Esophageal Adenocarcinoma Metastatic to the Choroid with Extrascleral Extension

A 78-year-old man with history of esophageal adenocarcinoma, in remission 9 months after resection, chemotherapy, and radiation, presented with a peripapillary choroidal lesion with leopard-spot pigmentation and disc edema (A). Extraocular extension was demonstrated on B-scan and magnetic resonance imaging (B, C). A transconjunctival orbitotomy approach was performed rather than choroidal fine-needle biopsy to maximize tissue yield. Histopathology revealed expression of keratin (D), cytokeratin 20, caudal-related homeobox transcription factor 2 (CDX-2), and cytokeratin 7, consistent with metastatic esophageal adenocarcinoma. Positron emission tomography scan showed no primary tumor recurrence or additional metastases (Magnified version of Figure A-D is available online at www.aaojournal.org).