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Show Poster 23 Unusual Manifestation of Histopathologic Confirmed Metastatic Esophageal Carcinoma Dilip Thomas1, Venkatkrish Kasetty1, Daniel Kleven1 Medical College of Georgia, Augusta, Georgia, USA 1 Introduction: Intraocular metastasis from esophageal carcinoma are rare. Cases of esophageal carcinoma with metastasis to the choroid have been infrequently reported, especially in ophthalmic literature, and to our knowledge, none have included histopathology. Description of Case(s): A white male in his late 60s was referred for evaluation of left orbital mass. The patient presented with transient vision loss OS, intermittent "pressure-like" headaches originating from behind the left eye, and central vision loss. Two years ago, he was diagnosed with esophageal adenocarcinoma. Uncorrected VA was 20/30 OD and HM OS with RAPD. Temporal constriction and central scotoma OS were noted on confrontation VF. EOM was full. Fundus examination OS showed circumferential peripapillary retinal elevation, most pronounced infratemporally. OCT revealed diffuse irregular and undulating contour to the choroid RPE and retina. MRI revealed an intraconal left orbital mass arising from the uvea. Transconjunctival lateral orbitotomy was performed. A violaceous mass was seen emanating from the temporal aspect of the sclera 15 mm posterior to the lateral rectus insertion. A shave biopsy revealed clusters of tumor cells in an infiltrative pattern and desmoplastic stroma. Tumor cells showed significant pleomorphism, apoptosis, and mitotic activity. Immunostaining with cytokeratin-7 supported the diagnosis of metastatic esophageal adenocarcinoma. The patient was referred to the ocular oncology service with no evidence of systemic disease otherwise. He was treated with IMRT with partial resolution and subjective improvement. Conclusions, including unique features of the case(s): Ocular manifestations of metastatic esophageal adenocarcinoma depend on its location; symptoms include vision loss, diplopia, and VF defects. This can be seen bilaterally or unilaterally, and may be the presenting symptom. Our case presented with a central scotoma with visual loss, which has rarely been reported and histopathologic confirmation even less common. It is important to differentiate between metastases and primary choroidal melanoma. Confirmatory biopsy can rarely be obtained but is useful for determination of definitive management. References: None. Keywords: Tumors, Orbit/ocular pathology, Neuro-ophth & systyemic disease (eg. MS, MG, thyroid) Financial Disclosures: The authors had no disclosures. Grant Support: None. 2019 Annual Meeting Syllabus | 79 |
