Case report Adenocarcinoma of the esophagus with choroidal metastasis C. J. Buskens, 1 H. S. Tan, 2 J. B. F. Hulscher, 1 M. D. de Smet, 2 J. J. B. van Lanschot 1 Departments of 1 Surgery and 2 Ophthalmology, Academic Medical Center/University of Amsterdam, The Netherlands SUMMARY. In this report, a case is presented of an adenocarcinoma in a Barrett's esophagus metastatic to the choroid. A 54-year-old woman presented with a rapidly progressive decrease of vision in the right eye 8 months after intentionally curative esophagectomy for an adenocarcinoma. Fundoscopy, ultrasonography, and magnetic resonance imaging ®ndings were suggestive of a metastasis. The patient received palliative external beam irradiation to the right eye for visual restoration, but she died before any bene®cial eect was achieved. INTRODUCTION Malignant tumors rarely metastasize to the eye. The most common primary tumors causing ocular meta- stasis are breast, lung, and prostate carcinomas. 1±4 In the literature, only a few cases have been described of gastrointestinal tumors such as stomach or colon carcinomas metastasizing to the intraocular space or orbit. 2±4 Here, a case is reported of a choroidal metastasis from an esophageal adenocarcinoma. CASE REPORT A 54-year-old woman presented with a 4-month history of dysphagia, odynophagia, and considerable weight loss after longstanding gastroesophageal re¯ux. Endoscopy showed a hiatal hernia and a 4-cm Barrett's esophagus, without macroscopic signs of irregularity. The pathologic diagnosis of adeno- carcinoma could only be established on random biopsies. Endosonographically the tumor extended 37±39 cm from the incisors, and was staged uT1 N1 M0. There were no signs of distant metastasis on preoperative work-up. The patient underwent a transhiatal esophagecto- my and reconstruction with a gastric tube. Post- operative histology showed a poorly dierentiated adenocarcinoma with a diameter of 2.5 cm in Bar- rett's epithelium, pT2 N1 M0. A radical resection (R0) had been achieved. After an uncomplicated postoperative course, the patient was readmitted to the hospital 2 months later because of severe nausea, vomiting, and abdominal pain. A radiologic contrast study showed a total stop at the ligament of Treitz. An exploratory laparotomy was performed and a torsion of the jejunum was found at the site of the previous feeding jejunostomy. There were no signs of intra-abdominal recurrence. After adhesiolysis and de-rotation, she was dis- charged in a good condition. Six months later, the patient developed a rapidly progressive decrease of vision in the right eye. Visual acuity was 20/200 in the right eye and 20/20 in the left eye. Fundus examination of the right eye revealed a temporally located elevation of choroid and retina, stretching from the fovea to the equator (Fig. 1). There was overlying retinal pigment epithelium mottling and, inferior to the choroidal mass, an extensive serous retinal detachment. The left fundus was normal. Ultrasonography showed high internal re¯ectivity of the lesion that was consistent with the diagnosis of choroidal metastasis (Fig. 2). Magnetic resonance imaging (MRI) not only showed the choroidal lesion (Fig. 3A), but also a bone lesion of the dens (Fig. 3B). Skeletal scintigraphy con®rmed the presence of multiple bone metastases. With these ®ndings it was felt unnecessary to take a biopsy specimen for histologic proof. As palliative treatment was chosen, the patient received external beam irradiation (5 ´ 4 Gy) to the right eye for visual restoration. The tumor showed signs of regression, Address correspondence to: Dr C. J. Buskens, Department of Surgery, Academic Medical Center/University of Amsterdam, Suite G4±130, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel: (+31) 2056 69111; Fax: (+31) 2069 14858; E-mail: C.J.Buskens@AMC.UVA.NL 70 Diseases of the Esophagus (2001) 14, 70±72 Ó 2001 ISDE/Blackwell Science Asia