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Rahman MA, Balakrishnan R, Mostofa MG, Islam MR, Kabir E, Islam MS, Naznin B, Das A, Chowdhury Q. Case Report: Primary Squamous Cell Carcinoma of the Orbit in a Patient With Carney's Syndrome Treated With Multidisciplinary Approaches. Cancer Rep (Hoboken) 2024; 7:e70020. [PMID: 39324687 DOI: 10.1002/cnr2.70020] [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] [Received: 02/11/2024] [Revised: 08/12/2024] [Accepted: 09/06/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Squamous cell carcinoma (SCC) is a rare malignancy of invasive epithelium with keratinocyte differentiation, and it is the most common form of eyelid malignant neoplasm, comprising 5%-10% of malignancies. While SCC rarely affects the orbit, it may be involved through local invasion from a cutaneous primary site or extension by perineural invasion. Only 12 cases of primary orbital SCC have been reported until now. Here, we present a case of primary carcinoma of the right orbit with coexisting Carney's syndrome, a rare genetic disorder associated with multiple endocrine neoplasias (MEN) syndromes. CASE A 62-year-old South Asian male presented with a painful swelling in the lateral aspect of the right eyebrow and protrusion of the eyeball in August 2020. He had a history of excision of Right atrial Myxoma in March 2020. Orbital computerized tomography (CT) and positron emission tomography (PET-CT) scans revealed an enhancing soft tissue lesion in the right orbit with the involvement of frontal and ethmoid sinuses. Biopsy confirmed HPV-related poorly differentiated SCC, positive for HPV-related markers. The patient received concurrent chemo irradiation with Cisplatin. Follow-up PET-CT done 3 months later showed a new lesion appeared in the right orbital region and right lobe of thyroid. Later had surgical excision and total thyroidectomy, and histopathological examination (HPE) from orbit was reported as invasive SCC and from the thyroid was reported as synchronous papillary thyroid cancer. The patient's proptosis resolved, and subsequent PET-CT and magnetic resonance imaging (MRI) scans did not show any residual or recurrent disease. CONCLUSION Primary SCC of the orbit is an extremely rare disease, and this case report presents the 13th reported case and the first one associated with Carney's syndrome. As there is no standard treatment regimen for primary SCC of the orbit, this case highlights the use of multimodality treatment, including surgical excision and chemo irradiation. The findings emphasize the importance of early detection and management of this uncommon and life-threatening condition, providing hope for patients and aiding in the prevention of recurrence.
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Affiliation(s)
- Md Arifur Rahman
- Department of Oncology, Bangladesh Specialized Hospital Limited, Dhaka, Bangladesh
| | | | | | | | - Enamul Kabir
- Department of Physics, Delta Medical College Hospital, Dhaka, Bangladesh
| | - Md Shariful Islam
- Department of Physics, Delta Medical College Hospital, Dhaka, Bangladesh
| | - Bidoura Naznin
- Department of Oncology, Square Hospitals Limited, Dhaka, Bangladesh
| | - Arunangshu Das
- Department of Oncology, Square Hospitals Limited, Dhaka, Bangladesh
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Korchnoy I, Jimenez JG, Izquierdo-Pretel G. Confronting the Unseen: A Journey Through Primary Intra-orbital Squamous Cell Carcinoma. Cureus 2024; 16:e59598. [PMID: 38832146 PMCID: PMC11144589 DOI: 10.7759/cureus.59598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Cases of squamous cell carcinoma (SCC) that are primary in origin occur even more infrequently due to the lack of squamous epithelium that is typically present in the orbital region. When SCC occurs in the orbit, it is more commonly due to invasion or metastasis from a local site. We report an uncommon case of intra-orbital SCC in a 74-year-old male, which is likely of primary origin. Brain, face, orbital, and neck magnetic resonance imaging proceeded to gather more information on the extent of the patient's orbital malignancy, which showed significant orbital burden and intracranial extension. The biopsy was performed with final pathology results showing moderately differentiated SCC. The patient was discharged with a follow-up with oncology for chemotherapy and a follow-up with oculoplastics for surgical intervention in nine months, after completing a course of chemotherapy with irradiation. We provide this case to shed insight into the difficulties associated with the extremely uncommon occurrence of primary SCC of the orbit.
