Salhab, Malek A.

Purpose: To describe an exceedingly rare presentation of vitreoretinal involvement of metastatic tonsillar squamous cell carcinoma and illustrate the utility of therapeutic and diagnostic epiretinal membrane biopsy. Methods: Case report. Results: A 57-year-old man presented with new vitreous opacities in the left eye. He had a history of tonsillar squamous cell carcinoma status postsurgical excision and was undergoing chemotherapy and radiation therapy. The patient underwent vitreous biopsy that revealed scant cellularity with concern for squamous neoplasia. Soon after, the patient developed a rapidly progressive epiretinal membrane. Membrane peel surgery with en-bloc removal of the epiretinal membrane was performed. Hematoxylin and eosin stain of the sample revealed multiple squamous eddies and mitotic figures, and cytokeratin AE1/AE3 marker was strongly positive, confirming the diagnosis of metastatic squamous cell carcinoma. Intravitreal melphalan injections were started in the left eye. The patient achieved anatomic and visual improvement. Conclusion: Intraocular squamous cell metastasis is rare, and diagnosis can be challenging. Despite initial inconclusive vitreous biopsy cytology in this case, an epiretinal membrane en-bloc sample was obtained, which confirmed involvement by the squamous cell carcinoma and prompted appropriate treatment.