Orbital Metastasis Research Articles

Orbital metastases from breast cancer: three case reports

Purpose: to describe rare cases of orbital metastases from breast cancer.Material and Methods. Three cases of Luminal A(1) and B(2) breast cancer with orbital metastases were identified and studied during the period from 01.01.2018 to 01.05.2024. Metastasis to the orbit was detected 5, 2 and 1.5 years after radical mastectomy for breast cancer. Patients received chemotherapy and radiation therapy.Results. Cases of orbital metastasis originating from breast cancer were found to have a low frequency, but may be associated with a long period between cancer diagnosis and initiation of treatment. Early detection of breast cancer and its active treatment with chemotherapy and radiation therapy are important factors in preventing orbital metastasis.Conclusion. A routine follow-up surveillance after radical treatment of breast cancer is important because there is an increase risk of developing orbital metastasis. Comprehensive strategies for treating breast cancer metastases can provide long-term disease control.

Double Vision as the Presenting Symptom of Metastatic Breast Cancer in an 83-Year-Old Lady

Breast cancer is the most common type of malignant tumor that occurs in women. Despite this, physicians report that they screen elderly patients for breast cancer less than young patients, regardless of cancer history. This case report describes an elderly patient who presented with diplopia, eyelid swelling, and restricted eye movement, leading to the discovery of a diffuse orbital tumor and Stage IV left breast carcinoma with metastases to bone, liver, and peritoneum. The patient had been told to stop mammograms years prior to her diagnosis despite her past history of uterine cancer. The case underscores the possibility of orbital metastasis from breast cancer and highlights the necessity of diligent cancer screening in elderly women.

Progressive Unilateral Proptosis and [18F]FDG-Avid Lesions Connoting Aggressive Disease in Radioiodine-Refractory Differentiated Thyroid Carcinoma

AbstractRadioiodine-refractory differentiated thyroid carcinoma (RAIR-DTC) have poor prognosis as compared with radioiodine concentrating thyroid carcinoma. We present a case of follicular thyroid carcinoma presenting as a disseminated disease initially, underwent thyroid surgery and radioiodine (RAI) therapy. Following RAI, the patient developed a sudden-onset unilateral proptosis, finally diagnosed as orbital metastasis. [18F]-Fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography identified FDG-avid metastatic lesions more numerous than the RAI-avid lesions. The patient was treated with local and systemic targeted therapy, but despite these treatments, he developed progressive disease indicating aggressive nature of the disease consistent with [18F]FDG-avid RAIR-DTC.

A Rare Case of Orbital Metastasis from Invasive Lobular Carcinoma: Challenges of 18F-FDG PET/CT and the Search for Consensus on Imaging.

Invasive lobular carcinoma (ILC) frequently underlies orbital metastasis. A 74-y-old woman, who was current with mammograms and had no cancer history, presented to her ophthalmologist with visual complaints and was found to have metastatic ILC. MRI was contraindicated, and an 18F-FDG PET/CT scan revealed a mildly hypermetabolic right orbital mass and low uptake in the left subareolar breast, suggestive of metastatic ILC. Small studies have found that in ILC, 16α-18F-fluoroestradiol and fibroblast activation protein inhibitors are more avid than 18F-FDG. There is currently no consensus regarding imaging for ILC. Many people have contraindications to MRI, and the higher rate of false-negative findings on mammography for ILC than for other breast cancers makes this patient population more vulnerable to inaccurate staging, incorrect assessment of tumor burden, and, consequently, insufficient treatment. We provide this interesting case to highlight the potential of 18F-fluoroestradiol PET/CT and fibroblast activation protein inhibitors over 18F-FDG in this breast cancer subtype.

