Metastatic orbital tumors in Japan: A review of the literature

Abstract

A review of reports on metastatic orbital tumors published from 1903 to 1998 in Japan revealed 128 patients, 74 males, 52 females and 2 whose sex was not recorded. The average age was 44.8 years, but varied depending on the primary tumor. Since 1980, metastatic orbital tumors have increased in Japan, especially those from the lung, liver and adrenal gland, while metastasis from the stomach has decreased slightly. Metastasis from the breast is still common. Most metastatic orbital tumors were from the lung, followed, in order, by breast, liver, adrenal gland and stomach. Males had four times as many metastatic orbital tumors from lung cancer than did females; only females had metastases from breast cancer; almost 90% of metastases from hepatoma were in males; metastasis from renal carcinoma was 2-3 times more common in males than in females. Metastasis from the liver and stomach is seen more frequently in Japan than in the United States and Europe. Ocular signs due to orbital metastases from hepatoma, neuroblastoma and gastric cancer were apt to appear earlier than the signs of the primary lesion. Metastases to the orbit were frequently bilateral in patients with neuroblastoma and malignant lymphoma. Specific ocular signs such as ecchymosis and conjunctival hemorrhages were seen in orbital metastasis from neuroblastoma and seminoma, while ocular pain was characteristic of malignant lymphoma. Orbital metastasis was very rare in patients with carcinoma of the uterus, ovaries, bladder, pancreas, colon or rectum in both Japan, the United States and Europe.

Massive Orbital Metastasis of Hepatocellular Carcinoma.

“…8,9 Likewise, in the Japanese series of 18 cases, approximately 80% of the patients had orbital metastasis as the first sign of liver cancer. 4 It is not always clear whether clinically apparent orbital metastases from hepatocellular carcinoma represent local extension from an osseous lesion or metastatic deposits in the soft tissues of the orbit. 4 Proptosis, visual disturbance, and ocular pain are the most frequent clinical findings.…”

“…4 It is not always clear whether clinically apparent orbital metastases from hepatocellular carcinoma represent local extension from an osseous lesion or metastatic deposits in the soft tissues of the orbit. 4 Proptosis, visual disturbance, and ocular pain are the most frequent clinical findings. 4,7 There seems to be no lateral preponderance for orbital involvement by hepatocellular carcinoma, but the lesion was consistently unilateral in the case reports and series.…”

“…In our patient, symptomatic improvement followed the administration of megestrol acetate and gemcitabine, but we were uncertain as to the relative contribution of these agents. The average survival of patients with orbital metastases from hepatocellular carcinoma has been reported as 10.4 months, 4 and often depends on the disease status elsewhere in the body. Our report illustrates the possibility of massive growth of an untreated orbital metastasis of hepatocellular carcinoma, and reminds clinicians of this possible cause of orbital tumor.…”

“…4 Proptosis, visual disturbance, and ocular pain are the most frequent clinical findings. 4,7 There seems to be no lateral preponderance for orbital involvement by hepatocellular carcinoma, but the lesion was consistently unilateral in the case reports and series.…”

“…In contrast, a recent review from Japan has shown that hepatocellular carcinoma is the third most frequent cause of orbital metastasis in that country, after lung and breast cancer. 4 In Japan, hepatocellular carcinoma is among the leading causes of cancer incidence and death. Although liver cancer is a major health problem in Japan, China, South East Asia, and sub-Saharan Africa, Brazil is a country with an intermediate age-standardized incidence rate 5 and in which the disease is not among the 10 most frequent tumor types.…”