J Korean Soc Radiol.  2017 Sep;77(3):143-147. 10.3348/jksr.2017.77.3.143.

Solitary Orbital Metastasis Presenting as Extraocular Muscle Mass in Lung Cancer Patient: A Case Report

Affiliations
  • 1Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. jeeyoungkim@catholic.ac.kr
  • 2Department of Radiology, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 3Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 5Department of Hospital Pathology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

A 74-year-old man presented with right ocular pain and diplopia. Contrast enhanced orbital computed tomography showed a bulging mass with homogenous density and mild homogeneous enhancement, at the right medial rectus muscle belly. Magnetic resonance imaging of the orbit showed a bulging mass along the medial rectus muscle, with superiorly displaced medial rectus muscle. The mass showed homogenous hyperintensity to extraocular muscle on T2-weighted images, and mild rim enhancement on contrast enhance T1-weighted images. Differential diagnosis of images included primary lesion of the extraocular muscle such as lymphoma, inflammatory pseudotumor and myositis. Chest X-ray incidentally revealed a left hilar mass. Histopathologic diagnosis of the hilar mass was confirmed as small cell lung cancer. A total body ¹â¸F-fluorodeoxy glucose positron emission tomography scan revealed abnormal uptake only in the left hilar region and the right orbit. Histopathologic diagnosis of the extraocular muscle mass was metastasis of the small cell lung cancer. Although there are few reports of small cell lung cancer with orbital metastasis, solitary extraocular muscle metastasis without other systemic metastasis is quite rare. Here, we report the case with an initial presentation of a solitary EOM metastasis, in a patient with small cell lung cancer.


MeSH Terms

Aged
Diagnosis
Diagnosis, Differential
Diplopia
Glucose
Granuloma, Plasma Cell
Humans
Lung Neoplasms*
Lung*
Lymphoma
Magnetic Resonance Imaging
Myositis
Neoplasm Metastasis*
Orbit*
Positron-Emission Tomography
Small Cell Lung Carcinoma
Thorax
Glucose

Figure

  • Fig. 1 A 74-year-old man with right ocular pain. A. Contrast-enhanced axial CT image of the orbit shows a bulging mass within the right medial rectus muscle belly, with mild homogenous enhancement. There is no adjacent fat infiltration and bone erosion. B. T2-weighted axial image shows a bulging mass of the right medial rectus muscle belly, with homogenous signal intensity. There are no adjacent fat infiltrations. Gadolinium based contrast enhanced T1-weighted axial and coronal images show mild rim enhancement of the bulging mass with superiorly displaced medial rectus. There is no adjacent fat infiltration. C. Initial 18F-FDG PET scan shows increased FDG uptake in the right orbit and left hilar region (arrows). D. Photomicrograph of biopsy specimen from the right medial rectus muscle. Hematoxylin-eosin staining (× 20) shows densely packed small cells with scant cytoplasm. Histologic diagnosis is metastatic small cell lung cancer. E. Follow up T2-weighted axial and contrast enhanced T1-weighted axial images after 6 weeks of chemotherapy, show decrease in size of the bulging mass of the right medial rectus muscle. FDG = fluorodeoxy glucose, PET = positron emission tomography


Reference

1. Char DH, Miller T, Kroll S. Orbital metastases: diagnosis and course. Br J Ophthalmol. 1997; 81:386–390.
2. Shields JA, Shields CL, Brotman HK, Carvalho C, Perez N, Eagle RC Jr. Cancer metastatic to the orbit: the 2000 Robert M. Curts Lecture. Ophthal Plast Reconstr Surg. 2001; 17:346–335.
3. Spaide RF, Granger E, Hammer BD, Negron FJ, Paglen PG. Rapidly expanding exophthalmos: an unusual presentation of small cell lung cancer. Br J Ophthalmol. 1989; 73:461–462.
4. Mena AM, Pardo J. Orbital metastasis as the initial manifestation of small cell lung cancer. Acta Ophthalmol Scand. 2002; 80:113–115.
5. Henning M, Hu Q, Siegelmann-Danieli N. Orbital metastasis as the presenting symptom of extensive stage small cell lung cancer. Eur J Intern Med. 2008; 19:65–66.
6. Cunnane ME, Sepahadari AR, Gardiner M. Pathology of the eye and orbit. In : Som PM, Curtin HD, editors. Head and neck imaging. 5th ed. St. Louis: Elsevier;2011. p. 591–756.
7. Lacey B, Chang W, Rootman J. Nonthyroid causes of extraocular muscle disease. Surv Ophthalmol. 1999; 44:187–213.
8. Gupta A, Chazen JL, Phillips CD. Carcinoid tumor metastases to the extraocular muscles: MR imaging and CT findings and review of the literature. AJNR Am J Neuroradiol. 2011; 32:1208–1211.
9. Meltzer DE. Orbital imaging: a pattern-based approach. Radiol Clin North Am. 2015; 53:37–80.
10. Surov A, Behrmann C, Holzhausen HJ, Kösling S. Lymphomas and metastases of the extra-ocular musculature. Neuroradiology. 2011; 53:909–916.
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