Treatment Outcomes and Definition Inconsistencies in High-Risk Unilateral Retinoblastoma

PurposeTo compare the clinical outcomes of children with unilateral retinoblastoma (Rb) and high-risk histopathology features (HRHF) following upfront enucleation with/without adjuvant chemotherapy, and investigate cases locally considered non-HRHF but converted to a standardized HRHF definition. DesignRetrospective multinational clinical cohort study. MethodsChildren with Rb who presented to 21 centers from 12 countries between 2011-2020, and underwent primary enucleation were recruited. Centers retrieved clinical data and were asked to report detailed histopathology findings, as well as indicate cases defined locally as high-risk. For analysis, only unilateral cases with standardized HRHF, defined as retrolaminar optic nerve invasion, massive choroidal invasion, scleral invasion, anterior-segment involvement, and/or combined non-massive choroidal and prelaminar/laminar optic nerve invasion, were included. Main Outcome Measures included orbital tumor recurrence, systemic metastasis, survival and number and outcome of cases converted to standardized HRHF. ResultsA total of 600 children presenting to 14 centers in 9 countries were included. Of these, 505 (84.2%) were considered locally as HRHF and received adjuvant chemotherapy. After a median follow-up period of 39.2±1.6 months (range: 0.8-60.0 months), 36 (6.0%) had orbital tumor recurrence, 49 (8.2%) metastasis, and 72 (12.0%) children died. Children not receiving adjuvant chemotherapy were at significantly increased risk of orbital tumor recurrence, metastasis, and death (p ≤0.002). Of the study children, 63/600 (10.5%) were considered locally non-HRHF, but converted to standardized HRHF and included in the analysis. Of these, 6/63 (9.5%) had orbital tumor recurrence, 5/63 (7.9%) metastasis, and 6/63 (9.5%) children died. Isolated minor choroidal invasion with prelaminar/laminar optic nerve invasion was reported in 114 (19.0%) children, but considered locally as HRHF only in 68/114 (59.6%). Of these, 6/114 (5.3%) children developed metastasis and subsequently died, yielding a number needed to treat of 15. ConclusionBased on this multinational cohort of children with Rb, we recommend the use of adjuvant chemotherapy following upfront enucleation and diagnosis of HRHF. Variation exists worldwide among centers when defining HRHF, resulting in adverse patient outcomes, warranting standardization.

Symptomatic orbital metastasis as an initial presentation of adenocarcinoma lung: A case report and review of literature.

Orbital metastasis is a rare entity in oncology. With increasing awareness and advancement, patients with initial ocular presentation can be diagnosed and treated. Ocular metastasis is more common in breast cancer followed by lung cancer. Lung cancer with ocular presentation generally have poor prognosis because of difficult diagnosis, Vision impairment and delayed management. Here, we report one such case of 59 year old female presented with painful periorbital swelling in left eye for 3 months with no pulmonary symptoms. On evaluation, she was diagnosed as ocular metastasis with primary being lung adenocarcinoma. Through this case, we enlighten the epidemiology, presentation, clinical features and evaluation of such patients which might help clinicians in further management.

High-Risk Histopathological Features of Retinoblastoma following Primary Enucleation: A Global Study of 1426 Patients from 5 Continents.

To evaluate high-risk histopathological features (HRHF) following primary enucleation of eyes with retinoblastoma (RB) and assess the patient outcomes across continents. Retrospective study of 1426 primarily enucleated RB eyes from five continents. Of all, 923 (65%) were from Asia (AS), 27 (2%) from Australia (AUS), 120 (8%) from Europe (EUR), 162 (11%) from North America (NA), and 194 (14%) from South America (SA). Based on the continent (AS vs. AUS vs. EUR vs. NA vs. SA), the histopathology features included massive choroidal invasion (31% vs. 7% vs. 13% vs. 19% vs. 27%, p=0.001), post-laminar optic nerve invasion (27% vs. 0% vs. 16% vs. 21% vs. 19%, p=0.0006), scleral infiltration (5% vs. 0% vs. 4% vs. 2% vs. 7%, p=0.13), and microscopic extrascleral infiltration (4% vs. 0% vs. <1% vs. <1% vs. 4%, p=0.68). Adjuvant chemotherapy with/without orbital radiotherapy was given in 761 (53%) patients. Based on Kaplan-Meier estimates in different continents (AS vs. AUS vs. EUR vs. NA vs. SA), the 6-year risk of orbital tumor recurrence was 5% vs. 2% vs. 0% vs. 0% vs. 12% (p<0.001), systemic metastasis was reported in 8% vs. 5% vs. 2% vs. 0% vs. 13% (p=0.001), and death in 10% vs. 3% vs. 2% vs. 0% vs. 11% (p<0.001) patients. There is a wide variation in the infiltrative histopathology features of RB across continents, resulting in variable outcomes. SA and AS had a higher risk of orbital tumor recurrence, systemic metastasis, and death compared to AUS, EUR, and NA.

