Spontaneous rupture of the eyeball due to choroidal metastasis of gastric carcinoma: A case report

Abstract

Rationale: Although metastatic tumor is the most common intraocular malignancy, choroidal metastasis from gastric cancer is relatively rare. We present the exact course of a spontaneous rupture of the eyeball with choroidal metastasis from gastric carcinoma (GC) and the applied surgical interventions.

Patient concerns: A 59-year-old male presented with pain and vision loss on his left eye for 6 months. He was diagnosed with GC, for which he received systemic chemotherapy for a year.

Diagnoses: Preoperative B-scan, color fundus photography, computed tomography, and magnetic resonance imaging showed a choroidal tumor in his left eye. The spontaneous rupture of the corneoscleral limbus from 2 to 5 o'clock, combined secondary glaucoma, exudative retinal detachment and choroidal detachment were found.

Interventions: The ruptured corneoscleral limbus was sutured and the orbit was lavaged with 0.4% cisplatin during the enucleation.

Outcomes: Histopathology confirmed high homology of the choroidal metastasis and GC. He survived for 2 months after surgery, without pain or orbital neoplasms.

Lessons: Choroidal metastasis from GC rapidly progressed to spontaneous rupture of the eyeball. Careful eyeball enucleation followed by orbital lavage with chemotherapeutics may reduce metastasis risk beyond the eyeball. Additional therapeutic interventions should be considered in patients resistant to single systemic chemotherapy.

Figure 1

(A) Color fundus photograph of the left eye reveal a nasal choroidal mass with associated serous retinal detachment; (B) B-scan ultrasonography of the left eye demonstrates a choroidal lesion measuring 8.78 × 13.64 mm with high reflectivity.

Figure 2

(A) B-scan ultrasonography of the left eye demonstrated a choroidal lesion measuring 12.08 × 15.32 mm with high reflectivity and extensive exudative retinal detachment; (B) Ultrasound biomicroscopy showed the squeezed anterior chamber with hyphemia; (C) Spontaneous rupture of the corneoscleral limbus from 2 to 5 o’clock, edema of cornea, and very shallow anterior chamber with hyphemia; (D) Nasal-posterior solid neoplasm was found in the enucleated eyeball, with massive hematocele.

Figure 3

(A) Computed tomography scan showing an enhanced mass at the nasal and posterior side of the left eye; (B) MRI scan showing the same lesion on the left eye; (C) The T1-weighted image shows isointensity with enhancement; (D) The T2-weighted image shows hypointensity. MRI = magnetic resonance imaging.

Figure 4

(A) Endoscopic biopsy specimen from the stomach showing well-differentiated tubular adenocarcinoma (H&E staining, original magnification ×100); (B) Enucleated specimen of the left eye showing a moderately differentiated tubular adenocarcinoma (H&E staining, original magnification ×100). H&E = hematoxylin-eosin.