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Khan Q, Farooq H, Ziad A, Rehman A, Siddique K. A Rare Case of Bilateral Orbital Metastases From Rectal Adenocarcinoma. Cureus 2022; 14:e29936. [PMID: 36348904 PMCID: PMC9634852 DOI: 10.7759/cureus.29936] [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] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Colorectal carcinoma is among the commonest malignancies in the World. However, metastases from rectal carcinomas to the orbit are extremely rare. Only a few such cases have been reported in the literature till date. We report a case of adenocarcinoma of the rectum in a 27-year-old male with bilateral orbital metastases who is currently undergoing palliative radiotherapy. Our aim is to highlight the role of imaging in the diagnosis and management of orbital metastatic disease.
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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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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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Gaddi MJS, Yuga ACQ, Dofitas RB, Legaspi GD. Surgery for orbital metastasis from breast carcinoma initially presenting with progressive proptosis. BMJ Case Rep 2020; 13:e237158. [PMID: 33293275 PMCID: PMC7725080 DOI: 10.1136/bcr-2020-237158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 02/01/2023] Open
Abstract
We present a 45-year-old woman with metastatic breast disease who initially presented with progressive proptosis of her right eye causing limited motility, diplopia and eye pain. MRI done showed an avidly enhancing right sphenoorbital mass causing displacement in the lateral and superior recti muscles with lysis and infiltration of the greater sphenoid wing and lateral orbital wall. The patient underwent surgery resulting in immediate relief of proptosis and resolution of symptoms. Although surgery is not recommended for orbital metastasis as it is not curative, it should be considered as a treatment option as it can provide relief to patients and improve their quality of life.
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Affiliation(s)
- Mairre James Sumang Gaddi
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Ann Camille Quito Yuga
- Division of Surgical Oncology, Head and Neck, Breast, Skin and Soft Tissue and Esophago-Gastric Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Rodney Banaria Dofitas
- Division of Surgical Oncology, Head and Neck, Breast, Skin and Soft Tissue and Esophago-Gastric Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Metro Manila, Philippines
| | - Gerardo Dizon Legaspi
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Metro Manila, Philippines
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Sun L, Qi Y, Sun X, Yu J, Meng X. Orbital metastasis as the initial presentation of lung adenocarcinoma: a case report. Onco Targets Ther 2016; 9:2743-8. [PMID: 27274270 PMCID: PMC4869644 DOI: 10.2147/ott.s99583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Orbital metastasis as the initial presentation of lung adenocarcinoma is very rare, and so the lack of knowledge about this phenomenon can easily result in misdiagnosis, either as a orbital primary tumor or benign lesion. Here, we report a rare case in which the orbital symptom appeared first without any pulmonary manifestations. Our patient developed decreasing vision in his right eye over a 3-month duration. He then presented with proptosis and multiple aches from head to back. After systemic evaluation, our patient was diagnosed with Stage IV non-small-cell lung cancer and was managed with palliative chemoradiotherapy. The final result of treatment suggests that the therapeutic efficacy of chemotherapy on orbital metastasis is uncertain, and only some orbital metastatic masses may have a favorable response to radiation. Furthermore, we review the recent data and provide an in-depth discussion on the clinical features and course of ocular pulmonary metastases, and explain a new type of non-small-cell lung cancer metastatic pattern for ophthalmologists and oncologists to help them distinguish the orbital metastasis as the first manifestation.
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Affiliation(s)
- Liangchao Sun
- Medical College of Shandong University, Shandong Academy of Medical Science, Jinan; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Yali Qi
- Medical College of Shandong University, Shandong Academy of Medical Science, Jinan; Department of Oncology, The Second Hospital of Lanzhou University, Lanzhou, People's Republic of China
| | - Xindong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, Jinan
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Pittoni P, Di Lascio S, Conti-Beltraminelli M, Valli MC, Espeli V, Bongiovanni M, Richetti A, Pagani O. Paranasal sinus metastasis of breast cancer. BMJ Case Rep 2014; 2014:bcr-2014-205171. [PMID: 24973353 DOI: 10.1136/bcr-2014-205171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 76-year-old woman presented with symptoms suggestive of acute sinusitis. Previously, her breast carcinoma was treated with right lumpectomy, adjuvant chemotherapy and breast radiotherapy. She remained free from recurrence for the following 8 years. After initial treatment with antibiotics, the local symptom worsened with exophthalmos, eye blindness and development of an ulceration of the hard palate. MRI showed irregular enhancement of the nasal cavity extended to the maxillary sinus and ethmoidal lamina and concomitant infiltration of the orbit and skull base. A biopsy of the palatal ulcer showed a poorly differentiated adenocarcinoma and was compared with the histology of the primary breast tumour and it was concluded for the same morphology. After discussion at the multidisciplinary team, a specific chemotherapy has been activated with an initial local response. Further surgical resection was not thought appropriate and the patient has subsequently undergone palliative radiotherapy to the right paranasal lesions to improve local disease control.