General characteristics of orbital metastasis in breast cancer: a narrative review of case reports.

Breast-cancer metastasis has seen an increased incidence in recent years, owing to advancements in surveillance, diagnostic imaging, histopathological assessment, and treatment modalities. Metastasis to various sites, including the bone, lung, liver, and brain, is common in cancer patients. Orbital metastasis (OM) from breast cancer can lead to a range of symptoms, such as pain, palpebral ptosis, diplopia, ocular pain, vision loss, and a recessed eyeball. To explore the topic of systemic malignancies metastasizing to the orbit, a search was conducted on the PubMed service using keywords such as "orbit," "orbital," "cancer," "malignancy," and "metastasis." This review article aims to summarize the findings from the identified literature. Overall, 103 patients with breast cancer from 77 articles were investigated. The patients' mean age ± standard deviation was 58.73 ± 11.86years. Types of breast pathology observed in the evaluated patients included lobular (32.1%), ductal pathology (35.9%), and unspecified (32%). The most common symptom was vision change 37.9% and diplopia 26.2%. Despite the rarity of OM in breast cancer, it is crucial to consider this condition due to its potential to exacerbate the functional status of the neoplastic disease. The primary treatment approach for orbital metastasis involves radiation therapy, often combined with systemic chemotherapy, hormone therapy or targeted therapy. These interventions aim to minimize symptoms and control disease progression. It is encouraging that advancements in medication, along with timely diagnosis and treatment, have the potential to improve outcomes for patients with orbital metastasis. However, further research is necessary to comprehensively evaluate all aspects of breast cancer metastasis to rare organs. A deeper understanding of the underlying mechanisms and identification of potential therapeutic targets could enhance treatment strategies and ultimately improve patient prognosis.

Breast cancer orbital metastases: Clinical, histopathological features and disease related survival in a retrospective case series

PurposeTo analyze the clinical, radiological and histopathological features, and long-term follow-up of patients with orbital metastases originating from a primary breast carcinoma. Main outcomes were: demographic characteristics of the population, clinical ophthalmological presentation, histological features, orbital metastasis latency, disease related survival, mortality rate. DesignA retrospective observational case-series. MethodsThe medical records of 10 female patients affected by orbital metastases originating from a primary breast carcinoma referring at our tertiary referral center from 01/2016 to 12/2023, were reviewed. ResultsThe median age was 63 (71.50 - 57.25) years (time of orbital biopsy). The prevalent histotype of orbital metastases of breast cancer was lobular 9.00 (90 %). The median orbital metastasis latency time in months was 9 months (IQR: 11 - 5) (in one case the orbital metastases were the first manifestation of an unknown primary tumor). The median Disease Related Survival (DRS) during the observation period was 17.50 months and the 24 months survival rate 57.14 %. The overall Mortality Rate in our population was 60 %. ConclusionsThe most frequent histotype of breast cancer orbital metastasis is the lobular one. The primary tumor precedes the onset of orbital metastasis in the majority of cases and tends to present with the classic symptoms of a mass occupying and infiltrating space. Orbital metastases are a sign that the disease is at an advanced stage, the mortality rate is high and DRS low.

