What happened, in summary

A 60-year-old man presented after 6 months of progressive painful vision loss in his left eye, followed by displacement of the eye. Examination and imaging showed a large choroidal and orbital mass with retinal detachment.

A systemic evaluation found anemia and occult blood in the stool. Endoscopy then revealed an ulcerating, infiltrative gastric lesion involving the antrum, body and cardia. Biopsy showed poorly differentiated gastric adenocarcinoma. Tissue from the eye and orbit confirmed metastatic adenocarcinoma involving the uvea, sclera, optic nerve and orbital soft tissue. Chest imaging also showed lung abnormalities considered suspicious for metastases, but these were not pathologically confirmed.

Because vision in the affected eye could not be preserved and the local spread was extensive, he underwent modified exenteration of the left orbit. He then received chemotherapy and radiation for gastric cancer. The metastatic disease had presented through the eye before the stomach cancer was known, and he died 6 months later.