Department of Hematology-Oncology, Prince George’s Medical Center, Cheverly, Maryland,USA

Recently, there have been more reports of intraocular metastatic tumours. Metastasis to the retina, in contrast to choroidal metastasis, is extremely uncommon and has only been documented in a small number of case cases. A 56-year-old man who underwent a lap colectomy for a primary cecal tumour after presenting with a history of cecum adenocarcinoma made the decision to quit receiving adjuvant chemotherapy after receiving it for a year. At this time, it was also determined that he had liver and lung metastases. Two years after the initial diagnosis, he returned with left eye pain, pressure, and impaired vision that would indicate retinal metastasis from the cecal main lesion.

Intraocular metastasis was once thought to be a rare type of intraocular malignancy, however it is now a widespread occurrence. 1 More frequently than retinal metastases, choroidal metastases are disseminated from breast cancer (50% of cases), then lung cancer. [1] Rare occurrences of retinal metastases have only recently been documented. The majority of retinal metastases originate from cutaneous melanoma, with breast and lung primary in men and women making up a smaller subset[2].Retinal metastases from primary gastrointestinal tumours are extremely uncommon, compared to choroidal metastases, which occur in 7% of visceral/gastrointestinal cancers.[2]

Few cases have been reported where colon cancer was the main cause. The third most frequent cancer in the United States is colorectal cancer, though.Few cases have been reported where colon cancer was the main cause. However, colorectal cancer deserves special attention because it is the third most frequent cancer in the US and the third greatest cause of cancer death in both sexes. 3 We outline the few examples that have been published before presenting a case report of retinal metastases from colon cancer.

This case report describes a cecal adenocarcinoma that metastasized to the retina. On May 12, 2013, a 56-year-old man with a history of alcohol addiction was admitted to the intensive care unit (ICU) at Prince George's Hospital Center (PGH) with acute symptomatic anaemia. He was also guaiac positive. He had a colonoscopy, and the cecal polyp biopsy results were consistent with a well-differentiated adenocarcinoma.

On May 19, 2013, he underwent a right colectomy with laparoscopic assistance. The well-differentiated adenocarcinoma with focal mucinous differentiation that originated in the cecum and invaded through the muscularis propria and focally into the sub serosa was present in the resected colon, according to the pathology report (size 3.7 cm). Invasive cancer was not present at the mesenteric, circumferential, or distal margins. Both lymphatic vascular invasion and lymph node metastases were absent.

The 12 lymph nodes were all cancer-free at the time of excision. The original colon carcinoma had a pathologic stage of T3 N0 Mx. For primary colon cancer, he underwent adjuvant chemotherapy. He was taken to PGH in January 2014 due to stomach pain. He had been diagnosed with pancreatitis and underwent further testing with MRCP on January 16, 2014, which revealed evidence of three liver lesions. A CT-guided core biopsy of the liver lesions revealed metastatic mucinous adenocarcinoma, which is consistent with colon cancer as the initial source. On February 14, 2014, his PET-CT scan revealed liver and lung metastases.It was suggested to the patient to keep up the treatment.The patient thought about alternative treatment plans like integrative oncology at Cancer Centers of Philadelphia America, but ultimately elected to forgo additional chemotherapy.

The ongoing case presents an exceptional site of metastasis for colorectal disease. All things considered intraocular metastasis was viewed as an interesting intraocular cancer; however as of late it is thought of more normal.[1] Dissimilar to metastasis to choroid,retinal metastasis is extremely uncommon.[1]

In spite of choroidal metastasis which happen 7% from instinctive or gastrointestinal malignant growths, 2,4,5 retinal metastasis from esophageal and pancreatic malignant growths are accounted for in scarcely any case reports. Using OVID,PUBMED/MEDLINE and Google Researcher, we directed a writing search to figure out earlier detailed instances of retinal metastasis starting from colon disease. Catchphrases utilized for the writing search included 'colorectal neoplasms', 'metastasis to retina'/'retinal metastasis' and 'eye neoplasms'.

The retinal etastasis from colon adenocarcinoma of the colon are accounted for in just 3 cases. 4,7,8 First case was depicted by Kennedy et al.3 in 1956 in a 51 year-old male patient who gave hazy vision in the right eye and on ophthalmoscopic assessment was found to have 1/6 dd. Estimated well delineated grayish white sore in the macula stretching out into the glassy. His previous clinical history was critical for discontinuous rectal draining and went through fistulecto my. He was alluded to a

proctologist who affirmed that the patient had annular carcinoma of the rectosigmoid intersection.The patient promptly went through rectosigmoidectomy and the pathology was reliable with adenocarcinoma of the rectosigmoid. The follow-up ophthalmoscopic assessment in 6 months from his underlying visit howed expanding size of the cancer and new vessels flowing over the cancer inciting enucleation of the eye. The histopathology of the areas of the eye was steady with that of the adenocarcinoma of the rectosigmoid. In any case, after 90 days the patient passed on no doubt from metastatic illness and necropsy was denied. A subsequent case was accounted for in a 74 year elderly person with Muir-Torre condition;an autosomal prevailing condition with skin sores related with instinctive diseases.[6]

