Indian Journal of Cancer Medknow Publications on behalf of Indian Cancer Society ISSN: 0019-509X EISSN: 1998-4774 Vol. 47, Num. 4, 2010, pp. 480-481

Indian Journal of Cancer, Vol. 47, No. 4, October-December, 2010, pp. 480-481

Letter to Editor

Carcinoma esophagus: A rare primary malignancy for ocular metastasis

D Pal, A Bahl, JB Sharma, RR Rao

Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini Sector-5, New Delhi - 85, India
Correspondence Address:
D Pal, Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini Sector-5, New Delhi - 85, India, drdevendra2006@yahoo.co.in

Code Number: cn10117

PMID: 21131773

DOI: 10.4103/0019-509X.73561

Sir,

Carcinoma of esophagus is a devastating disease because of its effects on nutrition in the patients. Half of the cancers are unresectable and metastatic at presentation, and curative success in dealing with cancer is less than 10%. Here, we report an unusual case of esophageal cancer with ocular metastasis.

A 68-year-old chronic smoker and alcoholic man presented with a complaint of progressive dysphagia of 2 months duration. Upper gastrointestinal endoscopy and biopsy of esophageal lesion were suggestive of moderately differentiated squamous cell carcinoma (SCC). Positron emission tomography (PET) scan with diagnostic computed tomography (CT) scan showed the disease to be locoregional (cT3N0M0) at the level of dorsal 8^th -12^th vertebrae.

The patient was started on preoperative chemoradiotherapy (CT/RT) following which he underwent McKeown′s esophagectomy and histopathologic examination (HPE) was suggestive of moderately differentiated SCC, stage pT₃ N₁ M₀ . He was lost to follow-up thereafter.

Two months later, the patient presented with complaints of headache, right eye pain and reduced vision. Visual acuity of the right eye was limited to finger counting at 2 meters, pupil was fixed and mid dilated. Left eye was normal. Ultrasonography of the right eye revealed a mass like lesion in the inferotemporal region of retina extending upto the optic disc. Fundoscopy showed smudged margins of the optic disc on the right side [Figure - 1]. Fluoroscine angiography showed hyperfluorescence in the infratemporal area in early phase and leakage of the dye in the late phase [Figure - 2] and [Figure - 3] suggestive of choreo retinal metastasis in the right eye. PET/CT scan [Figure - 4] and [Figure - 5] showed a soft tissue lesion measuring 1.0 Χ 0.5 cm at the right fovea and enlarged hypermetabolic upper abdominal lymph nodes. Cerebrospinal fluid studies were normal.

In order to avoid the morbidity of enucleation of eye in the metastatic setting, he was started on local radiotherapy to right eye with a dose of 30Gy in 10 fractions and palliative chemotherapy every week with paclitaxel and cisplatin. Post radiation therapy and 3 cycles of palliative chemotherapy, there was a marked subjective improvement in the symptoms with absence of headache and ocular pain and an improvement in the visual acuity from finger counting at two meters before therapy to 6/60 after treatment in the right eye. He also had partial regression in the abdominal disease on further re-evaluation. In view of the improvement, palliative chemotherapy was continued for three more cycles.

Metastasis to the eye are rare. Ocular metastasis of cancer is sometimes reported in breast cancer and lung cancer; however it is extremely rare in esophageal cancer.The most common site of metastases to the eye is the uvea. Among gastrointestinal tumors, common primary sites include stomach, ileum, colon, and rectum. Esophageal carcinoma as a primary lesion has been reported in only one of 70 cases in uveal metastasis in one series and none of 227 such patients in another series.^[2],[3]

The primary tumor in ocular metastatic cases is generally far advanced. In most case reports, the general condition was already so poor that curative therapy could not be performed when ocular metastasis was detected.^[4],[5] Common presentations of ocular metastasis include reduced visual acuity, ocular pain, and secondary glaucoma. Treatment includes systemic therapy directed at primary disease and local treatment modalities. Enucleation of eye should be avoided if there are no associated severe symptoms. A combination of systemic chemotherapy and local radiotherapy is effective in treatment of metastatic esophageal cancer and plays important role in maintaining the quality of life, especially in patient with ocular metastasis. Hence, the present case reinforces the role of chemotherapy and local radiotherapy in the esophageal cancer metastatic to the eye.

References

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