A Case of Mediastinal Lymph Node Recurrence Presented with Cancer-related Retinopathy that Developed after Esophageal Cancer Surgery

Abstract

A 78-year-old female patient became aware of a feeling of tightness in her throat in September 2018. After an examination, she was diagnosed with thoracic esophageal cancer (Lt, Type-3, T4bN2M0, Stage IV a). Two courses of 5-FU + cisplatin (FP) therapy were administered as neoadjuvant chemotherapy in December 2018. After the treatment, thoracic esophageal cancer (Lt, Type 5b, cT3N2M0, cStage III) was diagnosed, and in March 2019, the patient underwent right trans-thoraco-abdominal subtotal esophagectomy, two regional + cervical lymph node dissections, and gastric tube reconstruction via the retrosternal route. The patient had been followed up without recurrence until October 2020, when a sudden decrease in visual acuity and the onset of color blindness occurred. Cancer-associated retinopathy (CAR), a form of autoimmune retinopathy, was clinically diagnosed based on a visual field examination, electroretinogram, OCT, and ophthalmoscopic findings. A bronchoscopic biopsy revealed squamous cell carcinoma, and recurrent metastasis was diagnosed, for which the patient received chemoradiation therapy (CRT) consisting of FP and Σ60 Gy/30 Fr. No metastasis was detected by positron emission tomography. The metastasis continued to shrink, and no new recurrences were observed. The patient's visual function improved with shrinkage of the recurrence, and no deterioration in the disease was noted. CAR caused by esophageal cancer is extremely rare. We report a case of esophageal cancer recurrence presented with CAR.