PMC6249976_01
Fundus photographs obtained at presentation of a 69-year-old Japanese man with a history of stage 4 esophageal cancer. a In the right eye, a veil-like vitreous opacity and retinal whitening in the macular and peripheral retina were apparent. The retinal pigment epithelium appeared to be intact and no choroidal masses or lesions were visible. b The left eye had an old macular hole, which included hard exudates. No masses or lesions were visible. c Magnified fundus photograph showed a macular hole in the left eye
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Fig1
ARN (Fig. 1a). Although the view was limited due to the thick vitreous opacity, no obvious masses were detected in the retina or choroid. Fundus examination of the left eye was normal, except for evidence of the old macular hole with hard exudates along the superior temporal arcade (Fig. 1b, c).
a Cytological analyses of a vitreous sample, stained with Papanicolaou, revealed scattered, undifferentiated, malignant cells that were consistent with the previous diagnosis of esophageal cancer. b Histopathological analysis from the initial esophageal biopsy, stained with hematoxylin and eosin, revealed an anaplastic, squamous neoplasm with cohesive cells. Each sample was observed with a microscope of 400 magnification
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Fig2
However, the vitreous sample did contain scattered, undifferentiated malignant cells (Fig. 2a). Vitreous specimen findings matched those of the primary esophageal tumor biopsy (Fig. 2b).
Ultra-wide view fundus imaging was obtained two months after combined cataract extraction and 25 gauge pars plana vitrectomy. Multifocal white intraretinal lesions were present in the macula and periphery. A tractional retinal detachment was resolved under silicone oil. Visual acuity remained 20/200
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Fig3
Ultra-wide view fundus imaging revealed multifocal white intraretinal lesions in the macula and periphery two months after surgery (Fig. 3).
a OCT image showing hyper-reflective inner retinal lesions (arrows) in the same location as the white intraretinal fundus lesions. b Fundus photography illustrated white intraretinal lesions with a green arrow indicating the direction and area analyzed by OCT
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Fig4
Optical coherence tomography (OCT) through these white opacities displayed hyper-reflective inner retinal lesions with no choroidal involvement, suggestive of retinal metastasis (Fig. 4a, b).