rares et la localisation à l’iris l’est encore plus. Seuls un petit nombre de cas dans le monde ont été décrits à ce jour. Nous rapportons ici le cas d’un homme de 66 ans chez qui le diagnostic de cancer de la prostate métastatique a été porté. Neuf mois plus tard, il a vu se développer des métastases cérébrales et de la peau. Quelques semaines plus tard, une lésion métastatique est apparue sur son iris gauche. Elle a été traitée par une irradiation de l’ensemble de l’encéphale incluant la lésion de l’iris. À travers ce cas et une revue de la littérature, nous discutons de l’incidence, les différentes présentations cliniques et l’impact sur la survie de ce site métastatique rare. © 2015 Publie´ par Elsevier Masson SAS pour la Société française de radiothérapie oncologique (SFRO).
1. Introduction Iris metastasis from carcinomas are very rare and represent 3% of all the lesions of the iris and 5 to 10% of uveal metastasis [1–3]. The predominant primary sites are breast and lung in women and gastrointestinal tract in men [4–8].
Prostate carcinoma is the most common cancer in French and American men, representing 36% of all men cancer [9]. The first metastatic site for prostate carcinoma, after lymph nodes, is bone. We report here the case of a 66-year-old man with an iris metastasis from his prostate carcinoma. Through this observation and a review of the literature, we discuss the epidemiology, the clinical presentations, and the prognosis of this exceptional lesion. 2. Case report
∗ Corresponding author. E-mail address: [email protected] (X. Cuenca).
A 66-year-old man was diagnosed with a prostate adenocarcinoma. The radiological staging of the tumour was T3bNxM1
http://dx.doi.org/10.1016/j.canrad.2014.12.008 1278-3218/© 2015 Published by Elsevier Masson SAS on behalf of the Société française de radiothérapie oncologique (SFRO).
Please cite this article in press as: Martin V, et al. Iris metastasis from prostate carcinoma: A case report and review of the literature. Cancer Radiother (2015), http://dx.doi.org/10.1016/j.canrad.2014.12.008
G Model CANRAD-3235; No. of Pages 3 2
ARTICLE IN PRESS V. Martin et al. / Cancer/Radiothérapie xxx (2015) xxx–xxx
The iris lesion decreased in size but did not disappear. The visual acuity was improved. The patient died of septical complications one month later. 3. Discussion
Fig. 1. Patient diagnosed with a metastatic prostate carcinoma: photography of his left eye showing the lesion on the iris. Patient atteint d’un cancer de la prostate métastatique : photographie de l’œil gauche montrant la lésion de l’iris.
according to the TNM classification. The PSA was 17 ng/ml and the Gleason score was 8 (3 + 5). He already had skeletal metastases on the lumbar vertebrae with a L3 epiduritis. The patient refused to undergo a laminectomy and therefore, received hormonal therapy. Nine months after the initial diagnosis, he received analgesic radiation therapy on L2 and L3 vertebrae (2 × 8 Gy) and haemostatic irradiation on the bladder (5 × 4 Gy). At the same time and while still under complete androgen blockade he developed skin and brain metastases. The biopsy and pathological analysis of the skin sites showed cells from prostate carcinoma with neuroendocrine differentiation. The patient then received chemotherapy (carboplatine AUC 5 and docetaxel 80 mg/m2 ). One week later, he complained of a blurred vision with intraocular discomfort and redness. The examination of his left eye showed a lesion on the iris (Fig. 1). It was a multinodular, 2 mm, milky white lesion. The ophthalmologic examination found a decreased visual acuity of the left eye 6/10◦ , no intraocular hypertension. The ophthalmoscopy was unrealizable because of an irido-lenticular synechia. The examination of the right eye was perfectly normal. Due to the presence of brain metastases, whole brain radiation therapy including the iris lesion was decided. The patient received 30 Gy in ten fractions (Fig. 2).
