Purpose: To report choroidal metastasis from the newly described nested variant of urothelial carcinoma of the bladder as the initial presentation of metastatic disease.
Methods: A 58-year-old man with a history of urothelial bladder carcinoma developed progressive decreased visual acuity in the right eye. Fundus examination showed an amelanotic choroidal tumor simulating a choroidal melanoma. Results of ancillary diagnostic tests, needle aspiration biopsy, and systemic workup failed to confirm the diagnosis of choroidal metastasis. The patient was treated with enucleation the affected right eye.
Results: Histopathologic analysis of the enucleated eye disclosed a choroidal metastatic carcinoma with urothelial features similar to those of the bladder carcinoma excised previously. Despite adjuvant systemic chemotherapy, the patient died 7 months after enucleation.
Conclusion: Choroidal metastasis may be the initial manifestation of metastatic bladder carcinoma and is associated with a poor survival prognosis.