Bilateral choroidal metastases as the presenting sign of disseminated endometrial adenocarcinoma: a case report.

BACKGROUND: Choroidal metastases are the most common intraocular malignancy, typically resulting from breast and lung primary cancers. Ocular metastases of gynecologic origin are extremely rare. Reported cases involving endometrial adenocarcinoma are especially limited, with few documented instances globally of ocular involvement at initial presentation.

CASE PRESENTATION: We report the case of a 60-year-old woman with no known pertinent past gynecologic history who presented with two weeks of dyspnea, postmenopausal bleeding, and five days of progressively blurry vision with floaters in the left eye. Imaging revealed a markedly enlarged uterus, diffuse lymphadenopathy with lesions involving the lungs, liver, and bones, and bilateral choroidal lesions with overlying exudative retinal detachments, concerning for ocular carcinomatosis. Ophthalmologic examination confirmed bilateral choroidal metastases. Cytopathologic analyses of samples obtained from Pap smear and thoracentesis were consistent with high-grade adenocarcinoma of endometrial origin. Shortly following admission, the patient developed progressive multisystem organ failure requiring intubation and was not a candidate for chemotherapy. She passed away 17 days after presentation.

CONCLUSION: To our knowledge, this case represents the first report of bilateral choroidal metastases as the presenting manifestation of previously undiagnosed stage IV endometrial adenocarcinoma, underscoring the complex phenotypes seen with high-grade histologic manifestations of this increasingly prevalent disease. As the rate of high-grade endometrial cancer continues to rise, clinicians should remain aware that atypical presentations may arise. Early recognition and comprehensive systemic evaluation are essential, as unusual presentations of endometrial malignancy, as was the case with this patient, may signal advanced disease with limited treatment options.