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Affiliation(s)
| | - Juan Gabriel Jimenez
- Internal Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
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He LF, Mou P, Wei RL. Epidemiology and survival outcomes of patients with orbital region non-cutaneous squamous cell carcinoma: a population-based analysis. Front Oncol 2023; 13:1152337. [PMID: 37213302 PMCID: PMC10196690 DOI: 10.3389/fonc.2023.1152337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
Background Non-cutaneous squamous cell carcinoma (ncSCC) of the orbital region is very rare. Thus, its epidemiological characteristics and prognosis are poorly understood. The aim of the study was to assess the epidemiological characteristics and survival outcomes of ncSCC of the orbital region. Methods Incidence and demographic data on ncSCC of the orbital region were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and analyzed. The chi-square test was used to calculate the differences between groups. Univariate and multivariate Cox regression analyses were performed to determine the independent prognostic factors for disease-specific survival (DSS) and overall survival (OS). Results The overall incidence of ncSCC in the orbital region from 1975 to 2019 was 0.68/1,000,000, and the incidence showed an increasing trend during this period. A total of 1,265 patients with ncSCC of the orbital region (mean age, 65.3 years) were identified in the SEER database. Of these, 65.1% were aged ≥60 years, 87.4% were White, and 73.5% were male. The conjunctiva (74.5%) was the most common primary site, followed by the orbit (12.1%), lacrimal apparatus (10.8%), and overlapping lesion of the eye and adnexa (2.7%). Multivariate Cox regression analysis revealed that age, primary site, SEER summary stage, and surgery were independent prognostic factors for DSS, whereas age, sex, marital status, primary site, SEER summary stage, and surgery were independent prognostic factors for OS. Conclusions The incidence of ncSCC in the orbital region has increased over the past 40 years. It usually affects White people, men, and people aged ≥60 years, and its most common site is the conjunctiva. Orbital SCC has worse survival outcomes than SCC of other sites in the orbital region. Surgery is the independent protective treatment for ncSCC of the orbital region.
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Steren B, Burtness B, Bhatia A, Demirci H, Shinder R, Yoo D, Tse B, Pointdujour-Lim R. Cemiplimab for Orbital Squamous Cell Carcinoma in 11 Cases. Ophthalmic Plast Reconstr Surg 2022; 38:496-502. [PMID: 35502804 DOI: 10.1097/iop.0000000000002190] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To review the demographics, clinical features, and response of orbital squamous cell carcinoma treated with cemiplimab. METHODS This is a retrospective multi-institutional series. Patient characteristics, drug dosing, duration, and response to treatment were evaluated. RESULTS The study cohort consisted of 11 patients from 5 institutions. All patients received a regimen of 350 mg q 3 weeks and an average of 11.2 cycles (SD 5.8). No patient experienced significant side effects requiring treatment or cessation of cemiplimab. Complete response was achieved in 9 patients (82%) treated with cemiplimab. CONCLUSIONS Immune checkpoint inhibitors, such as cemiplimab provide a globe-sparing option for the treatment of orbital squamous cell carcinoma. It is important to consider these agents especially when orbital exenteration is the alternative.
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Affiliation(s)
- Benjamin Steren
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven
| | - Barbara Burtness
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, U.S.A
| | - Aarti Bhatia
- Department of Internal Medicine, Yale Cancer Center, New Haven, CT, United States; Yale University School of Medicine, U.S.A
| | - Hakan Demirci
- Department of Ophthalmology and Visual Science, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Roman Shinder
- Department of Ophthalmology and Visual Science, SUNY Downstate, Brooklyn, New York, U.S.A
| | - David Yoo
- Department of Ophthalmology and Visual Science, Loyola University Medical Center, Maywood, Illinois, U.S.A
| | - Brian Tse
- Department of Ophthalmology and Visual Science, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
| | - Renelle Pointdujour-Lim
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven
- Yale Smilow Cancer Center, New Haven, CT, U.S.A
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Invasive Orbital Squamous Cell Carcinoma in a Patient with Multiple Myeloma. Case Rep Ophthalmol Med 2022; 2022:8585692. [PMID: 35815062 PMCID: PMC9259366 DOI: 10.1155/2022/8585692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/03/2022] [Accepted: 06/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Orbital squamous cell carcinoma (SCC) is a rare entity. It is often a result of local invasion of SCC originating from the skin, nasopharynx, nasal cavity, paranasal sinuses, conjunctiva, lacrimal glands, or sac or less commonly occurs through hematogenous metastasis. Herein, we report a patient with orbital SCC with a history of multiple myeloma (MM). Case presentation. A 45-year-old woman with a history of MM in the past two years presented to our clinic complaining of gradual right eye proptosis for six months. The relative afferent pupillary defect was detected in the right eye on her examination. Ocular movements of the right eye were limited in all directions. Orbital magnetic resonance imaging demonstrated an infiltrative mass in the right orbit extended from the anterior to the orbital apex and the optic canal. The patient underwent debulking, and a histopathology examination revealed SCC results. No other secondary site was found to be the origin of the tumor. Result The patient underwent chemotherapy and subsequent radiotherapy. To our knowledge, this is the first report of concomitant MM and primary orbital SCC.
