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Shin, Lee, Lim, Lee, Park, Baek, Choi, Ahn, and Baek: Bilateral Extraocular Muscle Metastasis of Nasal Rhabdomyosarcoma Mimicking a Thyroid Associated Orbitopathy: A Case Report
Case Report
Journal of the Korean Society of Magnetic Resonance in Medicine

Journal of the Korean Society of Magnetic Resonance in Medicine 2011; 15(2): 176-180.

Published online: 31 August 2011

DOI: https://doi.org/10.13104/jksmrm.2011.15.2.176

Bilateral Extraocular Muscle Metastasis of Nasal Rhabdomyosarcoma Mimicking a Thyroid Associated Orbitopathy: A Case Report

Jin Ho Shin1, Jeong Hyun Lee1, Hyun Kyung Lim1, Ha Young Lee1, Jee Won Park1, Hye Jin Baek1, Young Jun Choi1, Jin-Hee Ahn2, Jung Hwan Baek1

1Department of Radiology and Reasearch Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Korea.

2Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Korea.

Corresponding author: Jeong Hyun Lee, M.D., Ph.D., Head & Neck Imaging Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea. Tel. 82-2-3010-4400, Fax. 82-2-476-0090, jeonghlee@amc.seoul.kr

Received 5 August 2011       Revised 9 August 2011       Accepted 23 August 2011

Copyright © 2011 Korean Society of Magnetic Resonance in Medicine

(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

Metastases to the orbit usually affect the intraorbital fat and bone than the extraocular muscles. Metastasis to the extracoular muscles commonly occurs unilaterally, and diffuse enlargement of the bilateral extraocular muscles due to metastasis is extremely rare. In this report, we will describe a case of diffuse metastasis to the bilateral extraocular muscles from nasal rhabdomyosarcoma masquerading as thyroid associated orbitopathy. We will also discuss about the MR imaging findings helpful for differential diagnosis from thyroid associated orbitopathy.

Keywords: Rhabdomyosarcoma, Alveolar, Extraocular muscle metastasis, Magnetic resonance imaging (MRI), Thyroid associated orbitopathy

Figures and Tables

Fig. 1
(a-c) Initial orbit MR. Coronal T1-weighted (a), axial T2-weighted (b) and contrast-enhanced axial T1-weighted (c) images show diffuse enlargement and mild enhancement of the extraocular muscles except the left superior and the right lateral rectus muscles with sparing of the tendinous parts. The fat plane is clearly defined between the extraocular muscles and the orbital fat. Note there is abrupt curving and nodularity of the dilated muscle belly at the tendinous portion of the left medial rectus muscle (arrow). (d-f) Follow-up orbit MR 25 days after steroid pulse therapy. In addition to marked enlargement of the extraocular muscles on coronal T1-wieghted image (d), focal nodularity of the involvement muscles are more clearly demonstrated on axial T2-weighted (e) and contrast-enhanced axial T1-weighted (f) images. (g-h) 18F-FDG PET/CT performed on the same day with the 2nd follow-up orbit MRI. An axial 18F-FDG PET/CT image (g) shows intense hypermetabolism of the thickened bilateral medial and left lateral rectus muscles (SUVmax, 6.0 - 7.4 g/mL). The coronal maximum intensity projection image (h) shows multifocal hypermetabolic areas involving the axial and appendicular skeleton from disseminated bone metastasis. Contrast-enhanced axial T2-weighted image (i) after additional chemotherapy shows remarkable regression of the metastatic tumor involving the bilateral extraocular muscles.
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