To our knowledge, less than ten cases of iris metastasis from prostate carcinoma have been described in the literature so far. At least 16 cases of prostate carcinoma metastatic to the choroid have been reported [10]. In a clinicopathologic series of 227 cases of carcinoma metastatic to the uvea, there were only two cases of choroidal metastasis from prostate cancer [11]. The predominant primary sites of the intraocular metastasis are breast and lung in women and gastrointestinal tract in men [4–8]. Although metastases from prostate carcinoma to the ocular area have been considered extremely rare, one study found prostate cancer to be the most common primary site of orbital metastasis in men, probably due to the affinity of metastatic prostate carcinoma for bone [12]. Intraocular metastases appear to be situated most of the time on the posterior uvea. Secondary lesions of the iris represent 5 to 10% of the uveal metastasis and 3% of all the lesions of the iris [1–3]. There is an anatomical explanation to the preferential situation of the metastasis in the posterior uvea. Tumour cells pass through the short posterior ciliary arteries that vascularize choroid rather than through the long posterior ciliary arteries or the anterior ciliary arteries that lead to the iris [13]. The average age at diagnosis for uveal metastasis is 66 years (range, 57–78 years). The average interval between the diagnosis of prostate carcinoma and uveal metastasis is 28 months (range, 0–67 months) [10]. In our case, this time was only 9 months. The most common symptoms are blurred vision (40 to 50%), redness of the eye (15%) as in our patient case, and intraocular pain (20–30%). However, some patients do not have any symptom (30%). Those manifestations are commonly due to a secondary glaucoma [2,10]. Glaucoma can be due either to a direct invasion of the filtration angle, or to its obstruction by tumour cells. The tumour can be visualized in only 10% of the cases. It looks like a nodular, white, light yellow or pink lesion. The shape is irregular in half the cases. The size of a metastasis of the iris, from any histological type, ranges from 1 to 12 mm. There are multiple lesions in 15% of the cases but they are exceptionally bilateral [1]. The standard method for diagnosis is fine-needle biopsy, which is positive in 88% of the cases [14]. The recommended treatment for uveal metastasis is radiation therapy, which can be externalbeam radiation therapy with photon, electron, or proton beams, or
Fig. 2. Patient diagnosed with a metastatic prostate carcinoma: planned beam and isodose value from the left eye and whole brain radiation therapy. Patient atteint d’un cancer de la prostate métastatique : champs d’irradiation et courbes isodoses du traitement de l’œil gauche et de l’encéphale en totalité.
Please cite this article in press as: Martin V, et al. Iris metastasis from prostate carcinoma: A case report and review of the literature. Cancer Radiother (2015), http://dx.doi.org/10.1016/j.canrad.2014.12.008
G Model CANRAD-3235; No. of Pages 3
ARTICLE IN PRESS V. Martin et al. / Cancer/Radiothérapie xxx (2015) xxx–xxx
episcleral plaque brachytherapy [15,16]. Indeed these tumours are very radiosensitive, and surgery alone appears to be insufficient [17]. The prognosis for patients with metastatic disease to the uvea generally is poor. Various series reported an overall median survival rate of 7.4 to 10.5 months from the time of ocular diagnosis [5,10,18]. In the De Potter et al. study, the average interval from the diagnosis of prostate carcinoma to death was 28 months (range, 7–57 months); the average interval from the diagnosis of uveal metastasis to death was 6 months (range, 3–9 months) [10]. For our patient, these times were respectively 10 and 1.5 months. 4. Conclusion Iris metastases are very rare and even more when they appear to come from a prostate carcinoma. They might be linked to undifferentiated cell types, including the neuroendocrine one, which is particularly invasive. The prognosis is generally poor, due to the aggressiveness of the global pathology. The gold standard for treatment is radiation therapy, including external-beam radiation therapy with photon, electron, or proton beams, or episcleral plaque brachytherapy. More case reports and studies are required to document the epidemiology and evaluate the therapeutic schemes of this exceptional lesion. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
3
