Branch retinal artery occlusion caused by an embolus of metastatic gastric adenocarcinoma.

We report a case of branch retinal artery occlusion caused by an embolus of metastatic gastric adenocarcinoma. A 67-year-old man sought treatment for sudden visual loss in his left eye. He had a medical history of gastric cancer with liver metastasis. Findings on funduscopic examination included localized edema of the inner retina consistent with a supratemporal branch retinal artery occlusion and a yellowish-white subretinal mass surrounded by shallow retinal detachment superior to the equator. Histopathological and immunohistochemical examinations of the eye obtained post mortem showed positive staining of the choroidal tumor for epithelial membrane and carcinoembryonic antigens. In addition, an embolus of tumor cells was found to cause occlusion of the retinal artery. Occlusion of the retinal artery is mostly ascribed to either embolus, thrombus, or vasculitis. It is strongly associated with carotid atheromatous plaque or cardiac valvular diseases with vegetation. Other causes, such as atrial myxoma, temporal arteritis, periarteritis nodosa, and systemic lupus erythematosus, have been described but are relatively rare. Embolism caused by neoplastic cells is extremely rare. We report a case of gastric adenocarcinoma that metastasized to the choroid and occluded a branch retinal artery with an embolus of carcinoma cells.