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Azad F, Singalavanija T, Beaulieu R, Mingardo F, Archer SM, Elner VM, Demirci H. Multispecialty Management of Metastatic Colon Adenocarcinoma Involving the Extraocular Muscles: Primary Excision and Simultaneous Treatment of Strabismus With a Review of the Literature. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00365. [PMID: 38534052 DOI: 10.1097/iop.0000000000002648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Metastatic colon adenocarcinoma involving the extraocular muscles is extremely rare. It usually develops following the diagnosis of the systemic disease and therefore, management and treatment require a multispecialty approach. Within this manuscript, we provide a summary of cases of orbital metastasis secondary to colon cancer. We further discuss a detailed case of a 42-year-old male patient who developed recent-onset diplopia in the left gaze. Orbital CT imaging showed a localized, well-circumscribed enlargement of the right medial rectus muscle. The biopsy of the right medial rectus showed adenocarcinoma originating from the gastrointestinal system. Further workup revealed colon adenocarcinoma with multiple metastatic sites. The patient started systemic chemotherapy. After 2 months of chemotherapy (5-fluouracil, oxaliplatin, irinotecan, and leucovorin), all systemic metastatic sites regressed; however, his medial rectus muscle continued to grow, causing compressive optic neuropathy. The patient underwent excisional biopsy of the right medial rectus muscle with simultaneous repair of the strabismus with transposition of superior and inferior recti muscles. He continued with systemic chemotherapy. Follow up in 1 year revealed no local orbital tumor recurrence with excellent visual acuity and no diplopia in primary gaze.
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Affiliation(s)
- Fereshteh Azad
- Department of Ophthalmology, Kresge Eye Institute
- Wayne State University, School of Medicine, Detroit, Michigan, U.S.A
| | - Tassapol Singalavanija
- Department of Ophthalmology, Kellogg Eye Institute, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Robert Beaulieu
- Department of Ophthalmology, Kresge Eye Institute
- Wayne State University, School of Medicine, Detroit, Michigan, U.S.A
- Consultants in Ophthalmic and Facial Plastic Surgery, PC, Southfield, Michigan, U.S.A
| | - Federica Mingardo
- Department of Ophthalmology, Kellogg Eye Institute, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Steven M Archer
- Department of Ophthalmology, Kellogg Eye Institute, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Victor Maurice Elner
- Department of Ophthalmology, Kellogg Eye Institute, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Hakan Demirci
- Department of Ophthalmology, Kellogg Eye Institute, University of Michigan, Ann Arbor, Michigan, U.S.A
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Pezzulla D, Di Franco R, Zamagni A, Pastore F, Longo S, Dominici L, Lillo S, Ciabattoni A, Arcidiacono F, Deodato F, Muto P, Morganti AG, Cellini F, Maranzano E. Radiotherapy of orbital metastases: a systematic review of management and treatment outcomes on behalf of palliative care study group of Italian association of radiotherapy and clinical oncology (AIRO). Br J Radiol 2023; 96:20230124. [PMID: 37751164 PMCID: PMC10607395 DOI: 10.1259/bjr.20230124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/09/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES We search the current literature on data regarding the role of RT in OM treatment, focusing on the improvement of symptoms and patient quality of life. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. RESULTS From 340 citations, 60 papers were finally selected: 45 case reports and 15 case series. The case reports accounted for 47 patients. In 37/39 cases (95%), EBRT was done. Patients were mainly treated with 3DCRT, IMRT, and with SBRT. The most used RT regimens were 30 Gy in 10 fractions (23%) and 20-25 Gy in 5 fx (13%). No sever toxicity was reported. A median LC of 11 months (range 1-54 months) and a median OS of 12 months (range 1-54 months) were registered. Among the case series, a total of 457 patients were examined, 227 of whom underwent RT. The main used techniques were 3DCRT, CK, GK, SBRT, and BRT. RT doses could vary from 30 Gy/10 fractions to 60 Gy/30 fractions, 50 Gy/5 fractions, or 16.5-21 Gy in single fraction. No toxicity above G2 was reported. ORR could vary between 75 and 100%. Only two study provided information on response duration: a mean LC time of 22.8 months and a mean time to local progression of 5 months (range: 3-7). Regarding OS, the data were heterogeneous, ranging between 1 and 54 months. CONCLUSIONS RT for OM seems to be a safe and feasible option. More information on the RT ideal techniques and dose are still needed. ADVANCES IN KNOWLEDGE This paper tried to sum up the few and fragmented data on the use of radiotherapy for orbital metastases: the possible option ranged from 3D- and 2D-CRT to SBRT, CK, and GK, with different possible fractionations (30Gy in 10 fractions, 60 Gy/30 fractions, 20-50 Gy/5 fractions, or 16.5-21 Gy in single fraction). Regardless of the chosen approach, almost all treated patients experienced a benefit after RT in terms of OM-related symptom intensity reduction and a good acute and late toxicity profile.