[2] Shields JA, Shields CL, Kiratli H, De Potter P. Metastatic tumors to the iris in 40 patients. Am J Ophtalmol 1995;119:422–30. [3] Shields JA, Shields CL. Intraocular tumors: a text and atlas. Philadelphia, PA: WB Saunders; 1992. p. 208. [4] Shields JA, Shields CL. Metastatic tumors to the intraocular structures. In: Shields JA, Shields CL, editors. Intraocular tumors: a text and atlas. Philadelphia, PA: WB Saunders; 1992. p. 207–38. [5] Shields JA, Shakin EP, Shields CL. Metastatic malignant tumors. In: Gold DH, Weingeist TA, editors. The eye in systemic diseases. Philadelphia, PA: JB Lippincott; 1990. p. 299–303. [6] Shakin EP, Shields JA. The eye and ocular adnexa in systemic malignancy. In: Duane TD, editor. Duane’s clinical ophthlamology. Philadelphia, PA: JB Lippincott; 1989. p. 5. [7] Ferry AP, Font RL. Carcinoma metastatic to the eye and orbit. I. A clinicopathologic study of 227 cases. Arch Ophthlamol 1974;92:276.11–86.11. [8] Nelson CC, Hertzberg BS, Klintworth GK. A histopathologic study of 716 unselected eyes in patients with cancer at the time of death. Am J Ophthalmol 1983;95:728–33. [9] Guérin S, Hill C. [Cancer epidemiology in France in 2010, comparison with the USA]. Bull Cancer 2010;97:47–54. [10] De Potter P, Shields CL, Shields JA, Tardio DJ. Uveal metastasis from prostate carcinoma. Cancer 1993;71:2791–6. [11] Shields CL, Shields JA, Peggs M. Tumors metastatic to the orbit. Ophthalmol Plast Reconstr Surg 1988;4:73–80. [12] Ferry AP, Font RL. Carcinoma metastatic to the eye and orbit: a clinicopathologic study of 227 cases. Arch Ophthlamol 1974;92:276–86. [13] Zografos L. Les tumeurs intraoculaires. Rapport de la Société franc¸aise d’ophtalmologie. Paris: Masson; 2002. p. 389–92. [14] Char DH, Miller T, Kroll S. Orbital metastases: diagnosis and course. Br J Ophtalmol 1997;81:386–90. [15] Martin M, Zierhut D, Piroth M, Gutwein S, Debus J, Dithmar S. [Solitary iris metastasis from breast cancer. Effective local therapy with electron beam irradiation]. Ophtalmologe 2006;103:48–51. [16] Kreusel KM, Wiegel T, Stange M, Bornfeld N, Foerster MH. [Intraocular metastases of metastatic breast carcinoma in the women. Incidence, risk factors and therapy]. Ophtalmologe 2000;97:342–6. [17] Fuirichi S, Omori C, Nakayama T, Miyagi K, Hachisuka H, Kayama Y, et al. [Relapse of small cell carcinoma of the lung with metastasis to the iris]. Nihon Kokyuki Gakkai Zasshi 2000;38:417–20. [18] Hart WM. Metastatic carcinoma to the eye and orbit. Int Ophthalmol Clin 1962;2:465–82.
References [1] Weisenthal R, Brucker A, Lanciano R. Follicular thyroid cancer metastatic to the iris. Arch Ophthalmol 1989;107:484–5.
Please cite this article in press as: Martin V, et al. Iris metastasis from prostate carcinoma: A case report and review of the literature. Cancer Radiother (2015), http://dx.doi.org/10.1016/j.canrad.2014.12.008
ARTICLE IN PRESS Cancer/Radiothérapie xxx (2015) xxx–xxx
Disponible en ligne sur
ScienceDirect www.sciencedirect.com
Case report
Iris metastasis from prostate carcinoma: A case report and review of the literature Métastase à l’iris d’un cancer de prostate : cas clinique et revue de la littérature V. Martin a , X. Cuenca a,∗ , S. Lopez a , A.-F. Albertini b , P. Lang a , J.-M. Simon a , C.-G. Hémery a , L. Feuvret a , J.-J. Mazeron a a b
Radiation Oncology, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l’Hôpital, 75651 Paris cedex 13, France Pathology Department, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l’Hôpital, 75651 Paris cedex 13, France
a r t i c l e
i n f o
Article history: Received 11 June 2014 Received in revised form 15 December 2014 Accepted 24 December 2014 Keywords: Prostate carcinoma Iris Metastasis Uveal tumor Radiation therapy
a b s t r a c t Despite the high incidence of prostate carcinoma, metastases of the uvea are very rare and the iris localization is even more. Only a few cases worldwide have been described so far. We report here the case of a 66-year-old man diagnosed with a metastatic prostate carcinoma. Nine months later, he developed brain and skin metastases. A couple of weeks later, the metastatic lesion appeared on his left iris. He has received whole brain radiation therapy including the iris lesion in the radiation fields. Through this case report and a literature review, we discuss the incidence, the different clinical presentations and the impact on the survival prognosis of this uncommon metastatic site. © 2015 Published by Elsevier Masson SAS on behalf of the Société française de radiothérapie oncologique (SFRO).
