The most common forms of metastasis for gastric cancer are direct infiltration,hematogenous metastasis, lymphatic metastasis, and implantation metastasis. Theinvasion of cancerous tissue damages local blood vessels, and allows cancer cells into the blood flow. Consequently, cancer cells can be readily transported to other parts of the body to form a distant metastasis. The most common metastatic sites from gastric cancer are the liver, peritoneum, and distant lymphnodes. Very few studies have reported cases involving the transfer of gastric cancer to the skin, brain and eye. The ocular metastasis of gastric cancer is most often located on the choroid, followed by the optic nerve, eyelid, conjunctiva, and iris. The present case demonstrates that gastric cancer can metastasize in multiple ways.
Intraocular malignancy is a rare disease and is most commonly caused bymetastatic tumors. Choroidal metastatic tumors from malignancies in the gastrointestinal tract are extremely rare compared with the more common metastatic breast and pulmonary carcinomas. Nevertheless, metastatic tumors in the orbit account for only 2–3% of all systemic cancers. A choroidal metastatic tumor needs to be differentiated from melanoma at the initial diagnosis. Patients with choroidal metastasis have a poor prognosis[11,12]. Ourpatient died 8 months after the first diagnosis of choroidal metastasis.
However, cases of choroidal metastasis have been rising; it is believed that this is due to improvements in ophthalmic diagnosis techniques. The typical symptoms of choroidal metastasis are ocular pain, exophthalmos, reduced vision, mass lesion, retinal detachment, uveitis, and secondary glaucoma. In our case, we were able to make a diagnosis based on prior medical history, computed tomography and MRI of the orbits, and histopathological findings. Based on these data, it would be appropriate to diagnose this choroidal tumor as a metastatic tumor that originated from the gastric cancer. The recognition of metastatic disease and early treatment are important in maximizing the quality of life in these patients. The main therapeutic options are chemotherapy, hormonal therapy, or plaque radiotherapy.Enucleation can relieve the pain in blind eyes as a palliative form of therapy.Since the nature of metastatic cancer cells is equivalent to in situ foci, the treatment of gastric cancer metastasis is carried out on the basis of the primary foci.
In summary, choroidal metastasis of gastric cancer is rare. We report a patient with gastric cancer who presented with choroidal metastasis. Despite surgery, the patient died soon after diagnosis.