tendon, and it covered the tissue plane of the levator aponeurosis and the levator palpebrae superioris muscle.An excisional biopsy of the mass was performed to confi rm the diagnosis. During the surgery, a mass was found just beneath the orbital septum with an anterior intraorbital extension, and a biopsy specimen was removed. Histopathological comparison of the specimen was then made with the previous esophageal biopsy specimen from this patient. The eyelid biopsy revealed a moderately differentiated metastatic squamous cell carcinoma (Fig. 2).After the diagnosis, the patient underwent palliative chemotherapy, but unfortunately the mass recurred 2 months after the surgery. Subsequent systemic work-up revealed lung and brain metastases.
CommentsThe most common features associated with orbital masses are acquired strabismus, blepharoptosis, proptosis, periorbital swelling, pain, reduced vision, 2,3 and headaches. 4 In our case, the apparent signs were blepharoptosis and acquired strabismus. As far as we know, metastasis of an esophageal squamous cell carcinoma to the anterior orbit involving the orbital septum is rare. In 1990, Goldberg et al. 1 reported that in a large series of orbital metastases there were ten cases of gastrointestinal tract tumors that metastasized to the orbit. The most common sites of these were the stomach, ileum, and colon.Esophageal cancer is a treatable disease, but it is rarely curable. The risk factors for squamous cell carcinoma of the esophagus have been identifi ed as smoking, alcohol consumption, and diet. 5 The 5-year overall survival rate in patients amenable to defi nitive treatment ranges from 5% to 30%. The fi ndings in our case highlight the need for increased awareness of the potential for orbital metastasis, especially of an esophageal primary neoplasm. It also reinforces the need for imagery-based investigations to detect the early stage of metastasis and blepharoptosis in patients with esophageal squamous cell carcinoma.
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