Uncommon orbital metastasis in ductal breast carcinoma: a rare presentation 12 years after treatment

Abstract Orbital metastasis originating from breast carcinoma, particularly ductal carcinoma, represents a rare clinical entity, with lobular carcinoma usually being more common. Long-term surveillance in breast cancer patients is crucial for early detection of metastasis. Herein, we present a case of a 70-year-old woman with a history of left ductal breast carcinoma, diagnosed and treated 12 years ago. She then developed left eye vision loss, diplopia, enophthalmos, and chemosis in October 2024. Imaging revealed orbital metastasis involving the left superior and lateral rectus extraocular muscles. Biopsy confirmed the diagnosis of orbital metastases arising from ductal breast carcinoma. This case underscores the significance of long-term surveillance in breast cancer patients, as metastasis can manifest years after the initial diagnosis. Despite its rarity, orbital metastasis warrants consideration in the differential diagnosis of ocular symptoms in patients with a history of breast carcinoma. Treatment primarily aims at palliation and preserving visual function, with prognosis typically poor.

Breast Carcinoma with Isolated Orbital Metastasis –A Rare Clinical Entity

Breast cancer with isolated orbital metastasis is a rare clinical entity.We hereby present a rare case report of 35 year old premenopausal lady with known case of carcinoma breast right side (operated for right modified radical mastectomy in year 2017 with final histopathology of pT2N2M0, hormone receptor-positive and Her2-negative disease). She completed adjuvant 8 cycles of standard dose chemotherapy with 4 cycles of Cyclophosphamide, Adriamycin followed by 4 cycles of Paclitaxel followed by local Radiation therapy. She was initiated Tab. Tamoxifen 20 mg once daily and was continued same for 4 years when in July 2021, she complained of sudden decreased visual acuity and diplopia of right eye lasting from last 1 month. Ophthalmological examination confirmed the findings with decreased visual acuity of 6/36 of right eye while visual acuity of left eye was normal. CT scan of orbits revealed 28 × 18mm heterogeneous enhancing soft tissue mass in right orbital compartment,extrabulbar, occupying postero-superior quadrant inseparable from lateral rectus muscle with optic nerve effacement. PET-CT scan was performed which revealed no metastasis elsewhere in the body. She was offered surgical oophorectomy followed by switch to another hormonal therapy of aromatase inhibitors. She showed complete response to treatment and is now disease from last 2 years.

Optimizing Surgical Management for Rhegmatogenous Retinal Detachment in Eyes with Active Retinoblastoma: A Safety-Driven Approach.

Introduction: Intraocular surgeries are conventionally contraindicated for patients with active retinoblastoma (Rb) due to the potential risk of tumor dissemination. However, surgery is occasionally necessary to preserve vision in patients with a single eye when the eye is complicated by rhegmatogenous retinal detachment (RRD). Objective: This study aims to evaluate the outcomes of surgical repair for RRD in pediatric patients with active Rb utilizing a non-drainage scleral buckling approach. Results: This cohort included six eyes from six patients who harbored active Rb and presented with RRD; one had a concurrent tractional component. All eyes (100%) had active intraocular Rb and were undergoing active therapy (systemic chemotherapy, cryotherapy, and thermal laser therapy) when RRD developed. RRD consistently manifested at the site of recent cryotherapy in all cases. RRD repair in the affected eyes was performed by scleral buckling without subretinal fluid drainage. Five of the six eyes (83%) achieved complete retinal reattachment. One eye (17%) with a tractional component exhibited partial reattachment and was eventually enucleated due to persistent active disease. At a median follow-up of 15 months (range 12-180 months) after scleral buckling, all five eyes had persistent retinal attachment, and no case developed orbital or distant metastasis. Conclusions: Our study demonstrates that nondrainage scleral buckling is an effective and safe method for the surgical repair of RRD in eyes harboring active Rb, as most cases achieved persistent complete retinal reattachment without the risk of tumor spread.

Metastatic anorectal melanoma presenting with bilateral orbital mass – A rare case

Due to the increased longevity of patients and advances in diagnostic modalities, an increase in the prevalence of patients with orbital metastasis is being observed. Here, we report a lady in her 40s who presented with complaints of painless protrusion of the left eyeball with restricted motility and reduced vision. She gave history of surgery for hemorrhoids. Based on clinical and imaging findings, a diagnosis of orbital metastasis was made. Thorough systemic evaluation revealed the primary tumor to be a melanoma of anorectal origin with widespread metastasis. An orbital surgeon should keep high suspicion for metastasis while working up cases of orbital malignancy, especially in the elderly population.