The patient had mvarious cancers including sebaceous adenomas of face and neck status post extraction, uterine leiomyoma, keratoacanthoma of the eyelid,squamous cell carcinoma of the temple, adenocarcinoma of the bosom status post mastectomy, adenocarcinoma of the colon and retinal cancer. The patient went through enucleation,of the eye for retinal cancer and the histopathology was reliable with adenocarcinoma. In any case, the wellspring of essential cancer was not checked on the grounds that of the inaccessibility of the bosom adenocarcinoma tests for survey. Most as of late one more instance of adenocarcinoma of the cecum metastasizing to retina was depicted by Apte et al.7 A 39 year-old male with adenocarcinoma of the cecum metastasizing to liver ,furthermore, lung went through hemicolectomy.

A month and a half after medical procedure, he got postoperative chemotherapy for quite some time and gave grumblings of vision changes in his left eye.Ophthalmologic assessment uncovered sub retinal discharge in the eye. No mass was recognized at that time. In any case, during his subsequent visit at 2.5 months, he was found to have a 2.8 mm x 5.3 mm x 6.6 mm retinal mass related with exudative retinal separation additionally including the fovea. One month after the fact, on expanded eye test and ultrasonography, the mass was found to have expanded in size essentially. He was all the while getting chemotherapy for the essential malignant growth and went through 3-port plana vitrectomy for the retinal growth. [7] The system dealt with the whole retinal growth en alliance because of restriction of the cancer to retina and not including any encompassing structure. The histopathology of the cancer was reliable with the mucin is charging adenocarcinoma of the colon essential. The patient gotten present usable palliative radiation on the mcircle and at 90 days follow-up visit he had a nonpainful eye with typical intraocular pressure. His fringe vision was recaptured ensuing to

retinal reattachment system.[7]At the point when there is malignant growth metastasis to retina there is a high likelihood of the disease spreading to focal sensory system which conveys unfortunate forecast.Subsequently, retinal metastasis ought to continuously be thought about in the differential analysis of any colon malignant growth patient giving vision changes. Moreover,as shown by our case, X-ray of the circle may not generally be definitive in diagnosing retinal growths.

A patient's history of colon/GI cancers should raise a high index of suspicion for retinal metastasis, which must be investigated by an ophthalmoscopic examination that includes a dilated fundus exam, a B-scan, and an OCT in order to make a diagnosis and help with the treatment plan, which is typically palliative radiation to the eye.[9] This case serves as a foundation for a challenging diagnosis of an uncommon clinical appearance.

We convey our sincere gratitude and appreciation to the patient who so graciously volunteered to take part in our study. For their ongoing assistance and support throughout the project, we also want to thank the staff at Prince George's Hospital in Cheverly, Maryland, Doctors Regional Cancer Center in Lanham, Maryland, Greater Washington Oncology Associates in Riverside, Maryland, and Retina Centers of Washington in Rockville, Maryland.

1. Jardel P, Sauerwein W, Olivier T, et al. Management of choroidal metastases. Cancer Treat Rev. 2014;40(10):1119-28.

2. Vajzovic L, Mruthyunjaya P, Retinal metastatic tumors.In: Arun D. Singh, Bertil E. Damato. Clinical Ophthalmic Oncology: Retinal Tumors, 2nd Edition, Philadelphia, Springer-Verlag Berlin Heidelberg, 2014; pages 94-96.ISBN: 978-3-642-39488-1.

3. Siegel R, DeSantis C, Jemal A. "Colorectal cancer statistics, 2014." CA Cancer J Clin. 2014; 64(2): 104-117.

4. Kennedy RJ, Rummel WD, Mc Carthy JL, et al. Metastatic carcinoma of the retina: report of a case and the pathologic findings. AMA Arch Ophthalmol. 1958;60(1):12-18.

5. Shields CL, Shields JA, Gross NE, et al. Survey of 520 eyes with uveal metastases. Ophthalmology. 1997; 104(8):1265-76.

6. Shields CL, McMahon JF, Atalay HT, et al. Retinalmetastasis from systemic cancer in 8 cases. JAMA Ophthalmology. 2014; 132(11):1303-8.

7. Spraul CW, Lang GE, Grossniklaus HE, et al. Metastatic adenocarcinoma to the retina in a patient with MuirTorre syndrome. Am J Ophthalmol. 1995; 120(2):248-50.

8. Apte RS, Dibernardo C, Pearlman JR, et al. Retinal metastasis presenting as a retinal hemorrhage in a patient with adenocarcinoma of the cecum. Arch Ophthalmol. 2005; 123(6):850-3.

9. Khawaja MR, Minturn JT, Spittler AJ, et al. Ocular metastasis of colorectal cancer: An uncommon presentation of a common malignancy. Hematol Oncol Stem Cell Ther. 2015; 8(4):176-80.

G.S.Chhabra . Colon Adenocarcinoma Retinal Metastasis: Difficult Diagnosis. World Journal Of Hematology And Oncology 2022.