Mucinous gastric cancer presenting with an iris metastasis

What happened, in summary

A 74-year-old Japanese woman sought care for blurred vision and high pressure in her right eye. Initial treatment for presumed eye inflammation did not resolve the problem, and biopsy of an iris mass showed an epithelial cancer most consistent with a gastrointestinal origin.

Gastroscopy then revealed multiple abnormal gastric lesions. Biopsy showed poorly differentiated adenocarcinoma with signet-ring features, and CT demonstrated diffuse thickening of the stomach wall with punctate calcifications. Cancer had also spread to the peritoneum and para-aortic and mesenteric lymph nodes. Taken together with the iris biopsy, this established Stage IV gastric cancer.

She received 7 cycles of S-1 plus cisplatin. The white iris masses became slightly smaller after 3 cycles and remained stable through the seventh cycle. CT after 6 cycles showed no clear disease progression, although tumor-marker levels were rising. After the seventh cycle, massive ascites developed.

She died of aspiration pneumonia 8 months after her initial presentation. Autopsy showed mucinous gastric adenocarcinoma with signet-ring cells, persistent invasion through the stomach wall and further extension into the esophagus and lymph nodes. Her death was therefore documented in the setting of extensive metastatic gastric cancer, but the immediate cause was aspiration pneumonia.