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Affiliation(s)
- Donato Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Largo A. Gemelli 1, Campobasso, Italy
| | - Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Alice Zamagni
- Radiation Oncology, Department of Experimental Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum-Bologna University, Bologna, Italy
| | - Francesco Pastore
- Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Silvia Longo
- Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Luca Dominici
- Department of Radiotherapy, Humanitas Clinical and Research Center–IRCCS, Rozzano, Milan, Italy
| | - Sara Lillo
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | | | | | - Paolo Muto
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | | | - Francesco Cellini
- Dipartimento di Diagnostica Per Immagini, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Ernesto Maranzano
- University of Perugia-Faculty of Medicine and Surgery Radiotherapy Oncology Centre-“S. Maria” Hospital, Terni, Italy
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Muhammad-Ikmal MK, Masnon NA, Hayati F, Wan HItam WH. Sino-orbital metastasis as the initial presentation of advanced breast cancer. BMJ Case Rep 2022; 15:e250108. [PMID: 36368736 PMCID: PMC9660501 DOI: 10.1136/bcr-2022-250108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A woman in her 70s presented with reduced vision in her left eye, progressive narrowing of right eye opening for 6 months and anosmia. On examination, she had right enophthalmos and pseudoptosis with inferior globe dystopia. Her visual acuity was 6/9 and nil light perception in the right and left eyes, respectively. Extraocular muscle examination showed limited right up gaze. Funduscopy showed a normal right optic disc and left optic disc atrophy. Systemic examination revealed left breast ulceration with skin tethering. CT revealed an infiltrative mass invading the ethmoidal sinuses, frontal sinuses and both orbits. A histological diagnosis of infiltrative ductal breast carcinoma was made after nasal endoscopic and left breast biopsy. She underwent palliative chemoradiotherapy and survived with good disease control after 1 year. Metastatic carcinoma is a differential diagnosis of a sino-orbital mass, and comprehensive clinical assessment is indicated for all patients presenting with non-acute eye injury.
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Affiliation(s)
- Mohamad Kamil Muhammad-Ikmal
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Nurul Ain Masnon
- Department of Ophthalmology and Visual Sciences, Universiti Sains Malaysia - Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Wan-Hazabbah Wan HItam
- Department of Ophthalmology and Visual Sciences, Universiti Sains Malaysia - Health Campus, Kubang Kerian, Kelantan, Malaysia
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Mathieu A, Nicot R, Schlund M. A Recurrent Orbital Hemorrhage in an Older Adult. JAMA Ophthalmol 2022; 140:1129-1130. [PMID: 35951333 DOI: 10.1001/jamaophthalmol.2022.2875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An adult patient in their 70s presented with unilateral painless proptosis and blurred vision of the right eye that resolved with corticosteroid treatment. Magnetic resonance imaging revealed a retrobulbar hemorrhage. Six months later, the hemorrhage and proptosis recurred, with incomplete resolution despite similar treatment. What would you do?
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Affiliation(s)
| | - Romain Nicot
- University Lille, CHU Lille, Inserm, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008-Controlled Drug Delivery Systems and Biomaterial, Lille, France
| | - Matthias Schlund
- University Bordeaux, CHU Bordeaux, Inserm, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1026-Bioengineering of Tissues, Bordeaux, France
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Orbital Tumors-Clinical, Radiologic and Histopathologic Correlation. Diagnostics (Basel) 2022; 12:diagnostics12102376. [PMID: 36292065 PMCID: PMC9600631 DOI: 10.3390/diagnostics12102376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Orbital masses include a broad spectrum of benign and malignant entities. Often these masses are asymptomatic or show a slow growth rate, so that emergence of clinical symptoms is prolonged. In this context, cross-sectional imaging plays an elementary role in the characterization of these lesions. Aside from the characterization of the underlying entity, an evaluation of the involved compartments is possible by sufficient imaging, which also facilitates optimal treatment and surgery planning. The purpose of this review is to explore different benign and malignant orbital tumors and their typical appearance in imaging together with histopathologic findings.