r é s u m é Mots clés : Cancer de prostate Iris Métastase Tumeur uvéal Radiothérapie
Malgré l’incidence élevée du cancer de la prostate, les métastases à l’uvée sont très rares et la localisation à l’iris l’est encore plus. Seuls un petit nombre de cas dans le monde ont été décrits à ce jour. Nous rapportons ici le cas d’un homme de 66 ans chez qui le diagnostic de cancer de la prostate métastatique a été porté. Neuf mois plus tard, il a vu se développer des métastases cérébrales et de la peau. Quelques semaines plus tard, une lésion métastatique est apparue sur son iris gauche. Elle a été traitée par une irradiation de l’ensemble de l’encéphale incluant la lésion de l’iris. À travers ce cas et une revue de la littérature, nous discutons de l’incidence, les différentes présentations cliniques et l’impact sur la survie de ce site métastatique rare. © 2015 Publie´ par Elsevier Masson SAS pour la Société française de radiothérapie oncologique (SFRO).
1. Introduction Iris metastasis from carcinomas are very rare and represent 3% of all the lesions of the iris and 5 to 10% of uveal metastasis [1–3]. The predominant primary sites are breast and lung in women and gastrointestinal tract in men [4–8].
Prostate carcinoma is the most common cancer in French and American men, representing 36% of all men cancer [9]. The first metastatic site for prostate carcinoma, after lymph nodes, is bone. We report here the case of a 66-year-old man with an iris metastasis from his prostate carcinoma. Through this observation and a review of the literature, we discuss the epidemiology, the clinical presentations, and the prognosis of this exceptional lesion. 2. Case report
∗ Corresponding author. E-mail address: [email protected] (X. Cuenca).
A 66-year-old man was diagnosed with a prostate adenocarcinoma. The radiological staging of the tumour was T3bNxM1
http://dx.doi.org/10.1016/j.canrad.2014.12.008 1278-3218/© 2015 Published by Elsevier Masson SAS on behalf of the Société française de radiothérapie oncologique (SFRO).
Please cite this article in press as: Martin V, et al. Iris metastasis from prostate carcinoma: A case report and review of the literature. Cancer Radiother (2015), http://dx.doi.org/10.1016/j.canrad.2014.12.008
G Model CANRAD-3235; No. of Pages 3 2
ARTICLE IN PRESS V. Martin et al. / Cancer/Radiothérapie xxx (2015) xxx–xxx
The iris lesion decreased in size but did not disappear. The visual acuity was improved. The patient died of septical complications one month later. 3. Discussion
Fig. 1. Patient diagnosed with a metastatic prostate carcinoma: photography of his left eye showing the lesion on the iris. Patient atteint d’un cancer de la prostate métastatique : photographie de l’œil gauche montrant la lésion de l’iris.
