J Korean Ophthalmol Soc.  2017 Apr;58(4):463-466. 10.3341/jkos.2017.58.4.463.

A Case of Small Cell Lung Cancer Diagnosed via Incisional Biopsy of an Orbital Mass

• Jeon H
• Cho MH
• Choi HY

• KMID: 2376604
• DOI: http://doi.org/10.3341/jkos.2017.58.4.463

Abstract

PURPOSE
To report a case of an orbital mass diagnosed as metastasis from small cell lung cancer and to provide a review of the literature.
CASE SUMMARY
A 66-year-old male with a history of diabetes mellitus and hypertension presented with decreased visual acuity and exophthalmos in his left eye. He had been diagnosed with age-related macular degeneration 13 years prior and had a history of pneumonia that was treated for one month. The best corrected visual acuity was hand-motion in the right eye and 0.04 in the left eye. Optic disc swelling and splint hemorrhage of the left eye was observed on fundus examination. The left eye was protruded and eye movement was limited. On orbital magnetic resonance imaging, an irregular mass in the left intraconal space was found. Incisional biopsy was performed, and histopathologic examination revealed a small round tumor. According to the results of immunohistochemical staining, metastatic tumors were suspected. After systemic evaluation, the patient was diagnosed with primary small cell lung cancer with multiple metastases. After 2 months, the visual acuity was hand-motion and proptosis was not resolved.
CONCLUSIONS
In patients with orbital masses, the possibility of metastatic tumors should be considered during differential diagnosis and early biopsy should be performed.

Keyword

Exophthalmos; Orbital mass; Orbital metastasis

MeSH Terms

Aged
Biopsy*
Diabetes Mellitus
Diagnosis, Differential
Exophthalmos
Eye Movements
Hemorrhage
Humans
Hypertension
Macular Degeneration
Magnetic Resonance Imaging
Male
Neoplasm Metastasis
Orbit*
Pneumonia
Small Cell Lung Carcinoma*
Splints
Visual Acuity

Figure

• 

  Figure 1. Magnetic resonance image of the patient (A: axial, B: coronal). Moderate to high intensity intraconal mass with irregular margin was observed in T2 image.

• 

  Figure 2. Metastatic poorly differentiated neuroendocrine carcinoma was considered on histopathologic findings. Small round cell was found in Hematoxylin and eosin staining (A: ×40, B: ×400). The tumor cells shows positivity for synaptophysin, one of the neuroendocrine marker (C: ×200).

Reference

References

1. Nelson CC, Hertzberg BS, Klintworth GK. . A histopathologic study of 716 unselected eyes in patients with cancer at the time of death. Am J Ophthalmol. 1983; 95:788–93.

2. Velten IM, Gusek-Schneider GC, Tomandl B. . Diplopia as first symptom of a bronchogenic carcinoma. Klin Monbl Augenheilkd. 2000; 217:52–4.

3. Baek SH, Kim YE, Lee KS. . Breast cancer metastasis to retrobulbar area. J Korean Ophthalmol Soc. 2002; 43:1801–5.

4. Jeon YH, Shin JC, Kim DS. . A case of metastatic uterine cervical carcinma of the orbit. J Korean Ophthalmol Soc. 1998; 39:2822–6.

5. Ahmad SM, Esmaeli B. . Metastatic tumors of the orbit and ocular adnexa. Cur Opin Ophthalmol. 2007; 18:405–13.

6. Rootman J. . Diseases of the Orbit: a Multidisciplinary Approach. 2nd ed.Philadelphia: Williams & Wilkins;2003; 330–9.

7. Garrity JA, Henderson JW, Cameron JD. . Metastatic carcinomas. Henderson’s orbital tumors. 4th ed.New York: Raven Press;2007; 313–26.

8. Goldberg RA, Rootman J, Cline RA. . Tumors metastatic to the or-bit: a changing picture. Surv Ophthalmol. 1990; 35:1–24.

9. Char DH, Miller T, Kroll S. . Orbital metastases: diagnosis and course. Br J Ophthalmol. 1997; 81:386–90.

10. Shields JA, Shields CL, Brotman HK. . Cancer metastatic to the orbit: the 2000 Robert M. Curts Lecture. Ophthal Plast Reconstr Surg. 2001; 17:346–54.

11. Goldberg RA, Rootman J. . Clinical characteristics of metastatic or-bital tumors. Ophthalmology. 1990; 97:620–4.

12. Ferry AP, Font RL. . Carcinoma metastatic to the eye and orbit. I. A clinicopathologic study of 227 cases. Arch Ophthalmol. 1974; 92:276–86.