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Mahyuddin M, Theresia K, Anggraini N, Subekti HI. Orbital metastases as the initial clinical manifestation of thyroid carcinoma: A case series. Oman J Ophthalmol 2022; 15:85-88. [PMID: 35388250 PMCID: PMC8979405 DOI: 10.4103/ojo.ojo_76_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/21/2021] [Accepted: 10/11/2021] [Indexed: 11/08/2022] Open
Abstract
Thyroid carcinoma rarely metastasizes to the orbit. Approximately only 2%-7% of orbital metastatic lesion were found originally from thyroid carcinoma. We present three cases to increase the awareness of orbital metastases as the initial manifestation of thyroid carcinoma. Three female patients aged 28-65 years old presented with initial complaint of orbital mass. Further examination discovered an asymptomatic lump on every patient's neck. However, one patient was unaware of her lump. Examination revealed that all lesions were metastases from papillary thyroid carcinoma. These cases conclude several similarities. First, prominent unilateral proptosis, orbital mass in the superior quadrant, limited eyeball movement, and orbital bone destruction were found in every patient. Second, all the orbital computed tomography scan showed extraconal solid masses involving adjacent structures and expanding intra-cranially or intrasinusly. These findings should raise one's suspicion of a metastatic lesion primarily caused by thyroid carcinoma. Despite the rarity of orbital metastases, thyroid carcinoma must be considered as a potential primary tumor in patients with initial presentation of orbital mass. Thorough physical examination is important to determine the origin of metastases.
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Affiliation(s)
- Mutmainah Mahyuddin
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia,Address for correspondence: Dr. Mutmainah Mahyuddin, Jl. Kimia No. 8, Jakarta 10320, Indonesia
| | - Kania Theresia
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - Neni Anggraini
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
| | - H. Imam Subekti
- Department Internal Medicine, Faculty of Medicine, Universitas Indonesia – Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Montejano-Milner R, López-Gaona A, Fernández-Pérez P, Sánchez-Orgaz M, Romero-Martín R, Arbizu-Duralde A. Orbital metastasis: Clinical presentation and survival in a series of 11 cases. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:81-88. [PMID: 35152953 DOI: 10.1016/j.oftale.2020.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/21/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Orbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20%-42%. The clinical presentation and survival is presented in a series of 11 cases of orbital metastasis corresponding to 10 patients. MATERIAL AND METHODS Descriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastasis involving the orbit was included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established. RESULTS One-half (50%) of the patients were women. Mean age at diagnosis was 60.9 years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases); followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%). The most common signs were resistance to ocular retropulsion (60%), presence of a mass on orbital palpation, and ocular dystopia (50%), and bulbar hyperaemia and proptosis (40%). The most employed management modality was clinical observation (5 patients). In 3 patients radiotherapy was administered, combining chemotherapy plus hormonal therapy in one case, and orbital exenteration in another one. In 2 cases, chemotherapy was administered as an isolated regime. Median survival time was 4.8 months since the diagnosis. There was a statistically significant difference between the survival time in the observation group (median 2.5 months) and in the active treatment group (median 29.2 months), p=.034. CONCLUSIONS In the series presented, 27% of the cases established the clinical debut of the malignant neoplasm. The ophthalmologist plays an essential role when this condition is suspected, diagnosing it, and proposing its management together with the Oncology Service.
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Affiliation(s)
- R Montejano-Milner
- Servicio de Oftalmología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - A López-Gaona
- Servicio de Oftalmología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - P Fernández-Pérez
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain
| | - M Sánchez-Orgaz
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain
| | - R Romero-Martín
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain
| | - A Arbizu-Duralde
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain
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Palmisciano P, Ferini G, Ogasawara C, Wahood W, Bin Alamer O, Gupta AD, Scalia G, Larsen AMG, Yu K, Umana GE, Cohen-Gadol AA, El Ahmadieh TY, Haider AS. Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes. Cancers (Basel) 2021; 14:94. [PMID: 35008259 PMCID: PMC8750198 DOI: 10.3390/cancers14010094] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Orbital metastases often lead to severe functional impairment. The role of resection, orbital exenteration, and complementary treatments is still debated. We systematically reviewed the literature on orbital metastases. METHODS PubMed, Scopus, Web-of-Science, and Cochrane were searched upon PRISMA guidelines to identify studies on orbital metastases. Clinical characteristics, management strategies, and survival were analyzed. RESULTS We included 262 studies comprising 873 patients. Median age was 59 years. The most frequent primary tumors were breast (36.3%), melanoma (10.1%), and prostate (8.5%) cancers, with median time interval of 12 months (range, 0-420). The most common symptoms were proptosis (52.3%) and relative-afferent-pupillary-defect (38.7%). Most metastases showed a diffuse location within the orbit (19%), with preferential infiltration of orbital soft tissues (40.2%). In 47 cases (5.4%), tumors extended intracranially. Incisional biopsy (63.7%) was preferred over fine-needle aspiration (10.2%), with partial resection (16.6%) preferred over complete (9.5%). Orbital exenteration was pursued in 26 patients (3%). A total of 305 patients (39.4%) received chemotherapy, and 506 (58%) received orbital radiotherapy. Post-treatment symptom improvement was significantly superior after resection (p = 0.005) and orbital radiotherapy (p = 0.032). Mean follow-up was 14.3 months, and median overall survival was 6 months. Fifteen cases (1.7%) demonstrated recurrence with median local control of six months. Overall survival was statistically increased in patients with breast cancer (p < 0.001) and in patients undergoing resection (p = 0.024) but was not correlated with orbital location (p = 0.174), intracranial extension (p = 0.073), biopsy approach (p = 0.344), extent-of-resection (p = 0.429), or orbital exenteration (p = 0.153). CONCLUSIONS Orbital metastases severely impair patient quality of life. Surgical resection safely provides symptom and survival benefit compared to biopsy, while orbital radiotherapy significantly improves symptoms compared to not receiving radiotherapy.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, 95029 Viagrande, Italy;
| | - Christian Ogasawara
- John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA;
| | - Waseem Wahood
- Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL 33328, USA;
| | - Othman Bin Alamer
- Department of Neurosurgery, King Abdullah International Medical Research Center, Riyadh 11451, Saudi Arabia;
| | - Aditya D. Gupta
- College of Medicine, Texas A&M University, Houston, TX 77030, USA; (A.D.G.); (A.S.H.)