according to the TNM classification. The PSA was 17 ng/ml and the Gleason score was 8 (3 + 5). He already had skeletal metastases on the lumbar vertebrae with a L3 epiduritis. The patient refused to undergo a laminectomy and therefore, received hormonal therapy. Nine months after the initial diagnosis, he received analgesic radiation therapy on L2 and L3 vertebrae (2 × 8 Gy) and haemostatic irradiation on the bladder (5 × 4 Gy). At the same time and while still under complete androgen blockade he developed skin and brain metastases. The biopsy and pathological analysis of the skin sites showed cells from prostate carcinoma with neuroendocrine differentiation. The patient then received chemotherapy (carboplatine AUC 5 and docetaxel 80 mg/m2 ). One week later, he complained of a blurred vision with intraocular discomfort and redness. The examination of his left eye showed a lesion on the iris (Fig. 1). It was a multinodular, 2 mm, milky white lesion. The ophthalmologic examination found a decreased visual acuity of the left eye 6/10◦ , no intraocular hypertension. The ophthalmoscopy was unrealizable because of an irido-lenticular synechia. The examination of the right eye was perfectly normal. Due to the presence of brain metastases, whole brain radiation therapy including the iris lesion was decided. The patient received 30 Gy in ten fractions (Fig. 2).
To our knowledge, less than ten cases of iris metastasis from prostate carcinoma have been described in the literature so far. At least 16 cases of prostate carcinoma metastatic to the choroid have been reported [10]. In a clinicopathologic series of 227 cases of carcinoma metastatic to the uvea, there were only two cases of choroidal metastasis from prostate cancer [11]. The predominant primary sites of the intraocular metastasis are breast and lung in women and gastrointestinal tract in men [4–8]. Although metastases from prostate carcinoma to the ocular area have been considered extremely rare, one study found prostate cancer to be the most common primary site of orbital metastasis in men, probably due to the affinity of metastatic prostate carcinoma for bone [12]. Intraocular metastases appear to be situated most of the time on the posterior uvea. Secondary lesions of the iris represent 5 to 10% of the uveal metastasis and 3% of all the lesions of the iris [1–3]. There is an anatomical explanation to the preferential situation of the metastasis in the posterior uvea. Tumour cells pass through the short posterior ciliary arteries that vascularize choroid rather than through the long posterior ciliary arteries or the anterior ciliary arteries that lead to the iris [13]. The average age at diagnosis for uveal metastasis is 66 years (range, 57–78 years). The average interval between the diagnosis of prostate carcinoma and uveal metastasis is 28 months (range, 0–67 months) [10]. In our case, this time was only 9 months. The most common symptoms are blurred vision (40 to 50%), redness of the eye (15%) as in our patient case, and intraocular pain (20–30%). However, some patients do not have any symptom (30%). Those manifestations are commonly due to a secondary glaucoma [2,10]. Glaucoma can be due either to a direct invasion of the filtration angle, or to its obstruction by tumour cells. The tumour can be visualized in only 10% of the cases. It looks like a nodular, white, light yellow or pink lesion. The shape is irregular in half the cases. The size of a metastasis of the iris, from any histological type, ranges from 1 to 12 mm. There are multiple lesions in 15% of the cases but they are exceptionally bilateral [1]. The standard method for diagnosis is fine-needle biopsy, which is positive in 88% of the cases [14]. The recommended treatment for uveal metastasis is radiation therapy, which can be externalbeam radiation therapy with photon, electron, or proton beams, or
Fig. 2. Patient diagnosed with a metastatic prostate carcinoma: planned beam and isodose value from the left eye and whole brain radiation therapy. Patient atteint d’un cancer de la prostate métastatique : champs d’irradiation et courbes isodoses du traitement de l’œil gauche et de l’encéphale en totalité.
Please cite this article in press as: Martin V, et al. Iris metastasis from prostate carcinoma: A case report and review of the literature. Cancer Radiother (2015), http://dx.doi.org/10.1016/j.canrad.2014.12.008
G Model CANRAD-3235; No. of Pages 3
ARTICLE IN PRESS V. Martin et al. / Cancer/Radiothérapie xxx (2015) xxx–xxx
episcleral plaque brachytherapy [15,16]. Indeed these tumours are very radiosensitive, and surgery alone appears to be insufficient [17]. The prognosis for patients with metastatic disease to the uvea generally is poor. Various series reported an overall median survival rate of 7.4 to 10.5 months from the time of ocular diagnosis [5,10,18]. In the De Potter et al. study, the average interval from the diagnosis of prostate carcinoma to death was 28 months (range, 7–57 months); the average interval from the diagnosis of uveal metastasis to death was 6 months (range, 3–9 months) [10]. For our patient, these times were respectively 10 and 1.5 months. 4. Conclusion Iris metastases are very rare and even more when they appear to come from a prostate carcinoma. They might be linked to undifferentiated cell types, including the neuroendocrine one, which is particularly invasive. The prognosis is generally poor, due to the aggressiveness of the global pathology. The gold standard for treatment is radiation therapy, including external-beam radiation therapy with photon, electron, or proton beams, or episcleral plaque brachytherapy. More case reports and studies are required to document the epidemiology and evaluate the therapeutic schemes of this exceptional lesion. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article.
