small cell carcinoma constitutes the most aggressive type of lung cancer , with the greatest propensity for early disseminated disease . although commonly neglected due to its rarity and the presence of other comorbidities , cases of iris metastasis from small cell lung cancer have been reported in the literature . we present the case of a 76-year - old female . once diagnosed , the patient already had disseminated disease with metastatic foci found in the spleen , liver , and brain . the patient received six cycles of combination carboplatin / etoposide chemotherapy , followed by cranial irradiation . after an initial response , two months after the completion of cranial irradiation , the patient complained of visual impairment and was referred to an ophthalmologist . a diagnosis of secondary glaucoma was made , caused by metastasis to the left iris . early diagnosis is of paramount importance in order to effectively prevent the significant morbidity this condition can cause if left untreated . it carries the greatest propensity for early dissemination and is accompanied by a worse prognosis compared to other histologic types . delays in therapeutic interventions should not exceed one week due to the aggressive nature of this disease if left untreated . despite its aggressiveness , nearly all cases respond dramatically well to chemotherapy . however , most tumors finally relapse , eventually leading to widespread disease . the most common sites of tumor metastasis involve the liver , adrenals , bone marrow and brain ; however , uncommon sites can also be affected ( 1 , 2 ) . lung cancer constitutes the second most common source of metastatic intraocular dissemination , after breast cancer ( 3 ) . the choroid layer is more commonly involved compared to the iris , due to the more abundant arterial distribution in the posterior chamber of the eye ( 3 ) . however , despite its rarity , cases of iris metastasis from small cell lung cancer have been reported in the literature ( 4 , 5 ) . a 76-year - old non - smoking caucasian female presented to our hospital complaining of left - sided hemiparesis . she reported a long medical history of psoriasis , and she also reported being in a chronic hcv - carrier state . the patient subsequently underwent neurosurgical excision of the lesion . a whole - body imaging study performed shortly thereafter revealed enlarged mediastinal lymph nodes and a lesion in the upper lobe of the left lung , indicative of malignancy . additionally , the abdominal ct scan revealed multiple lesions in the liver and the spleen , while a post - surgery brain mri revealed novel temporal and left occipital lesions . histologic analysis of the tumor specimen surgically obtained from the brain revealed that the primary lesion was small cell lung carcinoma . the patient was therefore started on first - line chemotherapy with carboplatin auc 6 plus etoposide 120 mg / m every 21 days for 6 cycles , which successfully led to a complete response of the disease two months after the completion of radiotherapy , the patient complained of visual impairment and was referred to an ophthalmologist . a diagnosis was made of secondary glaucoma caused by metastasis to the left iris ( figure 1 ) . whole - body reclassification exams were subsequently performed , which showed significant disease progression in the chest . the patient was entered into a clinical trial and received oral pazopanib 800 mg once daily . however , after three months , while on the pazopanib therapy , the disease progressed and the patient was changed to oral topotecan 2.3 mg / m on days 1 to 5 , every 21 days . however , three months later , the patient once again was diagnosed with disease progression . additionally , she suffered severe clinical deterioration , with a significant decline in her performance status . because of the severity of her condition and her poor performance status , the therapeutic approach was changed to best supportive care . despite advances in the management of iris metastases during the last few decades , iris metastases generally occur late in the course of sclc implicating advanced disease . prognosis usually remains dismal . survival ranges between 1 and 18 months , with a median of 7 months ( 6 ) . the eye is involved during the course of the disease in 6% of lung cancer cases ( 7 ) . the choroid is the most commonly affected layer , followed by the iris - ciliary body . given that our patient already had systemic disease with multiple affected organs , we assumed that the iris lesion was a metastasis from the primary malignancy . however , it may occasionally be difficult to distinguish between a primary neoplasia and metastatic disease . the available diagnostic methods include fine - needle aspiration biopsy , iridocyclectomy and autopsy ( 8) . fine - needle aspiration biopsy constitutes the most widely used method , due to its simplicity . however , the diagnosis is based on immunohistochemical staining of tumor molecules rather than direct pathologic analysis , because of the inability of the method to collect a sufficient amount of cytologic material ( 5 ) . in our case , we decided not to perform any invasive diagnostic procedures because of the limited expected benefits , both diagnostically and therapeutically . iris metastases can present as multiple white - to - yellow nodules , glaucoma , anterior uveitis or hypopyon . ophthalmologists are often the first physicians to face the diagnostic challenge of this finding , and should suspect , and be familiar with , the condition . . each case should be individualized , and therapeutic decisions should be carefully made after many factors are considered , such as the extent of local disease , local symptoms caused by the lesion , the extent of systemic disease , previous therapeutic interventions and overall performance status . disseminated small cell carcinoma constitutes a devastating condition , with a significant decline in the patient s quality of life . among other foci this condition is often neglected by physicians because of its rarity , along with the significant comorbidities that these patients suffer . early diagnosis is of paramount importance in order to effectively prevent the significant morbidity this condition can cause if left untreated . written informed consent was obtained from the patient for publication of this case report and any accompanying images . a copy of the written consent is available for review by the editor of this journal . disseminated small cell carcinoma constitutes a devastating condition , with a significant decline in the patient s quality of life . among other foci , metastases can develop in the iris . this condition is often neglected by physicians because of its rarity , along with the significant comorbidities that these patients suffer . early diagnosis is of paramount importance in order to effectively prevent the significant morbidity this condition can cause if left untreated . written informed consent was obtained from the patient for publication of this case report and any accompanying images . a copy of the written consent is available for review by the editor of this journal .
introductionsmall cell carcinoma constitutes the most aggressive type of lung cancer , with the greatest propensity for early disseminated disease . 
 although commonly neglected due to its rarity and the presence of other comorbidities , cases of iris metastasis from small cell lung cancer have been reported in the literature.case presentationwe present the case of a 76-year - old female . once diagnosed , the patient already had disseminated disease with metastatic foci found in the spleen , liver , and brain . 
 the patient received six cycles of combination carboplatin / etoposide chemotherapy , followed by cranial irradiation . 
 after an initial response , two months after the completion of cranial irradiation , the patient complained of visual impairment and was referred to an ophthalmologist . 
 a diagnosis of secondary glaucoma was made , caused by metastasis to the left iris.conclusionsphysicians should be aware of this rare site of metastasis . 
 early diagnosis is of paramount importance in order to effectively prevent the significant morbidity this condition can cause if left untreated .