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95126 Catania, Italy;
| | - Alexandra M. G. Larsen
- Department of Neurosurgery, Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.M.G.L.); (K.Y.); (T.Y.E.A.)
| | - Kenny Yu
- Department of Neurosurgery, Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.M.G.L.); (K.Y.); (T.Y.E.A.)
| | - Giuseppe E. Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, 95126 Catania, Italy;
| | - Aaron A. Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN 46077, USA;
| | - Tarek Y. El Ahmadieh
- Department of Neurosurgery, Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.M.G.L.); (K.Y.); (T.Y.E.A.)
| | - Ali S. Haider
- College of Medicine, Texas A&M University, Houston, TX 77030, USA; (A.D.G.); (A.S.H.)
- Department of Neurosurgery, Anderson Cancer Center, The University of Texas M.D., Houston, TX 77030, USA
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Rana S, Khosla D, Periasamy K, Kapoor R, Bhardwaj S, Madan R, Goyal S, Rajwanshi A. Orbital Metastasis as Initial Clinical Presentation in a Patient of Hepatocellular Carcinoma – A Rare Case with Review of Literature. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1736682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractOrbital metastasis, as the initial clinical presentation in hepatocellular carcinoma (HCC), is a rare manifestation. A 66-year-old male patient presented with a history of protrusion of the eyeballs, double vision, and swelling over the left side of the head for 8 months. Magnetic resonance imaging of the brain with orbit revealed a heterogeneous lesion in the left frontal lobe causing its destruction with intraorbital and intracranial extension. Triphasic contrast-enhanced computed tomography was suggestive of multiple hypodense areas in both lobes of the liver. Tissue diagnosis from the liver was suggestive of HCC. A diagnosis of multifocal HCC with orbital metastasis was made. The patient was treated with palliative radiotherapy and sorafenib. Orbital metastasis in HCC is rare. Prognosis is somber in such cases. The treatment should focus on providing palliation from symptoms.
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Affiliation(s)
- Sakshi Rana
- Department of Radiotherapy, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kannan Periasamy
- Department of Radiotherapy, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunny Bhardwaj
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shikha Goyal
- Department of Radiotherapy, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Safi M, Fethat K, Silkiss RZ. A 'never miss' diagnosis: Ptosis secondary to metastatic breast cancer diagnosed as involutional ptosis and a review of the literature. SAGE Open Med Case Rep 2021; 9:2050313X211040680. [PMID: 34457303 PMCID: PMC8385588 DOI: 10.1177/2050313x211040680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
We present a case of ptosis secondary to metastatic lobular carcinoma of the breast which was initially diagnosed as involutional ptosis. A 67-year-old woman previously diagnosed with lobular carcinoma of the breast presented to our clinic with mild restriction of lateral gaze and persistent droopiness of her right eyelid (associated with decreased levator function) despite recent repair of a suspected involutional ptosis. Orbital magnetic resonance imaging revealed a mass in the right orbit which was biopsied and diagnosed as lobular carcinoma of the breast. Poor levator function is rarely present in involutional ptosis. Especially in conjunction with abnormal extraocular motility, other etiologies of acquired ptosis must be considered. This case highlights the importance of patient history and ocular examination in identifying the underlying etiology of ptosis. A review of the literature to evaluate the incidence of signs and symptoms associated with metastatic breast cancer to the orbit is included.
