HCC/CCC has emerged as a distinct subtype; it represents less than 1% of primary liver cancers [
4]. There are no clearly defined diagnostic criteria, and no guidelines regarding therapy [
5]. Known risk factors include cholelithiasis, cirrhosis and viral hepatitis [
4,
5]. HCC/CCC metastasizes through the venous or lymphatic system or along the biliary lumen with a predilection for the liver [
4]. Its distant metastases are rare; however, bony metastases were noted in one patient [
5]. There is only one case in the literature of a solitary lacrimal gland tumor from metastatic HCC [
6].
Metastatic lesions are the most common intraocular malignancies. The majority of intraocular metastases affect the choroid, while the ciliary body, the iris, the retina and the vitreous are less frequently affected. The current case illustrates the first case of a rare site of metastasis to the vitreous and retina for HCC/CCC. Breast and lung cancer most commonly metastasises to the uvea [
2,
3]. Patients with ocular metastasis most often present with blurring vision, metamorphopsia, floaters, photopsia, and a visual field defect [
2]. Our patient was complaining of floaters in his RE over the past 5 months. Retinal metastases are usually unilateral, appear white, yellow, or brown; are located in the inner retina or full-thickness retina; and have vitreous infiltrates, vitreous hemorrhage, retinal hemorrhage, subretinal fluid, intraretinal exudation [
3] and are initially often misdiagnosed as retinitis, hemangioma, choroidal neovascular membrane, or nerve fiber layer infarction [
3]. In the present case it was a unilateral white, full-thickness retinal lesion with vitreous infiltration and subretinal fluid, which resembled the clinical picture of a localized retinitis.
As the patient presented with a recently diagnosed systemic malignancy and some primary tumours tend to metastasize to the retina and vitreous, the suspected diagnosis was that of retinal and vitreous metastatic lesion. The differential diagnosis included fungal endophthalmitis an infectious retinitis of unknown origin. The biopsy was performed to establish the suspected diagnosis of an intraocular metastasis against the background of the unusual location of the lesion [
2,
3] as the treatment for these entities varies significantly and severe and permanent visual loss was to be expected in case of progressive, untreated disease. Our patient was diagnosed with a metastatic HCC/CCC to the vitreous and retina which was confirmed by biopsy. Treatment of ocular metastasis includes radiotherapy, resection with/out intravitreal anti-VEGF injection, enucleation, observation along with/or systemic chemotherapy or biologic therapy [
2,
3].