Bilateral metastases to the extraocular muscles from small cell lung
            carcinoma

Crisóstomo, Sara; Cardigos, Joana; Fernandes, Diogo Hipólito; Luís, Maria Elisa; Pires, Guilherme Neri; Duarte, Ana Filipa; Boavida, Ana Magriço

doi:10.5935/0004-2749.20190081

Cited by 5 publications

(8 citation statements)

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“…Interestingly, several prior reports of metastatic NEC to the orbit showed a propensity for extraocular muscle involvement, like in our patient 6 21–23. This is unusual because the extraocular muscles are generally rare sites of orbital metastasis 24.…”

Section: Discussionsupporting

confidence: 65%

“…In the orbit, most case reports of NECs have been managed with chemotherapy with or without additional radiotherapy, though primary excisions have also been attempted in rare localised presentations as summarised in table 1 10 21. Metastatic NECs involving the orbit treated with chemoradiotherapy have been reported to have survival ranging from 3 months to 36 months,22 28 while primary localised eyelid involvement seemed to have survival to at least to 1.5 and 3 years after excision only or with adjunctive chemoradiotherapy, respectively 10 21…”

Section: Discussionmentioning

confidence: 99%

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Poorly differentiated orbital neuroendocrine carcinoma

Zhang,

Jiro,

Pekmezci

et al. 2023

BMJ Case Rep

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A man in his 70s presented with painless bilateral eyelid oedema and vertical diplopia. Evaluation showed a restrictive pattern of extraocular motility testing with MRI demonstrating significant enlargement of the right superior rectus and left superior oblique muscles along with right orbital fat stranding. Subsequent right orbital biopsy revealed poorly differentiated high-grade neuroendocrine carcinoma without a systemic primary site on further diagnostic workup. The patient was treated with carboplatin and etoposide and passed away from an infection a month after diagnosis. This case along with a review of other published cases highlights the varied presentation of orbital neuroendocrine carcinomas that may mimic a broad differential of orbital processes, thus requiring careful diagnostic workup. Subsequently, additional considerations in metastatic evaluation should be based on tumour histological features.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Poorly differentiated orbital neuroendocrine carcinoma

Zhang,

Jiro,

Pekmezci

et al. 2023

BMJ Case Rep

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“…We found that most metastases occurred unilaterally and diffusely infiltrated intra/extraconal orbital soft tissues, causing globe displacement with proptosis, diplopia and impaired eye motility [ 3 , 4 , 5 ]. The direct compression of the optic nerve, commonly at the orbital apex, additionally led to RAPD and vision decline, with a serious impact on patients’ functional status [ 33 , 34 ]. Less frequently, paradoxical enophthalmos of the affected eye resulted from the infiltration of neoplastic cells into the extraocular muscles and retro-bulbar stromal tissues causing desmoplasia, fibrosis and globe retraction [ 35 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes

Palmisciano

Ferini²,

Ogasawara

et al. 2021

Cancers

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Background: Orbital metastases often lead to severe functional impairment. The role of resection, orbital exenteration, and complementary treatments is still debated. We systematically reviewed the literature on orbital metastases. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched upon PRISMA guidelines to identify studies on orbital metastases. Clinical characteristics, management strategies, and survival were analyzed. Results: We included 262 studies comprising 873 patients. Median age was 59 years. The most frequent primary tumors were breast (36.3%), melanoma (10.1%), and prostate (8.5%) cancers, with median time interval of 12 months (range, 0–420). The most common symptoms were proptosis (52.3%) and relative-afferent-pupillary-defect (38.7%). Most metastases showed a diffuse location within the orbit (19%), with preferential infiltration of orbital soft tissues (40.2%). In 47 cases (5.4%), tumors extended intracranially. Incisional biopsy (63.7%) was preferred over fine-needle aspiration (10.2%), with partial resection (16.6%) preferred over complete (9.5%). Orbital exenteration was pursued in 26 patients (3%). A total of 305 patients (39.4%) received chemotherapy, and 506 (58%) received orbital radiotherapy. Post-treatment symptom improvement was significantly superior after resection (p = 0.005) and orbital radiotherapy (p = 0.032). Mean follow-up was 14.3 months, and median overall survival was 6 months. Fifteen cases (1.7%) demonstrated recurrence with median local control of six months. Overall survival was statistically increased in patients with breast cancer (p < 0.001) and in patients undergoing resection (p = 0.024) but was not correlated with orbital location (p = 0.174), intracranial extension (p = 0.073), biopsy approach (p = 0.344), extent-of-resection (p = 0.429), or orbital exenteration (p = 0.153). Conclusions: Orbital metastases severely impair patient quality of life. Surgical resection safely provides symptom and survival benefit compared to biopsy, while orbital radiotherapy significantly improves symptoms compared to not receiving radiotherapy.

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“…The most common primary tumors are breast cancer, melanoma, prostate cancer and gastrointestinal tumors [14,38]. In general, the prognosis is poor [39]. Patients report diplopia, pain, restricted eye movement and proptosis [21,40].…”

Section: Metastasismentioning

confidence: 99%

“…Patients report diplopia, pain, restricted eye movement and proptosis [21,40]. Most metastases are unilateral, bilateral cases are rare [39].…”

Section: Metastasismentioning

confidence: 99%

Orbital Muscle Enlargement: What if It’s Not Graves’ Disease?

Lakerveld

Gijp

2022

Curr Radiol Rep

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Purpose of Review To provide the radiologist with tools to recognize findings atypical for Graves’ ophthalmopathy and differentiate between the most important and common alternative causes of extraocular muscle enlargement on CT and MR imaging. Recent findings We introduce five ‘red flags’ representing features that are atypical for Graves’ ophthalmopathy: unilateral disease, atypical pattern of muscle involvement, adjacent structure involvement, restricted diffusion, and absence of pain. Summary About 95% of the cases with extraocular enlargement are due to Graves’ ophthalmopathy, other causes are less well known and recognized. The ‘red flags’ may aid in recognizing and suggesting alternative diagnoses.

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Bilateral metastases to the extraocular muscles from small cell lung carcinoma

Cited by 5 publications

References 0 publications

Poorly differentiated orbital neuroendocrine carcinoma

Poorly differentiated orbital neuroendocrine carcinoma

Orbital Metastases: A Systematic Review of Clinical Characteristics, Management Strategies, and Treatment Outcomes

Orbital Muscle Enlargement: What if It’s Not Graves’ Disease?

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