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Affiliation(s)
- Mustafa Safi
- California Pacific Medical Center, San Francisco, CA, USA
| | | | - Rona Z Silkiss
- California Pacific Medical Center, San Francisco, CA, USA.,Silkiss Eye Surgery, San Francisco, CA, USA
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11
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Ghali A, Bahr T, Sherwani A, Nashawi M, Wilde D, Woolf S. Acute inflammatory presentation of orbital metastasis from urothelial carcinoma: a case report. Orbit 2021; 41:786-790. [PMID: 34078220 DOI: 10.1080/01676830.2021.1933082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Orbital metastasis of urothelial carcinoma is very rare; only 22 cases have been documented. In this case report, we describe a patient 1 month status post transurethral resection of urothelial carcinoma who presented with a clinical picture suggestive of orbital cellulitis. However, neither broad-spectrum antibiotics nor a subsequent trial of methylprednisolone was effective at relieving the patient's symptoms. CT imaging of the head, chest, abdomen, pelvis, and lower extremity showed no signs of metastatic disease. Six days after presentation, punch biopsy of the mass was performed and confirmed urothelial carcinoma metastatic to the orbit. The patient died 3 months later due to multiple sites of distant metastasis. This case report suggests that a high index of suspicion for orbital metastasis is important for patients with a history of urothelial carcinoma with new and acute onset of ocular symptoms and emphasizes the need for urgent systemic evaluation and treatment.
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Affiliation(s)
- Abdullah Ghali
- School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Tyler Bahr
- School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Anusha Sherwani
- School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Mouhamed Nashawi
- School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - David Wilde
- School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Scott Woolf
- Department of Ophthalmology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
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Oprean CM, Badau LM, Segarceanu NA, Ciocoiu AD, Rivis IA, Vornicu VN, Hoinoiu T, Grujic D, Bredicean C, Dema A. Unilateral Orbital Metastasis as the Unique Symptom in the Onset of Breast Cancer in a Postmenopausal Woman: Case Report and Review of the Literature. Diagnostics (Basel) 2021; 11:725. [PMID: 33921735 PMCID: PMC8073535 DOI: 10.3390/diagnostics11040725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 01/08/2023] Open
Abstract
The orbit represents an unusual metastases site for patients diagnosed with cancer, however, breast cancer is the main cause of metastases at this level. These orbital metastases were discovered in patients with a history of breast cancer as unique or synchronous lesions. We present a rare case of a unique retroocular metastasis as the first initial symptom of a tubulo-lobular mammary carcinoma in a postmenopausal woman. A 57-year-old patient complains of diplopia, diminishing visual acuity, orbital tenderness, slight exophthalmia and ptosis of the left eyelid, with insidious onset. Clinical examination and subsequent investigations revealed a left breast cancer cT2 cN1 pM1 stage IV. Breast conserving surgery was performed on the left breast. Pathological examination with immunohistochemistry staining established the complete diagnostic: pT2pN3aM1 Stage IV breast cancer, luminal B subtype. After two years from the initial breast cancer diagnosis, the patient was diagnosed by the psychiatrist with a depressive disorder and was treated accordingly. Orbital metastases are usually discovered in known breast cancer patients and they are found in the context of a multi-system end-stage disease. Most reports cite that up to 25% of the total orbital metastases cases are discovered before the diagnosis of the primary tumor, as our case did. MRI is the gold standard for evaluating orbital tumors. The ILC histological subtype metastasizes in the orbitals more frequently than invasive ductal carcinoma. The prognosis of patients with orbital metastases is poor. The median survival after diagnosis of orbital metastases from a breast cancer primary is ranging from 22 to 31 months. Overall survival of our patient was 56 months, longer than the median survival reported in literature. Orbital metastases must be taken into account when patients accuse ophthalmologic symptoms even in the absence of a personal history of cancer. Objective examination of every patient that incriminates these types of symptoms is essential, and breast palpation must be made in every clinical setting. Orbital biopsy is necessary for the confirmation of the diagnosis and for an adequate treatment. Although recommendations for management of orbital metastases are controversial, it appears that multidisciplinary treatment of both metastases and primary cancer improves overall survival.
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Affiliation(s)
- Cristina Marinela Oprean
- Morphopathology Department, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania; (C.M.O.); (A.D.)
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (L.M.B.); (N.A.S.); (A.D.C.); (V.N.V.)
- Department of Oncology—ONCOMED Outpatient Unit Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania
| | - Larisa Maria Badau
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (L.M.B.); (N.A.S.); (A.D.C.); (V.N.V.)
- Hygiene Department, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. No.2, 300041 Timişoara, Romania
| | - Nusa Alina Segarceanu
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (L.M.B.); (N.A.S.); (A.D.C.); (V.N.V.)
- Department of Oncology—ONCOMED Outpatient Unit Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania
| | - Andrei Dorin Ciocoiu
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (L.M.B.); (N.A.S.); (A.D.C.); (V.N.V.)
| | - Ioana Alexandra Rivis
- Neurosciences Department, “Carol Davila” University of Medicine and Pharmacy of Bucharest, 020021 Bucharest, Romania;
| | - Vlad Norin Vornicu
- Department of Oncology—ONCOHELP Hospital Timisoara, Ciprian Porumbescu Street, No. 59, 300239 Timisoara, Romania; (L.M.B.); (N.A.S.); (A.D.C.); (V.N.V.)