3
[2] Shields JA, Shields CL, Kiratli H, De Potter P. Metastatic tumors to the iris in 40 patients. Am J Ophtalmol 1995;119:422–30. [3] Shields JA, Shields CL. Intraocular tumors: a text and atlas. Philadelphia, PA: WB Saunders; 1992. p. 208. [4] Shields JA, Shields CL. Metastatic tumors to the intraocular structures. In: Shields JA, Shields CL, editors. Intraocular tumors: a text and atlas. Philadelphia, PA: WB Saunders; 1992. p. 207–38. [5] Shields JA, Shakin EP, Shields CL. Metastatic malignant tumors. In: Gold DH, Weingeist TA, editors. The eye in systemic diseases. Philadelphia, PA: JB Lippincott; 1990. p. 299–303. [6] Shakin EP, Shields JA. The eye and ocular adnexa in systemic malignancy. In: Duane TD, editor. Duane’s clinical ophthlamology. Philadelphia, PA: JB Lippincott; 1989. p. 5. [7] Ferry AP, Font RL. Carcinoma metastatic to the eye and orbit. I. A clinicopathologic study of 227 cases. Arch Ophthlamol 1974;92:276.11–86.11. [8] Nelson CC, Hertzberg BS, Klintworth GK. A histopathologic study of 716 unselected eyes in patients with cancer at the time of death. Am J Ophthalmol 1983;95:728–33. [9] Guérin S, Hill C. [Cancer epidemiology in France in 2010, comparison with the USA]. Bull Cancer 2010;97:47–54. [10] De Potter P, Shields CL, Shields JA, Tardio DJ. Uveal metastasis from prostate carcinoma. Cancer 1993;71:2791–6. [11] Shields CL, Shields JA, Peggs M. Tumors metastatic to the orbit. Ophthalmol Plast Reconstr Surg 1988;4:73–80. [12] Ferry AP, Font RL. Carcinoma metastatic to the eye and orbit: a clinicopathologic study of 227 cases. Arch Ophthlamol 1974;92:276–86. [13] Zografos L. Les tumeurs intraoculaires. Rapport de la Société franc¸aise d’ophtalmologie. Paris: Masson; 2002. p. 389–92. [14] Char DH, Miller T, Kroll S. Orbital metastases: diagnosis and course. Br J Ophtalmol 1997;81:386–90. [15] Martin M, Zierhut D, Piroth M, Gutwein S, Debus J, Dithmar S. [Solitary iris metastasis from breast cancer. Effective local therapy with electron beam irradiation]. Ophtalmologe 2006;103:48–51. [16] Kreusel KM, Wiegel T, Stange M, Bornfeld N, Foerster MH. [Intraocular metastases of metastatic breast carcinoma in the women. Incidence, risk factors and therapy]. Ophtalmologe 2000;97:342–6. [17] Fuirichi S, Omori C, Nakayama T, Miyagi K, Hachisuka H, Kayama Y, et al. [Relapse of small cell carcinoma of the lung with metastasis to the iris]. Nihon Kokyuki Gakkai Zasshi 2000;38:417–20. [18] Hart WM. Metastatic carcinoma to the eye and orbit. Int Ophthalmol Clin 1962;2:465–82.
References [1] Weisenthal R, Brucker A, Lanciano R. Follicular thyroid cancer metastatic to the iris. Arch Ophthalmol 1989;107:484–5.
Please cite this article in press as: Martin V, et al. Iris metastasis from prostate carcinoma: A case report and review of the literature. Cancer Radiother (2015), http://dx.doi.org/10.1016/j.canrad.2014.12.008
