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Neumann I, Borrelli M, Al Kallaa M, Parker RT, Trigaux C, Teichert N, Geerling G. Rare periorbital, pseudocystic metastasis of squamous cell carcinoma of the bladder: Case report and review of the literature. Orbit 2021; 42:336-342. [PMID: 34913824 DOI: 10.1080/01676830.2021.2012203] [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: 10/19/2022]
Abstract
We present the case of a man in his fifties with a history of bladder carcinoma who presented with a large periorbital cystic lesion that was found to be a metastasis. Bladder carcinomas are a very rare cause of peri-/orbital metastasis. The primary tumor in this case predominately showed squamous cell differentiation and small areas of adenoid differentiation. To our knowledge only one previous case of orbital metastasis from squamous cell carcinoma of the bladder has been reported. Cyst formation in bladder cancer metastasis has not been reported and is very rare for orbital metastases in general. The pathogenesis of metastatic cyst development is not fully understood and may vary from case to case. A biopsy of an atypical cyst is indicated.
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Affiliation(s)
- Inga Neumann
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Borrelli
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Al Kallaa
- Institute of Pathology, University Hospital Duesseldorf, Germany
| | - R T Parker
- Adnexal Department, Moorfields Eye Hospital, London, UK
| | - C Trigaux
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - N Teichert
- Institute of Diagnostic and Interventional Radiology, University Hospital Duesseldorf, Germany
| | - G Geerling
- Department of Ophthalmology, University Hospital Duesseldorf, Duesseldorf, Germany
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Orbital Metastasis From Urothelial Carcinoma: A Comprehensive Literature Review. Ophthalmic Plast Reconstr Surg 2020; 35:213-217. [PMID: 30489454 DOI: 10.1097/iop.0000000000001256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the clinical features of orbital and choroidal metastases from urothelial carcinomas of the urinary tract among cases reported in the literature, and to describe a case of orbital metastasis from bladder cancer presenting as apparent internuclear ophthalmoplegia. METHODS Case reports of orbital and choroidal metastases from urothelial carcinomas published in the literature from 1965 to 2018 were reviewed. Data collected included patient demographics, cancer stage and primary site, time to onset of ocular symptoms, length of presenting ocular symptoms, types of primary ocular symptoms, diagnostic imaging, histology, systemic and ocular treatments, and survival time. RESULTS Twenty-eight cases of urothelial carcinoma with metastasis to the orbit or choroid were reviewed. Men were significantly more likely to suffer from this condition than women (p = 0.011). The average age of presentation with orbital symptoms was 63 years, with an average time of 19 months between primary cancer diagnosis and onset of orbital symptoms. Twenty-two patients had metastasis to the orbit and 6 to the choroid. In 4 cases, ocular deficits secondary to orbital and/or choroidal metastases were the initial presenting symptoms in patients with previously undiagnosed urothelial carcinoma. The most commonly noted primary ocular symptoms and signs consisted of decreased visual acuity, decreased ocular motility, proptosis, and diplopia. Average survival from onset of ocular symptoms was 4.67 months. CONCLUSIONS Urothelial carcinoma may metastasize to the orbit or choroid; furthermore, its presentation may mimic internuclear ophthalmoplegia. It is recommended that any patient with visual symptoms and known urothelial cancer should undergo expedited workup for metastatic disease.
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Yadav D, Singh M, Gupta K, Kaur M, Gupta P. A report of orbital metastasis from a urinary bladder adenocarcinoma. Indian J Ophthalmol 2019; 67:1377-1380. [PMID: 31332150 PMCID: PMC6677044 DOI: 10.4103/ijo.ijo_1699_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 60-year-old man presented with sudden-onset proptosis of the left eye and intermittent diplopia of 2 months duration. Ophthalmic examination revealed bilateral eyelid retraction, left eye proptosis and a firm, non-tender mass (2 cm × 1.5 cm) in left supero-medial orbit with restricted extraocular movements. Contrast-enhanced computed tomography showed a well-defined, enhancing antero-medial orbital mass which was removed via anterior orbitotomy approach. The histopathology/immunohistochemistry showed adenocarcinoma; metastasis of urothelial origin. The oncology consultation and metastatic workup revealed a urinary bladder carcinoma with distant metastasis. Our patient expired within 6 months of diagnosis. The ophthalmic symptoms due to orbital metastasis may be the first presentation of some cancer patients.
