Metastatic adenocarcinoma of bilateral cavernous sinus and optic nerve with unknown primary mimicking orbital pseudotumor

Kumar, R Praveen; Deopujari, C.E.; Shah, Ritesh; Kumar, Ashish

doi:10.4103/0028-3886.48807

Cited by 2 publications

(4 citation statements)

References 8 publications

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“… 27 Thomas and Yoss recorded 23% parasellar lesion to be metastatic tumors. 27 28 The role of biopsy and surgical resection in known systemic cancer and MRI-confirmed cavernous sinus lesions is unclear. 29 Various reported primary tumors in literature includes squamous cell carcinoma (SCC) of the head and neck, 30 nasopharyngeal carcinoma, 31 oropharyngeal carcinoma, 31 melanoma, 32 papillary adenocarcinoma, 33 rhabdomyosarcoma of the head and neck, 34 35 salivary gland duct carcinoma, and SCC of salivary glands.…”

Section: Discussionmentioning

confidence: 99%

“…25,26 Adenocarcinoma Metastases to the cavernous sinus are uncommon and the incidence of central nervous system (CNS) involvement is approximately 30 to 40% of systemic cancer patients. 27 Thomas and Yoss recorded 23% parasellar lesion to be metastatic tumors. 27,28 The role of biopsy and surgical resection in known systemic cancer and MRI-confirmed cavernous sinus lesions is unclear.…”

Section: Cavernous Angiomamentioning

confidence: 99%

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Spectrum of Surgically Resected Lesions of the Cavernous Sinus: A Neuropathologic Audit

Ramalingaiah

Arivazhagan

et al. 2022

JNRP

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Background The cavernous sinus is a complex space composed of extradural venous plexus within dural folds. Several important structures like the carotid artery, cranial nerves, and sympathetic nerve fibers traverse through this space. Radiological diagnosis may not be definitive and in the context of discordance between clinical and neuroimaging diagnosis, histopathological evaluation becomes essential for diagnosis and management. Literature on the pathological spectrum of lesions is scarce as, with a shift in the treatment paradigm, most small lesions of cavernous sinus are treated with radiosurgery. However, surgical management still plays a role for larger lesions and in radiologically ambiguous cases for planning the definitive management. Materials and Methods We retrospectively reviewed all surgically resected lesions of the cavernous sinus over the last two decades (1998–2019). The clinical presentation, neuroimaging features, and histopathological findings were reviewed. Lesions extending from sella and other adjacent areas were excluded. Results Thirty-eight cases of isolated cavernous sinus mass lesions were diagnosed over the last two decades (1998–2019). Cavernous hemangiomas (19 cases, 50%) constituted the most frequent pathology, followed by aspergilloma, meningioma, schwannoma, metastatic adenocarcinoma, chondrosarcoma, and chordoma. Overall, 29.4% (10/34) could not be accurately diagnosed on neuroimaging. Of these, four cases of cavernous hemangiomas were mistaken for either meningioma (three cases) or schwannoma (one case). Neither chordoma nor chondrosarcoma was suspected. Conclusion This is the first study in literature, enumerating the pathological and imaging spectrum of surgically resected cavernous sinus lesions. Cavernous hemangiomas, metastases and chordomas, and chondrosarcoma posed the greatest difficulty in diagnosis on neuroimaging and the reasons for the same are analyzed. In the context of clinical and neuroimaging discordance in diagnosis, pathological characterization becomes essential for appropriate and timely management.

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Section: Discussionmentioning

confidence: 99%

Section: Cavernous Angiomamentioning

confidence: 99%

Spectrum of Surgically Resected Lesions of the Cavernous Sinus: A Neuropathologic Audit

Ramalingaiah

Arivazhagan

et al. 2022

JNRP

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“…Idiopathic orbital inflammation (IOI) is an immune mediated infiltrative condition that has distinct variants, a non-sclerosing and a sclerosing type, which is characterized by a polymorphous lymphoid infiltrate or a predominance of fibrosis, respectively 1 , 2 . The non-sclerosing type is fairly common, representing the majority of orbital inflammatory syndromes 3 .…”

Section: Introductionmentioning

confidence: 99%

“…The non-sclerosing type is fairly common, representing the majority of orbital inflammatory syndromes 3 . The differentiation of idiopathic orbital inflammation and orbital inflammation secondary to neoplasia can be challenging, as both processes may manifest with similar clinical presentations 2 …”

Section: Introductionmentioning

confidence: 99%

Primary adenocarcinoma of the orbit initially diagnosed as idiopathic sclerosing orbital inflammation

Reed

Mehta

Hayes

et al. 2019

American Journal of Ophthalmology Case Reports

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Purpose Differentiating idiopathic sclerosing orbital inflammation from orbital inflammation secondary to neoplasia may be challenging, as both processes can present similarly. Neoplasms in the orbit may induce inflammation with accompanying fibrosis. Limited sections of histopathological specimens may demonstrate nonspecific inflammation and lead to an inaccurate diagnosis. Observations The authors present a case of infiltrating adenocarcinoma of the orbit with mucinous features which was misdiagnosed as idiopathic sclerosing orbital inflammation due to three separate benign biopsy specimens. Conclusions and Importance The ophthalmologist must remain suspicious of malignancy in cases of suspected idiopathic orbital inflammation with an atypical clinical course, regardless of apparently benign biopsy results.

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Metastatic adenocarcinoma of bilateral cavernous sinus and optic nerve with unknown primary mimicking orbital pseudotumor

Cited by 2 publications

References 8 publications

Spectrum of Surgically Resected Lesions of the Cavernous Sinus: A Neuropathologic Audit

Spectrum of Surgically Resected Lesions of the Cavernous Sinus: A Neuropathologic Audit

Primary adenocarcinoma of the orbit initially diagnosed as idiopathic sclerosing orbital inflammation

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