Metastatic Pancreatic Neuroendocrine Tumor With Primary Presentation as Orbital Cellulitis

Abstract

ABSTRACT Neuroendocrine tumors (NET) are rare malignancies of the gastrointestinal tract or lung with the most common metastases being the liver. Surgery remains the mainstay of treatment. We describe a 53-year-old woman with pancreatic NET metastatic to the liver, spleen, and orbital fossae. She presented with orbital cellulitis and was managed as a case of ocular tuberculosis after a preliminary ultrasound of the eye which showed soft-tissue edema of the orbit, and aspiration cytology showed ill-formed lymphocyte clusters. Eight weeks later, she developed antitubercular therapy-induced hepatitis. Further investigations revealed the real diagnosis of metastatic NET with orbital deposits. She received somatostatin analogue therapy, everolimus, and peptide receptor radionuclide therapy with significant reduction in size of lesions and resolution of symptoms.