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Moon, Kang, Ahn, and Sa: Clinical Characteristics of Metastatic Orbital Tumors: Our Experience with 27 Cases
Original Article

Journal of the Korean Ophthalmological Society 2018; 59(1): 1-8.

Published online: 12 January 2018

DOI: https://doi.org/10.3341/jkos.2018.59.1.1

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

Yeji Moon, MD, Sunah Kang, MD, Chan Joo Ahn, MD, Ho-Seok Sa, MD, PhD

Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address reprint requests to Ho-Seok Sa, MD, PhD. Department of Ophthalmology, Asan Medical Center, #88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: 82-2-3010-3680, Fax: 82-2-470-6440, lineblue@hanmail.net

Received 24 August 2017       Revised 14 October 2017       Accepted 20 December 2017

©2018 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Metastasis, Orbital tumor

Figures and Tables

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).

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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).

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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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Table 1

Primary sites of metastatic tumor to the orbit and sex of the patients

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Values are presented as n (%).

*Four patients had hepatocellular carcinoma, the other patient had cholangiocarcinoma; †One patient had diffuse large B-cell lymphoma.

Table 2

Initial presenting symptoms and signs of the patients

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Values are presented as n (%).

Table 3

Involving orbital structures of metastatic orbital tumors

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Values are presented as n (%).

Table 4

Pathologic study, treatment and prognosis of patients with metastatic orbital tumors

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F = female; M = male; CTx = chemotherapy; RTx = radiotherapy; FNAB = fine needle aspiration biopsy.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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