Orbital Metastasis as Initial Clinical Presentation in a Patient of Hepatocellular Carcinoma – A Rare Case with Review of Literature

Abstract

Orbital metastasis, as the initial clinical presentation in hepatocellular carcinoma (HCC), is a rare manifestation. A 66-year-old male patient presented with a history of protrusion of the eyeballs, double vision, and swelling over the left side of the head for 8 months. Magnetic resonance imaging of the brain with orbit revealed a heterogeneous lesion in the left frontal lobe causing its destruction with intraorbital and intracranial extension. Triphasic contrast-enhanced computed tomography was suggestive of multiple hypodense areas in both lobes of the liver. Tissue diagnosis from the liver was suggestive of HCC. A diagnosis of multifocal HCC with orbital metastasis was made. The patient was treated with palliative radiotherapy and sorafenib. Orbital metastasis in HCC is rare. Prognosis is somber in such cases. The treatment should focus on providing palliation from symptoms.

Orbital Metastasis as the First Manifestation of Hepatocellular Carcinoma, and Its Effective Treatment with Combined Dual Immunotherapy: A Case Report and Review of the Literature

“…Dataon the optimal treatment of HCC with orbital metastasis are lacking, and therapeutic options are limited. To the best of our knowledge, only 5 patients among the 45 reported patients with advanced HCC and orbital metastasis underwent standard systemic therapy [ 4 , 12 , 13 , 33 , 34 ]. Among them, 1 patient received atezolizumab plus bevacizumab (survival of only 6 months) [ 13 ], whereas 4 received sorafenib (survival not reported).…”

“…In real-world clinical practice, the affordability of both immunotherapies and targeted therapies remains challenging. Orbital RT can be performed to reduce tumor size and alleviate symptoms [12,13,[29][30][31] in cases in which surgery is contraindicated. Surgical debulking is effective in reducing tumor mass-related symptoms [20,21,29,32]; however, it could result in serious complications, including permanent visual deficits.…”

“…Orbital metastases originating from HCC are exceptionally rare, with only a few cases with confirmed histopathology [ 12 – 14 ]. Unfortunately, the prognosis of HCC metastasized to the orbit remains unfavorable [ 9 , 15 ].…”