Retrobulbar metastasis and intracranial invasion from postoperative hepatocellular carcinoma: A case report and review of the literature

Chen, Chunyong; Zhong, Jian‐Hong; Liu, Jing‐Li

doi:10.3892/ol.2014.2733

Cited by 10 publications

(7 citation statements)

References 32 publications

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“…Based on imaging findings, many authors reported that HCC metastasizing to the orbits is associated with adjacent bone changes such as bone destruction, bone erosion, and notching. 5,6,22,31 Similarly, our case had lytic changes noted in both lateral walls and right frontal bones adjacent to the tumor masses.…”

Section: Discussionsupporting

confidence: 61%

Bilateral orbital metastasis as an initial presentation of hepatocellular carcinoma

Myint

Thant

Thazin³

2020

Asian JO

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Purpose: To describe a case of biopsy-confirmed bilateral orbital metastasis of previously undiagnosed hepatocellular carcinoma, presenting with bilateral proptosis. Case description: A 57-year-old man presented with painless bilateral proptosis over 2 months. At presentation, the best-corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye. Ocular examination revealed bilateral asymmetrical non-axial proptosis with Hertel exophthalmometer reading of 24 mm in the right eye and 22 mm in the left eye. There was mild inferior displacement in both eyes. Apart from mild exposure keratopathy in the right eye, both anterior and posterior segment examinations were not remarkable. Orbital computerized tomography (CT) scan showed soft tissue masses in the superotemporal quadrants of both orbits associated with lytic bone lesions. An orbital biopsy confirmed that it was metastatic hepatocellular carcinoma (HCC). Ultrasound abdomen revealed multifocal HCC with underlying cirrhosis. We planned for further investigations such as hepatitis serology, alfa-fetoprotein, and CT abdomen, but he refused to proceed with investigations and treatment. Conclusion: Orbital metastasis, more so as a bilateral involvement, is a rare phenomenon. It may present as an initial manifestation of undiagnosed systemic cancer. Orbital metastasis should be considered when diagnosing patients with bilateral proptosis, and orbital biopsy is crucial for histopathological diagnosis.

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Section: Discussionsupporting

confidence: 61%

Bilateral orbital metastasis as an initial presentation of hepatocellular carcinoma

Myint

Thant

Thazin³

2020

Asian JO

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“…Orbital metastases are unusual as first clinical presentation of neoplastic disease. Several case series reported lung, breast, melanoma and prostate cancer as the most frequent primary tumors (3,4). In patients with HCC, the presence of orbital metastases represents an highly rare finding, and requires a multimodal approach involving expert ophthalmologists, surgeons, radiotherapists and oncologists starting from the initial presentation (3,4).…”

Section: Discussionmentioning

confidence: 99%

Critical diagnostic delay associated with unusual presentation of hepatocellular carcinoma (HCC) with orbital metastases: a case report

et al. 2021

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Orbital metastases are an extremely rare finding in patients with hepatocarcinoma (HCC), especially as its first presentation. Therefore, the risk of misdiagnosis is high, as well as that of drastic delays of the therapeutic algorithm. Here we report a 71-year-old man presenting with orbital metastases as the initial sign of HCC, whose initial misdiagnosis led to the impossibility to start life-saving cancer treatment.The patient's history has begun on March 2018 with a growing tumefaction of the right orbit initially treted with antibiotics and corticosteroids without benefit. Subsequently, a facial CT scan showed a voluminous right intra-orbital mass, eroding the orbital roof. Tissue biopsy documented well differentiated malignant epithelial tumor cells. Under the suspect of primitive lachrymal gland tumor, the patient was admitted to the head and neck Unit with surgical intent. However, a subsequent 18F-FDG-PET documented the presence of liver lesions and multiple sites of metastasis. A new biopsy, this time on liver nodules, was carried out and the diagnosis of HCC was finally made. Samples from the first biopsy were then reviewed and judged consistent with HCC metastasis. Unfortunately, the initial misdiagnosis resulted in a six-month delay of the start of a therapeutic approach. During that time, patient's general conditions got extremely worse, making him unable to afford an antiblastic treatment. The patient died three months after the definitive diagnosis. This case suggests that the presence of intraorbital lesion requires a multimodal approach starting from the initial presentation. Performing a complete staging since tumor's clinical onset is mandatory, preferably before carrying out a tissue biopsy. Even though HCC represents a rare cause of intraocular metastasis, it needs to be ruled out when an orbital mass is documented, as the short median survival and the frequently poor conditions of HCC patients make a timely diagnosis crucial.

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“…1,2) Intracranial metastasis of hepatocellular carcinoma bleeds easily, and bone metastasis, in particular, occasionally causes extradural or subdural hemorrhage. 1,3) It is treated radiochemically or surgically, but we selected surgical resection for our present patient because the lesion was painful and grew rapidly in a short period. In addition, examinations before tumor resection demonstrated feeding vessels from the dura mater, bone, and skin via the middle meningeal and superficial temporal arteries, and massive hemorrhage during tumor resection was indwelling needle and a microcatheter alone.…”

Section: Discussionmentioning

confidence: 99%

A Case of Tumor Embolization for Metastatic Bone Tumor and Stanford Type A Aortic Dissection under Direct Carotid Puncture

Mochizuki

Ishikawa

Yamaguchi

et al. 2017

JNET

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Objective: A case of metastatic bone tumor difficult to approach via the transfemoral route in which preoperative tumor embolization through a small cervical incision was effective is presented.Case Presentation: The patient was a 73-year-old male being treated for liver cancer. A mass 60 mm in maximum diameter that rapidly grew inside and outside the cranium was noted in the parietal region. Since the lesion was difficult to approach transfemorally because of the history of Stanford type A aortic dissection, a sheath was inserted into the common carotid artery through a small incision in the neck, and tumor embolization was performed by settings similar to the transfemoral approach. No procedural complication was observed, and the control of hemorrhage during tumor resection was adequate. Conclusion:Tumor embolization by direct carotid artery puncture through a small cervical incision was a safe and effective approach.

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Retrobulbar metastasis and intracranial invasion from postoperative hepatocellular carcinoma: A case report and review of the literature

Cited by 10 publications

References 32 publications

Bilateral orbital metastasis as an initial presentation of hepatocellular carcinoma

Bilateral orbital metastasis as an initial presentation of hepatocellular carcinoma

Critical diagnostic delay associated with unusual presentation of hepatocellular carcinoma (HCC) with orbital metastases: a case report

A Case of Tumor Embolization for Metastatic Bone Tumor and Stanford Type A Aortic Dissection under Direct Carotid Puncture

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