Clinical and Imaging Characteristics of Metastatic Orbital Tumours in North China.

This study was designed to review the primary sites, clinical manifestations, imaging features, treatments, and outcomes of 36 patients with orbital metastasis in North China. This was a retrospective review of 36 patients with orbital metastasis at Tianjin Eye Hospital between January 2010 and December 2020 in North China as well as a review of the literature. Thirty-six patients were included in the study; 17 were male, and 19 were female, with an age range of 1-82 years (average 54.9 ± 19.8 years). All the tumours were unilateral. The mean duration from the onset of orbital signs to presentation at the hospital was 2.4 months (range 1-10 months). Breast carcinoma, gastrointestinal tract carcinoma, and lung carcinoma were the most common histological types. Proptosis, ocular pain, and diplopia were the most common clinical manifestations. The superior orbit was the most common quadrant involved. All patients received comprehensive therapy, including surgery, radiotherapy, or chemotherapy. The average follow-up time was 2.45 years (range 7 months to 5.5 years). Ten patients in this study died as a result of disseminated metastasis from the primary tumour. In North China, the most common primary cancer that metastasizes to the orbit is breast cancer, followed by gastrointestinal tract carcinoma and lung cancer. The increasing trend of orbital gastrointestinal tract metastases in North China in recent years is noteworthy. The survival rate of patients with orbital metastasis of neuroblastoma is low.

Metastasis to orbit: A case series from tertiary eye center in Western India

This study aims to understand the pattern of the metastatic tumors to orbit in a tertiary eye center. Metastasis to orbit is extremely rare and challenging to diagnose and often mimics with primary orbital tumor. Due to the tremendous recent advances in cancer therapy, surveillance, ancillary histopathology, and imaging techniques for primary tumor diagnosis, the longevity of patients increases, leading to more chances of detection of orbital metastasis. We retrospectively studied and reviewed a case series of five patients with orbital metastasis from various systemic malignancies from 2018 to 2023. Out of five patients, three patients were from metastasis from breast carcinoma, one from neuroblastoma, and monophasic synovial sarcoma each, found a median age of 49 years (range=3–70 years). The most common symptoms and sign were painful proptosis and restriction of ocular motility, respectively.

Presentation of Metastatic Cholangiocellular Cancer with Orbital Metastasis

Presentation of Metastatic Cholangiocellular Cancer with Orbital Metastasis

Orbital Metastasis of Cervical Squamous Cell Cancer during Treatment with Pembrolizumab

Purpose: This case report presents a rare occurrence of squamous cell carcinoma metastasizing to the orbit from the cervix.Case summary: A 48-year-old female with cervical cancer and multiple bone metastases experienced binocular diplopia two days prior to admission to the Department of Gynecology for scheduled chemotherapy. She was undergoing treatment with pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor, for metastatic cervical cancer. The patient exhibited unilateral ptosis and restricted eyeball movement in the right eye. Brain MRI revealed a well-defined lobulated lesion attached to the superior rectus muscle in the right orbit and orbital apex. In suspicion of metastasis, radiation therapy with a dosage of 3,600 cGy was administered to the right orbital area, resulting in a reduction in size of the metastatic lesion. However, distant metastases subsequently developed in the bone and soft tissue, leading to the patient's demise one month later.Conclusions: This report emphasizes the importance of considering orbital metastasis from cervical cancer in patients undergoing advanced stage chemotherapy. It highlights the rarity of such cases and underscores the need for heightened awareness of this malignancy in patients with underlying cancer.