- Neurosurgery Department, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania
| | - Teodora Hoinoiu
- Department of Clinical Practical Skills, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania
- Clinic of Burns, Plastic and Reconstructive Surgery, “Pius Branzeu” Emergency County Hospital, 300041 Timisoara, Romania;
| | - Daciana Grujic
- Clinic of Burns, Plastic and Reconstructive Surgery, “Pius Branzeu” Emergency County Hospital, 300041 Timisoara, Romania;
- Department of Plastic and Reconstructive Surgery, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania
| | - Cristina Bredicean
- Department of Psychiatry, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania;
| | - Alis Dema
- Morphopathology Department, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq. Nr.2, 300041 Timişoara, Romania; (C.M.O.); (A.D.)
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Alkatan HM, Helmi KA, Maktabi AMY. Pitfalls in diagnosing orbital malignancy through orbital incisional biopsy: A report of two cases with different scenarios. Saudi J Ophthalmol 2021; 34:205-208. [PMID: 34085016 PMCID: PMC8081074 DOI: 10.4103/1319-4534.310420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/11/2020] [Accepted: 12/20/2020] [Indexed: 01/23/2023] Open
Abstract
Several methods have been implemented to obtain suitable samples from patients for the purpose of histopathological examination and definitive diagnosis. This has been of paramount importance in dealing with oncology cases including orbital neoplasms. Open surgical biopsy has been the common standard technique used in our eye centers in Saudi Arabia for diagnosing various orbital lesions. Other modalities such as fine-needle aspiration biopsy, core biopsy, and imaging-guided core biopsy are not popular. We report two cases where open surgical biopsies may have not been optimal in reaching the desired tissue diagnosis of orbital malignancy on time, thus resulting in delaying further management of the two patients.
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Affiliation(s)
- Hind M Alkatan
- Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khaled A Helmi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Azza M Y Maktabi
- Department of Pathology and Laboratory Medicine, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Sivagnanasithiyar T, Okafor L, Faust G, Mudhar HS, Sii S, Knapp C, Sampath R. Metastatic testicular choriocarcinoma presenting as eyelid swelling and ptosis. Orbit 2021; 41:498-501. [PMID: 33632056 DOI: 10.1080/01676830.2021.1890134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A 34-year-old man presented with an 8-day history of swelling and ptosis affecting the right upper eyelid. An MRI scan showed right superior rectus enlargement. Histology of an incisional biopsy of the muscle demonstrated metastatic choriocarcinoma to the orbit, positive for pan-cytokeratins, beta-HCG and GATA3. Possible primary sites included testis. An ultrasound of the testes identified bilateral testicular masses, highly suspicious for primary testicular malignancy. A CT scan of the chest, abdomen and pelvis identified disseminated metastatic disease conferring a poor prognostic germ cell tumour. The overall interpretation was of disseminated testicular choriocarcinoma and the patient is currently undergoing intensive chemotherapy.
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Affiliation(s)
| | - Linda Okafor
- Ophthalmology Department, University Hospitals of Leicester, Leicester, UK
| | - Guy Faust
- Oncology Department, University Hospitals of Leicester, Leicester, UK
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, E-Floor, Royal Hallamshire Hospital, Sheffield, UK
| | - Samantha Sii
- Ophthalmology Department, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Christopher Knapp
- Ophthalmology Department, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Raghavan Sampath
- Ophthalmology Department, University Hospitals of Leicester, Leicester, UK
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Sthapit PR, Saiju R. Ocular involvement in metastatic and systemic malignancies is not rare. Cancer Rep (Hoboken) 2021; 4:e1347. [PMID: 33535273 PMCID: PMC8388170 DOI: 10.1002/cnr2.1347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Metastatic disease to the eye most commonly involves choroid followed by orbit leading to varied ocular manifestations. By comparison, it is relatively rarer than primary malignancies of eye as well as metastasis in other parts of the body. Aim The aim of this study is to evaluate the common eye and orbital structures involved in secondary ocular and metastatic disease, to describe its clinical manifestations and outline the management done. Methods A retrospective study of newly diagnosed cases of ocular metastasis in last 2 years conducted in our recently established department of ocular oncology at a tertiary eye care hospital in Nepal. Demography, age and sex distribution were noted. The patients were segregated into those with secondary or metastatic ocular malignancies. Detail study on the metastatic disease to eye was made in regards to presenting symptoms, signs, primary site of cancer, and the treatment done. Details of the investigations done, like biopsy and imaging were also recorded. Results There were a total of 28 patients, whose age group ranged from 9 years to 69 years with median age of 43 years. Females constituted 46% of total patients. Both the eyes were involved in 9 patients (32%). Eye was secondarily involved by paranasal sinus tumors and Non Hodgkin lymphoma (7 patients each). Ocular metastasis was commonly seen from broncogenic carcinoma in four and breast carcinoma in three patients. Simultaneous metastasis to other parts of the body was also seen in 61% of our patients. Diminution of vision in 49% was the most common presenting feature followed by proptosis in 16% and palpable mass in 14% of patients. Orbit in 43% cases is the commonest ocular structure involved. Histopathologic diagnosis was done in 32% only while rest was based on imaging alone. The most common treatment done was chemotherapy in 57% patients. Conclusion Ocular metastasis can display a wide variety of clinical and imaging features and therefore a high degree of suspicion is required. It is often associated with simultaneous metastasis to other parts of the body as well, hence the importance of earlier diagnosis and metastatic workup.
