Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :308
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
   
  Table of Contents
  
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (488 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed2102    
    Printed142    
    Emailed1    
    PDF Downloaded217    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents
LETTER TO EDITOR
Year : 2010  |  Volume : 47  |  Issue : 4  |  Page : 480-481
 

Carcinoma esophagus: A rare primary malignancy for ocular metastasis


Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini Sector-5, New Delhi - 85, India

Date of Web Publication4-Dec-2010

Correspondence Address:
D Pal
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini Sector-5, New Delhi - 85
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.73561

Rights and Permissions



How to cite this article:
Pal D, Bahl A, Sharma J B, Rao R R. Carcinoma esophagus: A rare primary malignancy for ocular metastasis. Indian J Cancer 2010;47:480-1

How to cite this URL:
Pal D, Bahl A, Sharma J B, Rao R R. Carcinoma esophagus: A rare primary malignancy for ocular metastasis. Indian J Cancer [serial online] 2010 [cited 2019 Aug 24];47:480-1. Available from: http://www.indianjcancer.com/text.asp?2010/47/4/480/73561


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 pT 3 N 1 M 0 . 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.
Figure 1 :Fundus photograph.

Click here to view
Figure 2 :Fluoroscine angiography of right eye showing hyperfluorescence in the infratemporal area in early phase and leakage of the dye in the late phase.

Click here to view
Figure 3 :Fluoroscine angiography of right eye showing hyperfluorescence in the infratemporal area in early phase and leakage of the dye in the late phase.

Click here to view
Figure 4 :PET scan image showing a hypermetabolic soft tissue lesion at right fovea.

Click here to view
Figure 5 :CT scan image showing a soft tissue lesion measuring 1.0 × 0.5 cm at right fovea.

Click here to view


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 Top

1.Jerry AS, Carol LS, Hayyam K, Patrick DP. Metastatic tumors to the iris in 40 patients. Am J Ophthalmol 1995;119:422-30.  Back to cited text no. 1
    
2.Stephens RF, Shields JA. Diagnosis and management of cancer metastatic to the uvea: A study of 70 cases. Ophthalmology 1979;86:1336-49.  Back to cited text no. 2
[PUBMED]    
3.Ferry AP, Fort RL. Carcinoma metastatic to the eye and orbit. A clinicopathologic study of 227 cases. Arch Ophthalmol 1974;92:276-86.  Back to cited text no. 3
    
4.Mooy CM, De Jong PT, Verbeek AM. Choroidal metastasis of oesophageal squamous cell carcinoma. Int Opthalmol 1990;14:63-71.  Back to cited text no. 4
    
5.McDonald JW, Proia AD. Ocular metastasis as the initial presentation of esophageal carcinoma. Can J Ophthalmol 1997;32:50-2.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

Top
Print this article  Email this article

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow