[Unilateral exophthalmos caused by orbital metastasis from carcinoma of the prostate]

Tumors metastatic to the orbit: a changing picture

Clinical characteristics of tumors metastatic to the orbit are related to primary tumor biology, and vary substantially among the various primary types. Common known primary sites include breast, lung, prostate, and melanoma. Tumor presentations can be classified into four generalized syndromes of mass, infiltrative, inflammatory, and functional effects. We found the infiltrative syndrome of presentation to be more common than for other types of orbital neoplasm. Accurate diagnosis often depends on recognition of the types of clinical syndromes and on the use of diagnostic modalities such as computed tomography, magnetic resonance imaging, fine needle aspiration biopsy, and open biopsy. Special histologic techniques are often useful in determining the origin of these often poorly differentiated tumors, and can provide a basis for specific hormonal therapy. Ophthalmologists play a vital role in the diagnosis of metastatic cancer; the orbital tumor was the presenting sign of systemic cancer in 42% of the cases reviewed. Although the overall prognosis for patients with metastatic cancer is quite poor, specific therapy is available for a growing number of cancers. Timely intervention based on accurate diagnosis can dramatically improve the duration and quality of life with selected tumors.

Carcinoma metastatic to the eye and orbit III. A clinicopathologic study of 28 cases metastatic to the orbit

Two hundred and twenty-seven cases of carcinoma metastatic to the eye and orbit have been reviewed previously. The orbit alone was involved in 28 cases: theses lesions constitute the basis of this clinicopathologic study. The most common signs and symptoms produced by orbital metastasis included exophthalmos (75%1, pain (29%), decreased vision (29%), periorbital swelling (25%), a visible mass (21%), ophthalmoplegia, and diplopia (18%). The ophthalmologists' preoperative (or premortem) clinical diagnoses were: orbital mass, 36%; metastatic carcinoma, 29%; leukemia, 7%; melanosarcoma, 4%; mixed tumor of lacrimal gland, 4%; and meningioma, 4%. The sites of the primary tumors in the 28 patients with orbital metastasis were as follows: breast, eight; lung, four; genitourinary tract, four; pancreas, one; and ileum, one. In 10 patients the site of the primary carcinoma was not determined. In 17 of the 28 patients, symptoms of orbital metastasis preceded detection of a primary tumor elsewhere in the body. In 10 of the remaining 11 patients, detection of the primary tumor had preceded the onset of orbital symptoms. In one patient, symptoms of the primary tumor and of orbital metastasis appeared at about the same time. The median survival of patients with carcinoma metastatic to the orbit was 15.6 months from the time of orbital surgery. This was much better than the median survival of the 227 patients in the overall study (7.4 months) and far better than the median survival of the patients with metastasis to the anterior segment of the eye (only 5.4 months).