Korean J Ophthalmol.  2010 Apr;24(2):123-125. 10.3341/kjo.2010.24.2.123.

Metastatic Esophageal Squamous Cell Carcinoma to the Orbit and Periorbit Masquerading as Periorbital Abscess

• Lee JY
• Lee HJ
• Jung MS
• Kim SY

• KMID: 946005
• DOI: http://doi.org/10.3341/kjo.2010.24.2.123

Abstract

A 61-year-old man with no history of malignancy presented with a rapidly expanding left periorbital mass, first noticed one month prior to presentation. The mass was firm, and a pus-like discharge drained spontaneously from the center of the lesion. A biopsy was performed, and histopathology confirmed squamous cell carcinoma. Systemic evaluation revealed that the patient had a primary esophageal squamous cell carcinoma with multiple metastases. The prognosis of orbital metastasis is generally poor, and this patient expired after one month of conservative treatment.

Keyword

Abscess; Orbital neoplasms; Squamous cell carcinoma

MeSH Terms

Abscess/diagnosis
Biopsy
Carcinoma, Squamous Cell/*diagnosis/*secondary
Diagnosis, Differential
Esophageal Neoplasms/*pathology
Fatal Outcome
Humans
Male
Middle Aged
Orbital Diseases/diagnosis
Orbital Neoplasms/*diagnosis/*secondary

Figure

• 

  Fig. 1 External photograph at the initial examination. The left periorbital mass was firm, and drainage was noted at the center of the lesion.

• 

  Fig. 2 Orbital CT findings. A 4.2 cm × 3.5 cm-sized lesion was seen in the left periorbital area (blue arrows). The lesion was extended from the extraconal space to the intraconal space, and compressed the globe. (A) Axial view. (B) Coronal view.

• 

  Fig. 3 Post-enhancement chest and abdominal CT findings. (A) An enhanced mass lesion was identified in the middle esophagus (white arrow), and narrowing was noted in the bronchus intermedius. (B) A small nodular lesion was identified in the right adrenal gland (blue arrow).

• 

  Fig. 4 (A) Histologic findings in the left periorbital biopsy specimen. Infiltration of undifferentiated malignant cells suggested the presence of squamous cell carcinoma (H & E, ×200). (B) Histologic examination of the left conjunctiva revealed focal nests of atypical cells suspicious for carcinoma (blue arrow) (H & E, ×200).

Reference

1. Ahmad SM, Esmaeli B. Metastatic tumors of the orbit and ocular adnexa. Curr Opin Ophthalmol. 2007. 18:405–413.

2. Oworu O, Kyle P, Morton R. Metastatic esophageal carcinoma presenting as a lacrimal gland tumour. Br J Ophthalmol. 2004. 88:972–973.

3. Aralikatti DA, Nylander AG. Orbital metastasis from squamous cell carcinoma of the esophagus. Eur J Ophthalmol. 2006. 16:458–460.

4. Collins MJ, Wojno TH, Grossniklaus HE. Metastatic esophageal carcinoma to the orbit. Am J Ophthalmol. 1999. 127:228–229.

5. Tumuluri K, Sharkawi E, Bindra M, Olver JM. Esophageal adenocarcinoma metastatic to the orbit. Ophthal Plast Reconstr Surg. 2006. 22:151–152.

6. Dieing A, Schulz CO, Schmid P, et al. Orbital metastases in breast cancer; report of two cases and review of the literature. J Cancer Res Clin Oncol. 2004. 130:745–748.

7. Goldberg RA, Rootman J, Cline RA. Tumors metastatic to the orbit; a changing picture. Surv Ophthalmol. 1990. 35:1–24.

8. Font RL, Ferry AP. Carcinoma metastatic to the eye and orbit III. A clinicopathologic study of 28 cases metastatic to the orbit. Cancer. 1976. 38:1326–1335.

9. Moss HM. Expanding lesions of the orbit. A clinical study of 230 consecutive cases. Am J Ophthalmol. 1962. 54:761–770.

10. Freedman MI, Folk JC. Metastatic tumors to the eye and orbit. Patient survival and clinical characteristics. Arch Ophthalmol. 1987. 105:1215–1219.

11. Ferry AP, Font RL. Carcinoma metastatic to the eye and the orbit I: a clinicopathologic study of 227 cases. Arch Ophthalmol. 1974. 92:276–286.

12. Char DH, Miller T, Kroll S. Orbital metastases: diagnosis and course. Br J Ophthalmol. 1997. 81:386–390.