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Affiliation(s)
- P Pittoni
- Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona-Lugano CH
| | - S Di Lascio
- Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona CH
| | - M Conti-Beltraminelli
- Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona CH Institute of Pathology, Locarno, Switzerland
| | - M C Valli
- Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona-Lugano CH Institute of Pathology, Locarno, Switzerland Centro di Senologia della Svizzera Italiana, Bellinzona-Lugano CH
| | - V Espeli
- Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona CH
| | | | - A Richetti
- Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona-Lugano CH Institute of Pathology, Locarno, Switzerland Centro di Senologia della Svizzera Italiana, Bellinzona-Lugano CH
| | - O Pagani
- Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona CH Institute of Pathology, Locarno, Switzerland
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Orbital pulsatile metastasis as initial presenting sign of metastatic clear cell renal carcinoma. ACTA ACUST UNITED AC 2014; 89:500-3. [PMID: 24389155 DOI: 10.1016/j.oftal.2013.11.012] [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: 05/05/2013] [Revised: 10/05/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022]
Abstract
CASE REPORT We present the case of a 56 year-old male with a pulsating lesion in the temporal region of the left orbit as presenting sign of a renal cell carcinoma. A review is also presented of all cases of orbital metastases diagnosed in our hospital between 1957 and 2012. DISCUSSION Carcinoma is the most common malignancy involving the kidney but, only rarely does it metastasize to the orbit. As these tumors can be confused with other amelanotic or vascular tumors, a high index of suspicion is required for early detection and management of the primary tumor.
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Qanneta R, Samitier Pastor A, Segarra Tomas J. [Acute complete left-side ophthalmoplegia as an initial manifestation of metastatic prostate carcinoma: a case report]. Rev Esp Geriatr Gerontol 2013; 48:248. [PMID: 23582700 DOI: 10.1016/j.regg.2013.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 12/22/2012] [Accepted: 01/09/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Rami Qanneta
- Servicio de Medicina Interna, Hospital Sociosanitari Francolí, Tarragona, España.
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Koma Y, Goto K, Yoshida C, Kimura K, Matsumoto Y, Koyama M, Nakashima N, Masuya D, Matsuoka H, Yoshimatsu H, Azumi A, Suzuki Y. Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report. J Med Case Rep 2012; 6:353. [PMID: 23079208 PMCID: PMC3543340 DOI: 10.1186/1752-1947-6-353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/13/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction Orbital metastases of lung cancer are rare. However, because the number of patients diagnosed with lung cancer is increasing, the probability that a physician will see a patient with an orbital metastasis is also increasing. Unfortunately, the clinical course and response of these patients to cytotoxic chemotherapy are generally poor and keeping a patient’s quality of vision is difficult. In recent years, gefitinib, an epidermal growth factor receptor tyrosine kinase inhibitor, has brightened the outlook for patients with advanced non-small cell lung cancer, especially for those who carry epidermal growth factor receptor-activating mutations. Case presentation A 62-year-old Japanese man presented with swelling of the eyelid margin and ptosis of his right eye. A physical examination revealed double vision in his right eye and an alteration in elevator muscle mobility. A magnetic resonance image demonstrated a right intra-orbital mass (18 × 16mm). Screening examinations were carried out because this mass was suspected to be a metastasis from another organ. Chest computed tomography revealed a 42 × 37mm mass shadow on the left side of the hilum with mediastinal lymph node metastases. Adenocarcinoma with an epidermal growth factor receptor gene mutation (exon 19 deletion L747-E749; A750P) was detected in a transbronchial biopsy specimen; the patient was diagnosed with stage IV (T2N2M1) non-small cell lung cancer. Gefitinib (250mg/day) was chosen as first-line chemotherapy because there was no pre-existing interstitial shadow. After two months of treatment, the patient’s right eye opened completely and follow-up magnetic resonance imaging revealed a marked reduction of the intra-orbital mass to 14 × 13mm. Three months after treatment initiation, a follow-up computed tomography showed a marked reduction in the size of the primary lesion to 23 × 20mm. The patient is continuing gefitinib treatment without any adverse effects noted on computed tomography, physical, or laboratory examination. Conclusions We report the case of a patient with an orbital non-small cell lung cancer metastasis with epidermal growth factor receptor-activating mutations. This metastasis, as well as the primary lesion, showed a marked response to the molecular targeting drug gefitinib, and the patient’s vision was kept without an invasive procedure. Gefitinib may be a good first choice for patients with orbital non-small cell lung cancer metastasis harboring epidermal growth factor receptor-activating mutations.
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Affiliation(s)
- Yasuko Koma
- Respiratory Center, Shinko Hospital, 1-4-47, Wakinohamacho, Chuo-ku, Kobe 651-0072, Japan.
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Vlachostergios PJ, Voutsadakis IA, Papandreou CN. Orbital Metastasis of Breast Carcinoma. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2009. [DOI: 10.1177/117822340900300001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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