Orbital Metastases as the First Manifestation of Lung Adenocarcinoma

Terzi, Eirini; Kouliatsis, George; Androuli, Sofia; Kontakiotis, Theodoros; Zaramboucas, Thomas; Zarogoulidis, Kostas

doi:10.1159/000323945

Cited by 8 publications

(10 citation statements)

References 22 publications

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“…The most common symptoms and signs are including abnormal eye position (65.22%), proptosis (63.04%), increased orbital pressure (54.35%), diplopia (54.35%), and limited eye motility (52.17%). These five symptoms are the most common clinical manifestations [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Zarogoulidis et al reported the beneficial efficacy of a combination of bevacizumab and pemetrexed chemotherapy for patients with orbital metastases. The efficacy of bevacizumab in radiation retinopathy has also been reported [ 9 ]. Koma et al reported cases of non-small cell lung cancer (NSCLC) patients with EGFR mutations, among which responded positively to the administration of gefitinib therapy, shown in the primary and orbital lesions [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Lung adenocarcinoma presenting with an orbital metastasis

Soeroso

Tarigan

Saragih

et al. 2018

Respiratory Medicine Case Reports

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Orbital metastasis of lung adenocarcinoma is very rare. The incidence is only found to be approximately 7%–12% of lung cancer cases. The lack of knowledge about orbital metastasis results in misdiagnosis between malignant or benign lesion. This was a case of a 39-year-old woman complaining about a protruding left eye and a blind pain in the left eye characterized by hyperemesis eyeball. A CT scan of the orbital showed a soft tissue tumor in the fronto-naso-superomedial area of the left orbital with suspicion of infiltration of the medial rectus muscle, left bulbus oculi, lamina papyracea, and left frontal sinus wall which causes proptosis and soft tissue tumor in the left temporal region with suspicion of infiltration in the left sphenoid wing with an impression of metastasis. A Fine Needle Aspiration Biopsy (FNAB) in the temporal and intra-orbital region showed metastatic adenocarcinoma. Moreover, findings of the chest x-ray and chest CT scan concluded that there was a tumor in the left lung, and a bronchoscopy found adenocarcinoma as the biopsy results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lung adenocarcinoma presenting with an orbital metastasis

Soeroso

Tarigan

Saragih

et al. 2018

Respiratory Medicine Case Reports

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“…Surgery is usually recommended only in selected patients, aiming at symptom relief and improvement of orbital function as long as possible; but in general, this is not the therapy of first choice. Recently, novel antitumor agents have had proven efficacy in patients with advanced NSCLC, and their integration into new treatment has evoked the exploration for orbital metastases; in fact, Zarogoulidis et al 19 reported favorable efficacy of a combination chemotherapy of bevacizumab and pemetrexed in patients with orbital metastasis. Bevacizumab’s efficacy in radiation retinopathy has also been reported.…”

Section: Discussionmentioning

confidence: 99%

Orbital metastasis as the initial presentation of lung adenocarcinoma: a case report

Sun

et al. 2016

OTT

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Orbital metastasis as the initial presentation of lung adenocarcinoma is very rare, and so the lack of knowledge about this phenomenon can easily result in misdiagnosis, either as a orbital primary tumor or benign lesion. Here, we report a rare case in which the orbital symptom appeared first without any pulmonary manifestations. Our patient developed decreasing vision in his right eye over a 3-month duration. He then presented with proptosis and multiple aches from head to back. After systemic evaluation, our patient was diagnosed with Stage IV non-small-cell lung cancer and was managed with palliative chemoradiotherapy. The final result of treatment suggests that the therapeutic efficacy of chemotherapy on orbital metastasis is uncertain, and only some orbital metastatic masses may have a favorable response to radiation. Furthermore, we review the recent data and provide an in-depth discussion on the clinical features and course of ocular pulmonary metastases, and explain a new type of non-small-cell lung cancer metastatic pattern for ophthalmologists and oncologists to help them distinguish the orbital metastasis as the first manifestation.

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“…Unfortunately, cytotoxic chemotherapy does not show as quick a response for NSCLC as it does for SCLC. Recently, several novel antitumor agents have brightened the outlook for patients with advanced NSCLC; in fact, Zarogoulidis et al reported favorable efficacy of combination chemotherapy including bevacizumab and pemetrexed in patients with orbital metastasis [6]. Gefitinib shows a rapid and improved response rate over combination chemotherapy in patients with NSCLC harboring EGFR-activating mutations [3].…”

Section: Discussionmentioning

confidence: 99%

Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report

et al. 2012

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IntroductionOrbital metastases of lung cancer are rare. However, because the number of patients diagnosed with lung cancer is increasing, the probability that a physician will see a patient with an orbital metastasis is also increasing. Unfortunately, the clinical course and response of these patients to cytotoxic chemotherapy are generally poor and keeping a patient’s quality of vision is difficult. In recent years, gefitinib, an epidermal growth factor receptor tyrosine kinase inhibitor, has brightened the outlook for patients with advanced non-small cell lung cancer, especially for those who carry epidermal growth factor receptor-activating mutations.Case presentationA 62-year-old Japanese man presented with swelling of the eyelid margin and ptosis of his right eye. A physical examination revealed double vision in his right eye and an alteration in elevator muscle mobility. A magnetic resonance image demonstrated a right intra-orbital mass (18 × 16mm). Screening examinations were carried out because this mass was suspected to be a metastasis from another organ. Chest computed tomography revealed a 42 × 37mm mass shadow on the left side of the hilum with mediastinal lymph node metastases. Adenocarcinoma with an epidermal growth factor receptor gene mutation (exon 19 deletion L747-E749; A750P) was detected in a transbronchial biopsy specimen; the patient was diagnosed with stage IV (T2N2M1) non-small cell lung cancer.Gefitinib (250mg/day) was chosen as first-line chemotherapy because there was no pre-existing interstitial shadow. After two months of treatment, the patient’s right eye opened completely and follow-up magnetic resonance imaging revealed a marked reduction of the intra-orbital mass to 14 × 13mm. Three months after treatment initiation, a follow-up computed tomography showed a marked reduction in the size of the primary lesion to 23 × 20mm. The patient is continuing gefitinib treatment without any adverse effects noted on computed tomography, physical, or laboratory examination.ConclusionsWe report the case of a patient with an orbital non-small cell lung cancer metastasis with epidermal growth factor receptor-activating mutations. This metastasis, as well as the primary lesion, showed a marked response to the molecular targeting drug gefitinib, and the patient’s vision was kept without an invasive procedure. Gefitinib may be a good first choice for patients with orbital non-small cell lung cancer metastasis harboring epidermal growth factor receptor-activating mutations.

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Orbital Metastases as the First Manifestation of Lung Adenocarcinoma

Cited by 8 publications

References 22 publications

Lung adenocarcinoma presenting with an orbital metastasis

Lung adenocarcinoma presenting with an orbital metastasis

Orbital metastasis as the initial presentation of lung adenocarcinoma: a case report

Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report

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