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Affiliation(s)
- Deepti Yadav
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Singh
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manpreet Kaur
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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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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Giordano G, Olivieri N, D'Andrea MR, Di Raimo T, Manfrin E, Remo A, Pancione M, Brunelli M, De Santis E, Coppola G, Scarpa A, Coppola L, Parcesepe P. Urothelial bladder carcinoma metastasizing to the eye: A systematic review and case report. Oncol Lett 2019; 17:462-467. [PMID: 30655788 PMCID: PMC6313172 DOI: 10.3892/ol.2018.9579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/23/2018] [Indexed: 02/05/2023] Open
Abstract
The eye is a rare site for disseminated malignancies; nevertheless, several tumors may metastasize to ocular structures. Few cases of urothelial and bladder cancer with eye involvement have been described in the literature thus far. The rarity of metastatic ocular localization implies an accurate differential diagnosis among the possible primary tumor sites. However, a specific diagnostic algorithm is not currently available, nor a defined therapeutic approach. Eye metastases are associated with advanced disease and poor prognosis. Physicians should be made aware of the possibility of eye involvement in patients with a past medical history of urothelial bladder cancer associated with ocular symptoms. The present case reports discusses the first documented case, to the best of our knowledge, of an urothelial bladder cancer metastasizing to the retro bulbar region that infiltrates the lacrimal gland. Furthermore, the report provides a systematic qualitative review of the current literature on eye metastases from urothelial bladder cancer using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
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Affiliation(s)
- Guido Giordano
- Oncology Division IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, I-71013 Foggia, Italy
- Biology Department, Federico II University of Naples, I-80134 Naples, Italy
- Medical Oncology Unit, San Filippo Neri Hospital, I-00135 Rome, Italy
- Dr Guido Giordano, Oncology Division IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, I-71013 Foggia, Italy, E-mail:
| | - Nunzio Olivieri
- Biology Department, Federico II University of Naples, I-80134 Naples, Italy
| | | | - Tania Di Raimo
- Medical Oncology Unit, San Filippo Neri Hospital, I-00135 Rome, Italy
| | - Erminia Manfrin
- Department of Diagnostics and Public Health-Section of Pathology, University and Hospital Trust of Verona, I-37134 Verona, Italy
| | - Andrea Remo
- Pathology Unit, Mater Salutis Hospital, ULSS9, Legnago, I-37045 Verona, Italy
| | - Massimo Pancione
- Department of Sciences and Technologies, University of Sannio, I-82100 Benevento, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health-Section of Pathology, University and Hospital Trust of Verona, I-37134 Verona, Italy
| | - Elena De Santis
- Department of Human Anatomy, Sapienza University of Rome, I-00185 Rome, Italy
| | - Giulia Coppola
- Department of Human Anatomy, Sapienza University of Rome, I-00185 Rome, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health-Section of Pathology, University and Hospital Trust of Verona, I-37134 Verona, Italy
- Pathology Unit, Mater Salutis Hospital, ULSS9, Legnago, I-37045 Verona, Italy
- Department of Sciences and Technologies, University of Sannio, I-82100 Benevento, Italy
- Department of Human Anatomy, Sapienza University of Rome, I-00185 Rome, Italy
- ARC-Net Centre for Applied Research on Cancer, University and Hospital Trust of Verona, I-37134 Verona, Italy
| | - Luigi Coppola
- UOC of Pathologic Anatomy, San Filippo Neri Hospital, I-00135 Rome, Italy
| | - Pietro Parcesepe
- Department of Diagnostics and Public Health-Section of Pathology, University and Hospital Trust of Verona, I-37134 Verona, Italy
- Correspondence to: Dr Pietro Parcesepe, Department of Diagnostics and Public Health-Section of Pathology, University and Hospital Trust of Verona, L.A. Scuro Square 10, I-37134 Verona, Italy, E-mail:
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Orbital cellulitis. Surv Ophthalmol 2018; 63:534-553. [DOI: 10.1016/j.survophthal.2017.12.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 12/12/2022]
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Solitary Orbital Metastasis in Carcinoma Esophagus: Findings on Serial 18F-FDG PET/CT Scans. Clin Nucl Med 2017; 43:19-22. [PMID: 29135612 DOI: 10.1097/rlu.0000000000001892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Orbital metastasis is an uncommon and atypical presentation of recurrent esophageal cancer that has been only seldom reported in literature. F-FDG PET/CT is routinely performed for staging and response assessment in patients with esophageal carcinoma. This case demonstrates use of follow-up FDG PET/CT scans in characterizing solitary metastatic disease in orbit and in evaluating response to therapy. It also highlights a key teaching point that postradiation-related inflammatory/infective changes may interfere in accurate assessment of PET/CT scan; however, frequently used clinical and radiological correlation may not be entirely sufficient to rule out pathological involvement.
