J Korean Ophthalmol Soc.  2018 Jan;59(1):1-8. 10.3341/jkos.2018.59.1.1.

Clinical Characteristics of Metastatic Orbital Tumors: Our Experience with 27 Cases

Affiliations
  • 1Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. lineblue@hanmail.net

Abstract

PURPOSE
To evaluate the clinical characteristics of metastatic orbital tumors.
METHODS
The medical records of patients who were diagnosed with metastatic orbital tumors at Asan Medical Center, Seoul, Republic of Korea, from May 2010 to May 2017, were retrospectively reviewed.
RESULTS
A total of 27 patients were studied, including 14 (51.9%) males. The mean age at diagnosis was 54.1 years and the mean follow-up period was 12.7 months. The most common primary tumor site was the breast (six patients, 46.2%) in females and the liver (five patients, 35.7%) in males. Proptosis (12 patients, 44.4%) was the most common complaint, with the other complaints including periorbital swelling, palpable masses and diplopia. Orbital imaging studies showed that the most common sites of orbital involvement were the orbital wall (nine patients, 33.3%) and the extraocular muscle (nine patients, 33.3%). Pathological diagnoses were performed in 10 patients (37.0%), 3 of these whom underwent a fine needle aspiration biopsy for intraconal lesions. Local and systemic therapies were conducted using a multidisciplinary approach, but the size of orbital tumors increased in 12 (44.4%) of 27 patients. Eight (29.6%) patients died because of systemic metastasis, seven (25.9%) patients were referred to other institutions for palliative treatment, and five (18.5%) patients showed malignant progression despite treatment.
CONCLUSIONS
Based on the varying clinical features of metastatic orbital tumors, it is important to carefully diagnose patients, especially those with a history of cancer. Breast cancer is the most common primary cancer, and liver cancer is also common because of the high prevalence of hepatocellular carcinoma in the Republic of Korea. Clinical diagnosis may be possible using patient history and/or imaging study data, but pathological confirmation may be necessary in some cases. The treatment options can be determined by the type of primary cancer and the general condition, but the overall prognosis is poor.

Keyword

Metastasis; Orbital tumor

MeSH Terms

Biopsy
Biopsy, Fine-Needle
Breast
Breast Neoplasms
Carcinoma, Hepatocellular
Chungcheongnam-do
Diagnosis
Diplopia
Exophthalmos
Female
Follow-Up Studies
Humans
Liver
Liver Neoplasms
Male
Medical Records
Neoplasm Metastasis
Orbit*
Palliative Care
Prevalence
Prognosis
Republic of Korea
Retrospective Studies
Seoul

Figure

  • Figure 1 Orbital metastasis from breast cancer. (A, B) Magnetic resonance images revealed thickened of left inferior rectus muscle and infiltrative lesion extending to left inferior oblique muscle and overlying lower eyelid. (C) Clinical photos showed supraduction limitation in the left eye. (D) HESS screen test also showed supraduction limitation in left eye and left hypotropia. (E) Pathologic study of left inferior rectus muscle biopsy demonstrated infiltration of metastatic cells with scant cytoplasm and hyperchromatic nuclei (H&E stain, original magnification ×200).

  • Figure 2 Magnetic resonance imaging of the metastatic orbital tumor from thymic origin neuroendocrine carcinoma. (A) coronal view (B) axial view, which showed an enhancing mass with lobulating contour (2.6 × 1.9 cm) in the left retrobulbar area. (C) Smear from fine-needle aspiration showed numerous spindle cells with hyperchromatic nuclei (H&E stain, original magnification ×400).

  • Figure 3 Clinical course of total patients. (A) Orbital lesion and (B) general conditions after treatment for metastatic orbital tumors (*Loss to follow-up).


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