Metastatic carcinoma masquerading as scleritis.

Area of Science:

• Ophthalmology
• Oncology
• Pathology

Background:

• A 36-year-old man presented with sudden, painless vision loss in his left eye.
• Initial clinical diagnosis was scleritis with exudative retinal detachment.

Observation:

• Fundoscopy revealed retinal detachment and choroidal infiltrate; angiography showed choroidal leakage.
• Imaging confirmed choroidal and scleral thickening.
• Despite systemic prednisone, the patient developed severe pain, proptosis, glaucoma, and episcleral injection.

Findings:

• Enucleation revealed a necrotic tumor infiltrating the choroid, sclera, and episclera.
• Microscopic analysis identified a well-differentiated, mucin-producing adenocarcinoma, consistent with bronchiolo-alveolar carcinoma.
• Electron microscopy showed characteristic features of bronchiolo-alveolar carcinoma, including apical villi and secretory granules.

Implications:

• This case demonstrates an unusual presentation of bronchiolo-alveolar carcinoma as "malignant scleritis."
• The patient later developed pulmonary infiltrates, confirming the systemic nature of the tumor.
• Highlights the importance of considering metastatic disease in atypical ocular presentations.