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Metastatic Colon Cancer to the Sphenoid Wing and Ethmoid Sinus Mimicking Orbital Cellulitis: A Rare Presentation. Ophthalmic Plast Reconstr Surg 2017; 33:S133-S136. [PMID: 26974420 DOI: 10.1097/iop.0000000000000669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Metastatic lesions to the orbit are most commonly seen with breast, lung, and prostate cancer, but are less commonly seen with colon cancer. Furthermore, the presence of metastatic colon cancer involving the sphenoid wing has only been reported once previously. The authors present a case of a 68-year-old woman with right upper and lower eyelid edema and erythema along with decreased vision, relative afferent pupillary defect, limitation of extraocular movements, and chemosis suggestive of orbital cellulitis. Imaging revealed an erosive lesion of the sphenoid wing along with unilateral ethmoid sinusitis. Biopsies taken from both lesions revealed metastatic adenocarcinoma, consistent with colonic primary. The extensive inflammatory component of her disease required life-long high-dose steroids to maintain quiescence and preserve vision.
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Esophageal Cancer Metastases to Unexpected Sites: A Systematic Review. Gastroenterol Res Pract 2017; 2017:1657310. [PMID: 28659974 PMCID: PMC5474273 DOI: 10.1155/2017/1657310] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 04/24/2017] [Indexed: 12/12/2022] Open
Abstract
The most common pattern of esophageal cancer metastases (ECM) is to the lymph nodes, lung, liver, bones, adrenal glands, and brain. On the other hand, unexpected metastasis (UM) spread to uncommon sites has increasingly reported and consequently affected the pathway of diagnosis, staging, and management. Using the PubMed database, a systematic search of the following headings “Esophageal” and “Metastasis” or “Metastases” was performed, 10049 articles were identified, and the articles were included if they demonstrated unexpected ECM. 84% of cases were men with an average age of 60.7 years. EC was located in the lower third in 65%. Two-thirds of the UM originated from the lower esophagus, and the two major histological types were adenocarcinoma 40% and squamous cell carcinoma 60%. Metastases were disseminated toward five main anatomical sites: the head and neck (42%), thoracic (17%), abdomen and pelvis (25%), extremities (9%), and multiple skin and muscle metastases (7%). The EC metastases were found to be synchronous 42% and metachronous 58%, isolated in 53.5% and multiple in 46.5%. The overall survival rate was 10.2 months. Since distant metastases are responsible for most EC-related deaths, understanding of ECM dissemination patterns needs more extensive studies. These critical data are the cornerstone of optimal cancer approach and treatment.
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Abstract
We report a case of adenocarcinoma of the esophagus presenting as an orbital metastasis prior to the primary diagnosis. A 66-year-old white male presented to his ophthalmologist with right orbital swelling for several months. Magnetic resonance imaging revealed a supraorbital infiltrative mass. Pathology from the mass revealed findings consistent with adenocarcinoma of gastrointestinal origin. Upper endoscopy revealed distal esophageal stricture and irregularities. Pathology from the esophagus showed the same malignancy found in the orbit. An orbital swelling can manifest as the initial presentation of metastatic disease and should be taken seriously to avoid delay in diagnosis and treatment.
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