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A new choroidal mass in a patient with known metastatic leiomyosarcoma: importance of fine-needle aspirate biopsy in diagnostic certainty and treatment planning.

PURPOSE
To report a patient with known metastatic leiomyosarcoma and a new choroidal mass wherein a fine-needle aspirate biopsy was performed to achieve diagnostic and treatment certainty.


METHODS
A retrospective case report of one patient.


RESULTS
A 63-year-old woman with known metastatic leiomyosarcoma presented with a new choroidal mass. Metastatic leiomyosarcoma to the choroid has been previously reported. An ab externo fine-needle aspirate biopsy was performed to achieve diagnostic and therapeutic certainty (metastatic leiomyosarcoma is considered radiation insensitive and requires local excision, and choroidal melanoma is treated with I135 plaque brachytherapy). The results were positive for choroidal melanoma as read by two different pathologists at two different sites, and the patient was treated in the conventional manner. The response to treatment at 30 months has been excellent.


CONCLUSION
When there is diagnostic uncertainty and treatment regimens vary, a fine-needle aspirate biopsy can be diagnostic and can provide direction for care. De novo tumors can be confounded with a metastatic disease in patients with complex histories.