A 77-year old woman with a 4-year history of nonproductive cough had a 4-month history of progressive blurred vision in the left eye. Her visual acuity was 20/20 OD, and hand motions OS. Fundus examination showed 2 subtle, amelanotic, acoustically solid choroidal masses on the right eye located along the inferotemporal arcade measuring 3 × 1.5 × 1.5 mm and 1 × 1 × 0.5 mm with no associated subretinal fluid. In the left eye, there was a solitary amelanotic mass measuring 13 × 12 × 6.4 mm with serous retinal detachment. (Figure, E) On ultrasonography, the acoustically solid mass displayed a hollow central cavity occupying 20% of the mass. (Figure, F) Fine-needle biopsy disclosed pleomorphic cells more consistent with melanoma than metastasis. Therapeutic options included radiotherapy or enucleation, and the patient preferred enucleation of the left eye. Gross examination of the enucleated eye showed a tan choroidal mass with overlying shallow retinal detachment. Microscopic analysis of the lesion (previously described5) showed a malignant neoplasm with pigmented dendritiform cells with slender processes and a fluid-filled, intralesional cavity without an endothelial lining. There was no area of necrosis, hemorrhage, or inflammation surrounding the cystic cavity. There was no sign of trauma from the needle biopsy inducing the cavity. Immunohistochemical staining of the mass showed immunoreactivity for cytokeratin markers (CAM 5.2, AE1), calcitonin, chromogranin, and synaptophysin, features that were indicative of a metastatic NET. Results of immunoreactivity testing for melanoma marker HMB45, as well as S100, vimentin, and breast carcinoma markers were negative. Systemic evaluation revealed a lung nodule on the right middle lobe with positive immunoreactivity to AE1, calcitonin, chromogranin, and synaptophysin, consistent with NET.5 On the last follow-up visit at 22 months, her visual acuity remained unchanged in the right eye and the choroidal metastases were stable.