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Affiliation(s)
| | - Rohit Saiju
- Department of Ocular Oncology and Oculoplasty, Tilganga Institute of Ophthalomology, Kathmandu, Nepal
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Muhd H, Zuhaimy H, Ismail MF, Arshad F, Azmi S, Sahak NH. Orbital Metastasis as The Initial Presentation of Breast Cancer. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:74-78. [PMID: 33329865 PMCID: PMC7735876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- H Muhd
- Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - H Zuhaimy
- Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - M F Ismail
- Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - F Arshad
- Department of Surgery, Hospital Sultanah Aminah, Johor Bahru Johor, Malaysia
| | - Snm Azmi
- Department of Pathology, Hospital Serdang, Selangor, Malaysia
| | - N H Sahak
- Department of Pathology, Hospital Serdang, Selangor, Malaysia
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Montejano-Milner R, López-Gaona A, Fernández-Pérez P, Sánchez-Orgaz M, Romero-Martín R, Arbizu-Duralde A. Orbital metastasis: Clinical presentation and survival in a series of 11 cases. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 97:S0365-6691(20)30317-8. [PMID: 32873479 DOI: 10.1016/j.oftal.2020.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Orbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20-42%. The clinical presentation and survival are presented in a series of 11 cases of orbital metastasis corresponding to 10 patients. MATERIAL AND METHODS Descriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastases involving the orbit were included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established. RESULTS One-half (50%) of the patients were women. Mean age at diagnosis was 60.9years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases), followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%). The most common signs were resistance to ocular retropulsion (60%), presence of a mass on orbital palpation and ocular dystopia (50%), and bulbar hyperaemia and proptosis (40%). The most employed management modality was clinical observation (5 patients). In 3 patients radiotherapy was administered, combining chemotherapy plus hormonal therapy in one case, and orbital exenteration in another one. In 2 cases, chemotherapy was administered as an isolated regime. Median survival time was 4.8months since the diagnosis. There was a statistically significant difference between the survival time in the observation group (median 2.5months) and in the active treatment group (median 29.2months), P=.034. CONCLUSIONS In the series presented, 27% of the cases established the clinical debut of the malignant neoplasm. The ophthalmologist plays an essential role when this condition is suspected, diagnosing it, and proposing its management together with the Oncology Service.
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Affiliation(s)
- R Montejano-Milner
- Servicio de Oftalmología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - A López-Gaona
- Servicio de Oftalmología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - P Fernández-Pérez
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España
| | - M Sánchez-Orgaz
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España
| | - R Romero-Martín
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España
| | - A Arbizu-Duralde
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España
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Abstract
Purpose: Due to improved survival durations and enhanced surveillance modalities, metastases of systemic malignancies to the orbit are increasing. This review is intended to discuss the epidemiologic, clinical, and management features of orbital metastases. Methods: A literature search for relevant publications on the topic was performed via PubMed, and the appropriate data were extracted from these manuscripts. Results: While rare, metastases to the orbit are regularly encountered in clinical practice. The overwhelming majority of these lesions present in adult patients, and metastatic disease may emerge several years after the diagnosis of the initial cancer. Subjectively, these lesions tend to present with complaints of diplopia, blurred vision, and pain, and objective signs tended to include vision loss, limitation of extraocular motility, proptosis, the presence of a palpable mass, and ptosis. Different studies reported a variety of primary tumors, although breast and lung malignancies were generally among the most common. A sizeable portion of patients may not have a known primary malignancy. After detection, survival rates are generally short, and metastatic disease suggests a worrisome prognosis. Radiation therapy may alleviate symptoms. Conclusions: Metastases of systemic disease present with specific subjective, clinical, and radiographic features. Furthermore, these lesions may present years after an initial diagnosis. Clinicians should be aware of the implications of this malady on patient survival and must consider interventions to improve quality of life.
