Orbital Metastasis of Hepatocellular Carcinoma

Abstract

We report a 74-year-old woman who presented with an orbital apex syndrome and pulsatile proptosis. CT showed a right orbital mass that destroyed the orbital sphenoid bone and extended intracranially. Biopsy revealed metastatic hepatocellular carcinoma (HCC), and subsequent investigations demonstrated a high level of serum-fetoprotein and a huge liver mass. The patient died shortly after the biopsy. Rarely reported in the English literature, metastatic HCC is common in Asia, perhaps because of a racial predisposition together with a relatively high prevalence of alcoholic cirrhosis, chronic hepatitis B and C, and exposure to aflatoxins.

Complete response to radiation therapy of orbital metastasisfrom hepatocellular carcinoma

“…Orbital metastases are uncommon and account for 3%-7% of all orbital neoplasms [7,10,11] . The most common symptoms of orbital metastases include pain, proptosis, decreased vision or blindness, diplopia, displacement of the globe, exophthalmos, and occasionally enophthalmos.…”

“…The average survival after occurrence of the orbital metastases is approximately 10 mo [11] , although the prognosis ultimately depends on the systemic tumor burden [5] . Among the 14 reported cases of orbital metastases from HCC (Table 2) [4][5][6][7][8][9][10][11][12][13][14][15] , only 4 received primary radiation as the palliative treatment in doses ranging from 30 to 54 Gy, and all showed a response. However, specific details of the radiation planning and treatment delivery in this challenging location are not available.…”

“…The most common symptoms of orbital metastases include pain, proptosis, decreased vision or blindness, diplopia, displacement of the globe, exophthalmos, and occasionally enophthalmos. HCC very rarely metastasizes to the orbits, and only a total of 14 case reports of orbital metastases from HCC have been described (Table 2) [4][5][6][7][8][9][10][11][12][13][14][15] . Orbital metastases are usually associated with advanced disease and early mortality.…”

“…The most common sites of metastatic disease are the regional lymph nodes and lung. Less common sites of metastases include bone, brain, adrenal glands, and skin [4,[6][7][8][9] . The orbit has been reported as a site of metastasis from HCC only 14 times in the literature, and information on the palliative response of this highly symptomatic condition with radiation therapy has been very sparse.…”

Metástase orbital como primeira manifestação clínica de hepatocarcinoma

“…Os sítios primários mais comuns de metástases orbitais são: mama (em mulheres), pulmão e próstata (em homens) (3)(4) . O carcinoma hepático tem como locais mais comuns de metástase os pulmões, nódulos linfáti-cos, glândulas adrenais e ossos (5) . Metástase orbital de carcinoma hepático primário é rara, sendo poucos os casos descritos na literatura (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) .…”