Rectal adenocarcinoma in the eye: An unexpected destination

Abstract

Colorectal cancer ranks third in cancer incidence in the United States, commonly metastasizing to the liver and lungs. Despite its high prevalence, colorectal cancer with intraocular metastasis is exceedingly rare, with only a few cases reported in the literature. This study presents a 58-year-old male, previously treated for rectal adenocarcinoma with liver and lung metastases, who developed choroidal metastasis causing visual impairment. Despite radiotherapy, moderate improvement was observed, and subsequent disease progression led to systemic chemotherapy. Intraocular metastasis, primarily affecting the choroid, is infrequent, often originating from breast and lung cancers. The presented case, originating from primary KRAS wild-type rectal cancer, adds to the limited gastrointestinal-tract-related occurrences. This report underscores the importance of recognizing intraocular metastasis in colorectal cancer, contributing valuable insights for improved understanding and potential guidance for future clinical decisions. Choroidal metastasis carries a poor prognosis, emphasizing the need for tailored management strategies.

Keywords: Visual impairment; choroid; colorectal cancer; metastasis.

Figure 1.

(a) Brain computed tomography demonstrated a fusiform-shaped choroidal tumor to the temporal side of the globe causing exudative retinal detachment, these findings were typically consistent with choroidal metastasis (arrow). Axial brain magnetic resonance imaging, (b) T2 weighted image and (c) diffusion-weighted magnetic resonance imaging, revealed a choroidal mass in the right eye (arrow).

Figure 2.

(a) Computed tomography (CT) scan lung window, marked increase in the sizes and count of the previously mentioned bilateral pulmonary, subpleural, and perifissural nodules, measuring up to 1.3 cm in the left upper lung lobe. (b) Mediastinal window, several enlarged mediastinal lymph nodes (pretracheal, subcarinal), infiltrating the right hilum and encasing the right main bronchus, measuring collectively up to 7.5 cm in maximum axial dimension (Compared to 3.4 cm in the previous exam), with newly noted mild right-sided pleural effusion and mild pericardial effusion. Surgical clips noted that the right upper lobe is suggestive of previous procedure/video-assisted thoracoscopic surgery. (c) Abdominal CT scan showed a marked increase in the size of the previously mentioned peripherally enhancing mass infiltration with necrotic center noted at the central hepatic region adjacent to hepatic venous confluence, measures up to 9 × 7 cm (compared to 5.6 × 4.1 cm in the previous exam) (upper arrow), invading the immediate suprahepatic part of the IVC going with malignant thrombosis (lower arrow), associated with heterogeneous liver enhancement (nut-meg appearance) during the venous phase suggesting hepatic congestion. (d) Newly noted multiple liver metastatic lesions with similar characteristics (multiple arrows).