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Improved systemic chemotherapy for metastatic testicular choriocarcinoma can result in excellent prognosis for life and vision.

Report of a Case. A 23-year-old healthy man visited the emergency department with decreased vision in his left eye. His best-corrected visual acuities were 20/20 OD and light perception OS. There was a left afferent pupillary defect. Slitlamp and fundus examination results of the right eye were unremarkable. Dilated funduscopic examination of the left eye was limited due to a vitreous hemorrhage. Standardized A-scan and contact B-scan ultrasonography of the left eye showed a large, irregularly shaped and structured, highly vascular mass lesion in the superotemporal quadrant (Figure 1). The mass measured approximately 19.0 15.8 mm in diameter with a maximal thickness of 12.4 mm. On further detailed review of systems, the patient admitted to a 6-week history of testicular pain. An initial workup revealed a testicular mass, and chest radiography revealed 2 mass lesions in the lungs. The patient was immediately referred to an oncologist for further metastatic workup. The patient was diagnosed with metastatic testicular choriocarcinoma requiring radical orchiectomy followed by a 5-cycle chemotherapy regimen of bleomycin sulfate, etoposide, and cisplatin. The patient responded well to the chemotherapy systemically, and serial ultrasonography examinations showed a dramatic decrease in the thickness of the choroidal mass from 12.4 mm to 3.0 mm. Three months after chemotherapy, the patient was clinically in remission. The choroidal mass continued to decrease in size until it became undetectable by ultrasonography (Figure 1) and the left afferent pupillary defect resolved. However, the visual acuity was 6/200 OS from a nonclearing vitreous hemorrhage. Five months into remission without resolution of the hemorrhage, the patient underwent a 25-gauge pars plana vitrectomy of the left eye. He later developed an epiretinal membrane and cataract that required a vitrectomy with membrane peeling and cataract extraction. Three years after his initial diagnosis, the patient remains in remission with a visual acuity of 20/40 OS. Subretinal fibrosis has replaced the previously active metastatic lesions (Figure 2).