Orbital metastasis of retroperitoneal leiomyosarcoma

Chen, Juan; Wei, Rui; Ma, Xin

doi:10.1007/s12032-010-9809-4

Cited by 13 publications

(15 citation statements)

References 16 publications

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“…9 The use of adjuvant chemotherapy and radiotherapy particularly for metastatic disease has demonstrated limited benefit. 10 Although our patient had no history of malignancy, the presentation of the lesion being indistinguishable from the extraocular muscle prompted a systemic work-up and identification of the patient's uterine malignancy. It is important for clinicians to know that orbital lesions intrinsic to extraocular muscles may be metastatic malignant lesions and a systemic work-up is indicated to rule out a distant primary tumor.…”

Section: Discussionmentioning

confidence: 84%

Orbital leiomyosarcoma metastasis presenting prior to diagnosis of the primary tumor

et al. 2017

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SummaryLeiomyosarcomas, neoplasms of smooth muscle, are rarely found within the orbit. Orbital leiomyosarcoma may be primary, metastatic, or secondary to radiation. When they are metastatic, patients almost exclusively have a history of a primary leiomyosarcoma, often occurring in the spermatic cord, skin, gastrointestinal tract, or the uterus. We present the case of 48-year-old woman who presented with a metastatic orbital leiomyosarcoma, which was identified before the primary tumor. Case ReportA 48-year-old woman with a history of primary openangle glaucoma presented at Massachusetts Eye and Ear with binocular, horizontal diplopia, intermittent left retrobulbar pain, and mild discomfort of the left eye with eye movement. The patient complained of a 4-month history of hypoesthesia of the left cheek, which she associated to apparent nerve injury from ipsilateral injection of a local anesthetic for a root canal performed just prior to onset of symptoms. The patient's visual acuity was 20/15 in each eye, with slight dyschromatopsia in both eyes. She had a superior arcuate visual field defect in the left eye secondary to glaucoma ( Figure 1A). There was 1 mm of proptosis and limitation of abduction of the left eye resulting in an incomitant esotropia larger in left gaze. Magnetic resonance imaging (MRI) demonstrated a well circumscribed lesion in the left orbital apex that appeared inseparable from the left lateral rectus muscle; the lesion enhanced slightly less than muscle, with more prominent enhancement of the rim of the lesion (Figure 2).Given that the lesion appeared intrinsic to the extraocular muscle, a common site to harbor an orbital metastasis, the patient underwent a systemic work-up searching for an occult primary malignancy. An 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) scan showed a right lower quadrant mass that was lobulated and heterogeneously enhancing with 18-FDG avidity in the pelvis demonstrating its hypermetabolic nature (Figure 3).A radiologically guided core needle biopsy was performed of the mass. The pathology demonstrated eosinophilic spindle-shaped cells with elongated nuclei, scattered mitotic figures, and areas of ischemic degeneration. The lesion stained positive for both desmin and smooth muscle actin, in keeping with a malignant smooth muscle neoplasm, specifically a leiomyosarcoma (Figure 4). Systemic chemotherapy was being considered for management of her metastatic disease when the patient developed worsening retrobulbar pain (2 months after initial presentation). On examination, her visual acuity was reduced to 20/25, and there was notable worsening of the dyschromatopsia and visual field defect in the left eye ( Figure 1B). In addition, she had further limitation of abduction of the left eye. Repeat MRI scan demonstrated enlargement of the lesion, with compression of the left optic nerve laterally ( Figure 5). In order

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Section: Discussionmentioning

confidence: 84%

Orbital leiomyosarcoma metastasis presenting prior to diagnosis of the primary tumor

et al. 2017

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“…The primary tumors originated in the uterus, gastrointestinal tract, vein, spermatic cord, hip, retroperitoneum, or soft tissue of the thigh. [3][4][5][6][7][8][9][10] Orbital leiomyosarcoma has no specific clinical symptoms. Because of the relatively fast growth of leiomyosarcoma, patients may experience progressive exophthalmos during the early stages of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…Other symptoms may include vision loss, diplopia, gaze limitation, and papilledema. 9 The differential diagnosis of a solid, enhancing mass includes both benign (peripheral nerve sheath tumor, cavernous hemangioma, fibrous histiocytoma, etc.) and malignant (metastases, sarcoma, lymphoma, etc.)…”

Section: Discussionmentioning

confidence: 99%

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A Case of Orbital Metastasis of Uterine Leiomyosarcoma With Intracranial Extension Presenting With Proptosis

Kim

Park

Min

et al. 2016

Ophthalmic Plastic &Amp; Reconstructive Surgery

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A 57-year-old woman presented with protrusion of the OS 2 months in duration and decreased vision 1 month in duration. The patient was diagnosed with uterine leiomyosarcoma approximately 3 years before presentation. Lung and liver metastases were diagnosed by biopsy 1 year prior to this visit. CT revealed a solid mass with central necrosis in the left lateral orbit that resulted in orbital shifting, bony destruction, and intracranial extension. The diagnosis was left orbital metastatic leiomyosarcoma, and the patient died 2 months after receiving the diagnosis.

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“…Leiomyosarcomas are generally resistant to radiotherapy and chemotherapy and there is a general opinion that aggressive surgery with wide resection margins is the treatment of choice [3].…”

Section: Introductionmentioning

confidence: 99%

Uterine Leiomyosarcoma Presenting With Bilateral Orbital and Left Neck Metastases

Sharma¹,

Kumar²,

Kaddour³

2015

J Med Cases

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Uterine leiomyosarcoma is a rare neoplasm of mesodermic origin with a predilection for hematologic dissemination, but bilateral orbital metastases have never been reported. A 63-year-old lady presented with an 18-month history of a left neck and left breast mass, and a short history of left eye pain and intermittent diplopia. Ultrasoundguided core biopsy of the left neck node showed evidence of leiomyosarcoma, and computed tomography of the orbits demonstrated bilateral infraorbital masses arising from the medial recti. The patient was diagnosed with uterine leiomyosarcoma with orbital metastases. She was treated with bilateral orbital radiotherapy but had further disease progression, and has since started doxorubicin. Surgery is usually advocated in the management of metastatic leiomyosarcoma, but given the extensive metastases in this case, radiotherapy was the preferred option. This is the first reported case of bilateral orbital and neck metastases from a uterine leimyosarcoma.

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Orbital metastasis of retroperitoneal leiomyosarcoma

Cited by 13 publications

References 16 publications

Orbital leiomyosarcoma metastasis presenting prior to diagnosis of the primary tumor

Orbital leiomyosarcoma metastasis presenting prior to diagnosis of the primary tumor

A Case of Orbital Metastasis of Uterine Leiomyosarcoma With Intracranial Extension Presenting With Proptosis

Uterine Leiomyosarcoma Presenting With Bilateral Orbital and Left Neck Metastases

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