Ocular Metastasis from Breast Carcinoma: A Case Report

Background: Eye metastases are a rare event in cancer, patients with breast cancer being the most common primary site (28.5%–58.8%). Patients with ocular metastatic disease can present with a variable clinical picture. Most often presents as a cutaneous or subcutaneous nodule simulating a chalazion but with rapid growth and possible superficial ulceration. The definitive diagnosis is based on the anatomopathological analysis of the lesion. The treatment remains palliative and the prognosis remains poor. Objectives: To further define the histopathologic features of breast carcinoma conducive to orbital metastasis. Methods: We report a case of ocular metastasis in a 46-year-old woman presenting with right eye pain. She had been treated for ductal carcinoma breast cancer with lymph node and bone metastases 5 years ago; a mastectomy with lymph node dissection was performed. The patient consults us for unilateral eyelid swellings evolving for 4 months. On examination, we find well-limited rounded tissue formation in the right upper eyelid ulcerated in places. Oculomotricity was preserved and the rest of the examination was unremarkable. A biopsy of the lesion was carried. Results &amp; Conclusions: Microscopic examination revealed a fibrofatty tissue seat of a tumoral proliferation made of spans and cords, of carcinomatous cells with moderate atypia showing some mitosis figures. The stroma is fibrous. Immunohistochemical studies showed positive immunoreactivity to pancytokeratin, estrogen receptor, progesterone receptor and HER-2, the results were in favor of a metastatic breast carcinoma. In summary, In the case of a metastatic orbital tumor, breast cancer should be considered as a possible source, especially in elderly women. Integrating the clinical information with histopathological findings is warranted.

A 66-year-old woman with two weeks of distorted vision in the left eye.

To report a case of concurrent melanoma metastasis to the orbit and MEK inhibitor-associated retinopathy. Case report of a 66-year-old female patient undergoing mutation targeted MEK-inhibitor treatment for metastatic melanoma with retinal manifestations. After initiating MEK-inhibitor therapy our patient presented with bilateral blurred vision. Clinical examination and OCT imaging revealed multifocal bilateral serous retinal detachments consistent with MEKAR. Extrafoveal subretinal fluid foci resolved after discontinuation of MEK-inhibitor therapy, but her foveal lesions persisted for over 18 months. Years after her initial evaluation for MEKAR, our patient developed metamorphopsia in the left eye resulting from chorioretinal folds secondary to intraconal orbital metastasis. MRI revealed additional intracerebral and lung metastases, and the patient expired in 2 months. We report a case of prolonged MEKAR with concomitant orbital metastasis from melanoma. Multimodal imaging in conjunction with history and clinical features allows for disease identification and monitoring.

SAT557 Unexpected Whole Body Scan Finding

Abstract Disclosure: A. Arce Gastelum: None. C.Y. Liu: None. K. McCowen: None. A 41-year-old man presented with a neck mass. Following total thyroidectomy with central and bilateral lateral neck node dissection, he received a diagnosis of stage I T2N1bMx multifocal papillary thyroid cancer with extensive extrathyroidal extension, angioinvasion and 14/65 positive lymph nodes. Surgery was complicated by temporary post operative hypoparathyroidism. Lab testing one week post thyroidectomy, before radioiodine ablation showed a serum TSH 23 uIU/mL, thyroglobulin: 34.1 ng/mL, with thyroglobulin antibody: &amp;lt;0.9 [IU]/mL.Post RAIA Whole Body Scan revealed increased uptake in the right orbit, concerning for metastatic disease. Confirmatory MRI of the brain showed a right superior intraorbital cystic lesion. Although orbital metastases are infrequent, a metastatic lesion was suspected due to the aggressiveness of his thyroid cancer. The patient was referred to ophthalmology several months after surgery and underwent right orbitotomy with excision and biopsy of the mass. The pathology was consistent with a multilocular cystic tumor lined by bland cuboidal epithelium, containing proteinaceous concretions and entirely negative for metastasis. Extensive thyroid cancer is treated with surgery followed by radioactive iodine (I-131) in case of tissue remnants or extra nodal metastases. Although unusual, false-positive scans exhibiting the presence of 131I uptake in the absence of residual thyroid tissue can occur.Fibrotic lung conditions, pleural effusions and bronchiectatic lesions have been reported to concentrate iodine in the absence of thyroid cancer metastasis. One prior report of a conjunctival inclusion cyst also resulted in radioiodine uptake in the orbit. Unless identified as a false positive, radioiodine uptake may result in a diagnostic fallacy. The correlation of clinical signs and serum thyroglobulin trends with imaging techniques should be emphasized to prevent unnecessary additional therapy. Presentation Date: Saturday, June 17, 2023