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primary tumors with choroidal metastases include , those originating from the lungs , breast and gastrointestinal tract , and were very rare in patients with carcinoma of the colon or rectum . here
a 60 year - old - man with a positive fecal occult blood test was diagnosed with early rectal cancer and underwent endoscopic mucosal resection at another hospital .
pathological findings showed well - differentiated adenocarcinoma with submucosal invasion(sm ; 3500  m ) , lymphatic infiltration ( ly1 ) , and no venous invasion ( v0 ) .
according to the japanese society for cancer of the colon and rectum ( jsccr ) 2010 guidelines for the treatment of colorectal cancer , the patient underwent laparoscopic low anterior resection with d2 lymphadenectomy .
final pathological findings revealed no residual tumor cell in the rectum and one metastasis in regional lymph nodes ( 1/15 ) .
the patient received postoperative adjuvant chemotherapy with uracil - tegafur ( uft ) plus leucovorin for six months .
two years after radical rectal surgery , a metastasis in left lung was detected by computed tomography ( ct ) .
pathological findings revealed metastatic tubular adenocarcinoma in the lung and the surgical cut margin was negative .
six months after pulmonary resection , the patient experienced left sided myodesopsia , examination for which showed a white and yellow choroidal mass .
ct scan of the brain demonstrated a metastatic lesion in the left eye ( fig .
a repeat ct scan of chest demonstrated the presence of multiple metastases in both lungs ( fig .
3a and b ) . no other metastatic lesions or recurrences were detected . the patient elected to undergo radiotherapy for his choroidal metastasis .
after radiotherapy ( 45  gy/25  fr ) to the left eye , bevacizumab  +  capeox ( capecitabine  +  oxaliplatin ) was initiated for 18 months and bevacizumab  +  folfiri was continued for 9 months until the time .
the patient has survived for 2 years and 3 months without signs of recurrence in the left eye and is receiving ongoing systemic chemotherapy for multiple lung metastases .
regarding ocular malignancy , metastatic tumors are becoming more common than primary tumors , and are mainly found in the choroid .
primary tumors with choroidal metastases include , those originating from the lungs , breast and gastrointestinal tract at frequencies of 47% , 21% , 4% , respectively .
reported that orbital metastases more frequently arise from the liver and stomach in japan compared to the united states and europe , and were very rare in patients with carcinoma of the uterus , ovaries , bladder , pancreas , colon or rectum .
we searched the pubmed database through 2014 and the japanese ichushi database of the japan medical abstracts society ( http://www.jamas.or.jp/ ) from 1983 through 2014 , using the following search terms :  choroidal metastasis ,   colorectal ,  and  cancer .  the results identified 14 patients in addition to the current patient who underwent primary colorectal tumor resection ( table 1 ) .
five patients had colon cancer and 9 patients had rectal cancer . regarding t stage , only our case was t1 ; all others were t3 or t4a .
four patients had a diagnosis of synchronous choroidal metastases , and 10 patients had metachronous metastases , which were diagnosed at a mean of 23.8 months after primary tumor resection .
the major symptom was vision loss in 7 patients , blurring of vision in 3 patients , photopsia in one patient , cloudy vision in one patient , eye pain in one patient and myodesopsia in one patient .
when choroidal metastasis was diagnosed , it was accompanied with metastases to another organ in all patients from our search .
of the 14 patients , 11 patients died because of progression of the other organ metastases after diagnosis of the choroidal metastasis .
the mean survival time was 5.6 months ( range , 112 ) in all cases , excluding ours from the analysis .
regarding treatment of choroidal metastases , systemic chemotherapy , radiotherapy , chemoradiotherapy and intravitreal bevacizumab therapy were all reported .
there were two reports of enucleation before the current standard chemotherapy , namely folfox and folfiri was established . in 3 patients who received systemic chemotherapy ,
two patients had good response of the choroidal metastasis , but ultimately succumbed because of the other organ metastases . using radiotherapy , cole et al . reported that choroidal metastasis had enlarged one month after treatment . in the 3 patients who received chemoradiotherapy , nakamura et al .
reported a patient who survived for 1 year without recurrence of choroidal metastasis and other organ metastases after systemic chemotherapy and radiotherapy for the right eye . in two patients who received intravitreal bevacizumab therapy , kuo et al .
lin et al . reported that intravitreal bevacizumab successfully treated choroidal metastasis in one eye but failed to do so in the other eye .
the current literatures have few recommendations regarding the appropriate treatment of choroidal metastasis from colorectal cancer , but an aggressive multi - disciplinary approach that includes chemotherapy , radiotherapy , chemoradiotherapy , and intravitreal bevacizumab therapy may be effective in local regression . with the current case , radiotherapy was chosen .
the lung metastases already presented at the time of the choroidal metastasis , making it is important to also enforce systemic chemotherapy in addition to radiotherapy .
this is the first report of choroidal metastasis from early rectal cancer . in our case ,
more experience and a long - term follow up are needed to establish the optimal treatment strategy for choroidal metastasis from colorectal cancer .
mitsuyoshi tei and the other co - authors have no conflict of interest to declare .
written informed consent was obtained from the patients for the information to be included in our manuscript .
his information has been de - identified to the best of our ability to protect his privacy .
highlightswe report a case of choroidal metastasis from early rectal cancer.radiotherapy was initiated for the left eye and systemic chemotherapy is initiated for the multiple lung metastases.the patient is living 2 years and 3 months after the diagnosis of choroidal metastasis without signs of recurrence in the left eye .