Flashes of light and floaters: an unusual presentation of urothelial carcinoma

Description 

A 59-year-old Caucasian woman with multiple sclerosis presented with blurred vision in the right eye, floaters and flashes of light for 2 weeks. She had right-sided optic neuritis which was treated 8 years prior. There was a 20 pack-year smoking history. Examination was remarkable for right-sided temporal field loss and a palpable breast lump. Ophthalmological examination revealed right exudative retinal detachment, with ultrasonography demonstrating a choroidal mass with medium to high internal reflectivity. MRI was significant for a 14 mm intraocular metastasis (figure 1). On further questioning, the patient described haematuria. Urine cytology demonstrated large cells with high nuclear to cytoplasmic ratio, irregular nuclear borders and necrosis, all suggesting high-grade malignancy. Abdominal imaging revealed an ill-defined heterogeneously hypoenhancing infiltrative lesion of the right kidney within the mid and superior portions measuring 7.5x6.6x8.5 cm (figure 2). Biopsy of both the renal and breast masses confirmed urothelial...

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