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Delayed referral preceded lung biopsy-confirmed diagnosis. Systemic octreotide plus capecitabine and temozolomide led to regression of choroidal tumors, improved visual acuity, and resolution of eye pain. Conclusions and importance: Bilateral choroidal metastasis from a slow-growing lung neuroendocrine tumor can present with eye pain and vision loss; systemic therapy alone improved outcomes despite delays.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/neuroendocrine-tumor-of-the-lung-presenting-as-slowly-progressive-painful-bilateral-choroidal-masses-case-report/443081/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/neuroendocrine-tumor-of-the-lung-presenting-as-slowly-progressive-painful-bilateral-choroidal-masses-case-report/443081.png","ImageObject",300,407,{"name":42,"@type":43},"Logic","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",7,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What symptoms first led to suspicion of the malignancy in this case?","Question",{"text":63,"@type":64},"The initial presentation was slowly progressive bilateral vision loss and retrobulbar pain, which prompted ophthalmic evaluation and further diagnostic workup.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was the lung neuroendocrine tumor diagnosis confirmed?",{"text":68,"@type":64},"Whole-body PET-CT identified a hypermetabolic lung focus, and eventual lung biopsy confirmed a slow-growing neuroendocrine tumor of the lung.",{"name":70,"@type":61,"acceptedAnswer":71},"What treatment was used and what was the outcome for eye pain and vision?",{"text":72,"@type":64},"Systemic therapy with octreotide, capecitabine, and temozolomide was initiated, resulting in regression of choroidal tumors, improved visual acuity, and resolution of eye 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Reports 41 (2026) 102503  \nContents lists available at ScienceDirect  \nAmerican Journal of Ophthalmology Case Reports  \njournal [homepage:](homepage: www.ajocasereports.com/)[ www.ajocasereports.com/](homepage: www.ajocasereports.com/)  \n| Neuroendocrine tumor of the lung presenting as slowly progressive, painful bilateral choroidal masses\u003Cbr>Sharon H. Zhao a,b , Susanna S. Parka,* \u003Cbr>a Department of Ophthalmology & Vision Science, University of California Davis., Sacramento, CA, USA\u003Cbr>b Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA |  |  |\n| --- | --- | --- |\n| A R T I C L E I N F O |  | A B S T R A C T |\n| Keywords:\u003Cbr>Choroidal metastasis Neuroendocrine tumor Eye pain\u003Cbr>Lung cancer |  | Purpose: To report a rare case of a metastatic slow growing neuroendocrine tumor of the lung that presented as slow-growing bilateral choroidal masses with progressive vision loss and retrobulbar pain.\u003Cbr>Observations: A 64-year-old male presented with vision loss and retrobulbar pain bilaterally, progressively worsened for four months. He had no significant past medical history but had seen an ophthalmologist in Mexico starting 1.5 years earlier and was informed he may have a mass in the eye when last seen five months earlier. Ophthalmic examination revealed visual acuity of 20/400 bilaterally with large elevated amelanotic choroidal masses in both maculae with overlying pigmentary changes and subretinal fluid. The initial differential diagnosis included choroidal metastasis and infectious and inflammatory etiologies such as posterior scleritis and granuloma. Whole body PET-CT scan revealed a focus of hypermetabolic activity in the lung suspicious for a slow growing malignancy or infectious/inflammatory lesion. Due to insurance issues, there was a delay in referral to medical oncology. The choroidal lesions gradually increased in size over four months. Eventual biopsy of the lung confirmed the diagnosis of a slow-growing neuroendocrine tumor of the lung. Systemic treatment with octreotide, Capecitabine, and Temozolomide was initiated with regression of choroidal tumors, improvement in visual acuity, and resolution of eye pain.\u003Cbr>Conclusions and importance: We describe a rare case of a bilateral choroidal metastasis from a slow growing neuroendocrine tumor of the lung that presented with slowly progressive bilateral vision loss and eye pain. Despite delays in diagnosis and treatment, eye pain resolved, and vision loss improved with systemic therapy alone. |\n\n1. Introduction  \nMetastasis is the most common uveal malignancy.1,2 Common primary malignancies associated with uveal metastasis include carcinomas of the lung, breast, kidney, and gastrointestinal tract.1 Choroidal metastases typically manifest as amelanotic choroidal masses which can be differentiated from uveal melanoma based on high internal reflectivity on ultrasound and relatively rapid growth. These lesions are often multifocal and bilateral. Here, we describe a rare case of slowly progressive bilateral vision loss and retrobulbar pain from bilateral choroidal metastasis of a slow-growing neuroendocrine tumor of the lung. Delay in diagnosis of almost 2 years resulted in severe vision loss in both eyes. Ocular symptoms of eye pain and vision loss were the initial presentation of the malignancy; these symptoms improved after  \nsystemic therapy, and regression of the choroidal masses was seen.  \n2. Case presentation  \nA 64-year-old Hispanic male presented to the emergency room with gradually worsening blurry vision and pulsating retrobulbar pain in both eyes for 3–4 months. The patient reports being seen by an ophthalmologist in Mexico starting 1.5 years ago; he was informed he may have an eye tumor when last seen 5 months earlier. He had no other significant past medical or ocular history. On review of systems, he reported an episode offever three months","cbCaimHwZaL6Yl90","https://ap.wps.com/l/cbCaimHwZaL6Yl90","pdf",5181671,"English","# Article Abstract\n# Introduction\n# Case presentation","[{\"question\":\"What symptoms first led to suspicion of the malignancy in this case?\",\"answer\":\"The initial presentation was slowly progressive bilateral vision loss and retrobulbar pain, which prompted ophthalmic evaluation and further diagnostic workup.\"},{\"question\":\"How was the lung neuroendocrine tumor diagnosis confirmed?\",\"answer\":\"Whole-body PET-CT identified a hypermetabolic lung focus, and eventual lung biopsy confirmed a slow-growing neuroendocrine tumor of the lung.\"},{\"question\":\"What treatment was used and what was the outcome for eye pain and vision?\",\"answer\":\"Systemic therapy with octreotide, capecitabine, and temozolomide was initiated, resulting in regression of choroidal tumors, improved visual acuity, and resolution of eye pain.\"}]","Neuroendocrine tumor of the lung presenting as slowly progressive, painful bilateral choroidal masses - Case Report | PDF",1790702813,13]