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Blandford AD, Bellerive C, Tom M, Koyfman S, Adelstein DJ, Plesec TP, Perry JD, Singh AD. Case Report: Primary Orbital Squamous Cell Carcinoma. Ocul Oncol Pathol 2019; 5:60-65. [PMID: 30675479 DOI: 10.1159/000490060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/14/2018] [Indexed: 11/19/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the orbit is almost uniformly the result of local invasion from a cutaneous primary, extension by perineural invasion, or the result of metastasis. This is owed to the lack of native squamous epithelium in the orbit. After review of the literature, to date, only 6 reports of 8 patients with primary orbital SCC exist. Of those cases, only 2 reported non-apical orbital SCC. There are 2 reports of orbital SCC after retina surgery with proposed transplanted conjunctival epithelium and subsequent malignant transformation of a conjunctival cyst. The initial signs and symptoms can be vague and lead to delay in diagnosis. We present a case of primary orbital SCC and discuss the workup, imaging, and multidisciplinary management of this rare condition.
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Affiliation(s)
| | | | - Martin Tom
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shlomo Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Thomas P Plesec
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Julian D Perry
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arun D Singh
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Elusively reaching the apex. Surv Ophthalmol 2017; 64:584-587. [PMID: 29248532 DOI: 10.1016/j.survophthal.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/08/2017] [Indexed: 11/22/2022]
Abstract
A 64-year-old man presented with a 3-month history of diplopia and left-sided proptosis. Examination was significant for impairment of his left second, third, fourth, fifth, sixth, and seventh cranial nerves. Magnetic resonance imaging revealed a left orbital apex and cavernous sinus lesion. However, subtle thickening of his left frontal and supraorbital nerve was not identified until later. A trial of steroids provided minimal effect. Biopsy of the lesion showed a well-differentiated squamous cell carcinoma. The patient was subsequently managed with palliative radiotherapy.
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Kennedy A, Allan K, Rajak S. A primary squamous cell carcinoma of the orbit. Can J Ophthalmol 2017; 52:e230-e233. [DOI: 10.1016/j.jcjo.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/27/2017] [Accepted: 04/05/2017] [Indexed: 11/27/2022]
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Maaß J, Sommer F. [Unexpected outcome in entropion lower eyelid repair]. Ophthalmologe 2016; 114:473-475. [PMID: 27620917 DOI: 10.1007/s00347-016-0356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Maaß
- Klinik und Poliklinik für Augenheilkunde, Medizinische Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - F Sommer
- Klinik und Poliklinik für Augenheilkunde, Medizinische Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Koukkoulli A, Koutroumanos N, Kidd D. Perineural Spread of Cutaneous Squamous Cell Carcinoma Manifesting as Ophthalmoplegia. Neuroophthalmology 2015; 39:144-146. [PMID: 27928347 PMCID: PMC5123107 DOI: 10.3109/01658107.2015.1035449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 11/13/2022] Open
Abstract
An 89-year-old female presented with horizontal diplopia and was diagnosed with VI nerve palsy attributed to a microvascular event. She subsequently progressed to develop an orbital apex syndrome, with neuroimaging demonstrating tumour invasion. Eighteen months earlier, she had squamous cell carcinoma of the forehead excised with clear margins. Intraneural and perineural spread of squamous carcinoma from the face to the cranial cavity is an important cause of delayed cranial nerve palsies after local excision of the skin tumour.
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Affiliation(s)
- Antigoni Koukkoulli
- Department of Neuro-Ophthalmology, Royal Free HospitalLondonUK and
- Moorfields Eye Hospital NHS TrustLondonUK
| | - Nikolas Koutroumanos
- Department of Neuro-Ophthalmology, Royal Free HospitalLondonUK and
- Moorfields Eye Hospital NHS TrustLondonUK
| | - Desmond Kidd
- Department of Neuro-Ophthalmology, Royal Free HospitalLondonUK and
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12
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Recurrent orbital squamous cell carcinoma with extension to the middle cranial fossa. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-013-0902-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Choi DY, Lee JH, Ahn JH, Suh YL, Woo KI, Kim YD. Primary Squamous Cell Carcinoma of the Orbit. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.8.1224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Da Ye Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hye Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hyun Ahn
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Duck Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Meilak L, Haliasos N, Narducci A, Powell M. More than meets the Wegener's eye. J Rheumatol 2013; 40:1226-7. [PMID: 23818723 DOI: 10.3899/jrheum.121403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Lara Meilak
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
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