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Affiliation(s)
- Edward J Wladis
- Lions Eye Institute, Department of Ophthalmology, Albany Medical College , Albany, New York, USA
| | - Katherine W Lee
- Lions Eye Institute, Department of Ophthalmology, Albany Medical College , Albany, New York, USA
| | - Tipu Nazeer
- Department of Pathology, Albany Medical College , Albany, New York, USA
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Fernández Berdasco K, Fernández Díaz L, Jiménez-Fonseca P, Calvo Blanco J, Burgueño Montanés C. Unilateral exophthalmos secondary to esophageal adenocarcinoma metastasis to the medial rectus muscle. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2019; 94:510-513. [PMID: 31387759 DOI: 10.1016/j.oftal.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/26/2022]
Abstract
A case is presented on a 51 year-old man with stage IV oesophageal adenocarcinoma. The patient was referred by the Oncology Department urgently for a same-day assessment by an ophthalmologist due to two weeks of severe unilateral exophthalmos and binocular diplopia. A comprehensive eye exam revealed the presence of an axial non-reductive exophthalmos and a limitation in left eye levoduction. A computed tomography scan was performed that showed a multiple lobed, intra-and extra-conal, heterogeneous left orbital mass, that surrounded the internal rectus muscle, compatible with metastasis, as well as another small extraconal mass at the base of the contralateral orbit. Palliative radiotherapy was then indicated. Metastases in the extraocular muscles are a very rare finding, but should be suspected in a case of unilateral exophthalmos and, if necessary, refer the patient to have the corresponding complementary tests performed.
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Affiliation(s)
- K Fernández Berdasco
- Sección de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - L Fernández Díaz
- Sección de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - P Jiménez-Fonseca
- Sección de Oncología Médica, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - J Calvo Blanco
- Sección de Radiodiagnóstico, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - C Burgueño Montanés
- Sección de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Mombaerts I, Ramberg I, Coupland SE, Heegaard S. Diagnosis of orbital mass lesions: clinical, radiological, and pathological recommendations. Surv Ophthalmol 2019; 64:741-756. [PMID: 31276737 DOI: 10.1016/j.survophthal.2019.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023]
Abstract
The orbit can harbor mass lesions of various cellular origins. The symptoms vary considerably according to the nature, location, and extent of the disease and include common signs of proptosis, globe displacement, eyelid swelling, and restricted eye motility. Although radiological imaging tools are improving, with each imaging pattern having its own differential diagnosis, orbital mass lesions often pose a diagnostic challenge. To provide an accurate, specific, and sufficiently comprehensive diagnosis, to optimize clinical management and estimate prognosis, pathological examination of a tissue biopsy is essential. Diagnostic orbital tissue biopsy is obtained through a minimally invasive orbitotomy procedure or, in selected cases, fine needle aspiration. The outcome of successful biopsy, however, is centered on its representativeness, processing, and interpretation. Owing to the often small volume of the orbital biopsies, artifacts in the specimens should be limited by careful peroperative tissue handling, fixation, processing, and storage. Some orbital lesions can be characterized on the basis of cytomorphology alone, whereas others need ancillary molecular testing to render the most reliable diagnosis of therapeutic, prognostic, and predictive value. Herein, we review the diagnostic algorithm for orbital mass lesions, using clinical, radiological, and pathological recommendations, and discuss the methods and potential pitfalls in orbital tissue biopsy acquisition and analysis.
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Affiliation(s)
- Ilse Mombaerts
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
| | - Ingvild Ramberg
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Section of Eye Pathology, Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, UK; Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, UK
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Section of Eye Pathology, Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Shahid Z, Kalayanamitra R, Groff A, Khalid MF, Jain R. Renal Cell Carcinoma Metastasis to an Uncommon Site: The Orbital Bone. Cureus 2019; 11:e4606. [PMID: 31309029 PMCID: PMC6609277 DOI: 10.7759/cureus.4606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Renal cell carcinoma (RCC) represents 90% of all renal cancers. Patients may present with weight loss, hematuria, abdominal mass, abdominal pain, fever, and night sweats. The classic symptoms of flank pain, hematuria, and a palpable flank mass occur in less than 10% of patients and suggest advanced disease. However, most patients are typically asymptomatic and diagnosed incidentally. RCC metastasizes most commonly to the lung parenchyma, bone, liver, and brain and less commonly to the thyroid, pancreas, muscle, skin, and soft tissue. It is very rare for RCC to metastasize to the orbital bone. We present a case of a patient who presented with left cheek pain, tingling, and numbness and was ultimately found to have orbital metastasis of RCC.
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Affiliation(s)
- Zainab Shahid
- Internal Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Ricci Kalayanamitra
- Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Andrew Groff
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Muhammad F Khalid
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Rohit Jain
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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