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The study included seven children. Twenty patients Breast carcinoma represented These two types of metastatic lesions represented The next common primary tumor site was cutaneous malignant melanoma, which accounted for The most common primary tumor in pediatric patients was neuroblastoma, with three cases Nine patients Three of these patients On the other hand, In 20 cases Two cases had bilateral involvement 5.

Benign Tumors of the Bony Orbital Wall | SpringerLink

Table 2 Clinical and imaging characteristics of orbital metastatic lesions Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging. The imaging studies computed tomography [CT], magnetic resonance imaging [MRI], or both showed infiltrative lesions in 23 patients Mass lesion was found in eight patients In four patients In two patients 5. The two patients had prostatic carcinoma Table 2 , Figure 1. Bone changes were detected in 15 patients In eleven cases The osteoclastic lesions were found among all patients with HCC six cases.

While in four cases Figure 1 Imaging patterns of orbital metastasis. Notes: A Magnetic resonance image showing right infiltrative metastatic lesion from breast carcinoma arrow. B Computed tomography CT scan with contrast showing well-defined right superior orbital metastatic mass from thyroid carcinoma arrow.

C CT scan with contrast showing right isolated medial rectus thickening in a case of orbital metastasis from cutaneous malignant melanoma arrow. Figure 2 Computed tomography scans with contrast showing bone changes in orbital metastasis.

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Notes: A Osteoclastic metastatic lesion from hepatocellular carcinoma arrow. B Osteoblastic metastatic lesion from prostatic carcinoma arrow. As regards lesion site, In six cases the lesions were found as muscle thickening or bone lesions and could not be classified as intraconal or extraconal.

The first case of orbital metastasis was described by Horner in , when he reported a case of a lung cancer metastasis to the orbit. A metastasis to the orbit is rare and occurs less frequently than a uveal metastasis. A number of factors may account for this increase: the improved treatment has led to an increase in the median survival of cancer patients, which in turn has increased the chances for development of metastatic lesions in unusual sites such as the orbit; advances in the diagnosis and application of serological and molecular diagnostic imaging techniques have led to the increased detection of such lesions; and an increased volume of medical literature on orbital metastasis has increased the awareness of these lesions.

Underestimation of the true incidence can be attributed to several factors. Patients who have small orbital lesions may remain asymptomatic, and general debility in patients with widespread disease may mask the orbital symptoms leading to a low rate of referral to ophthalmologists. Several authors have reported their experience with orbital metastasis. Breast carcinoma has been reported as the commonest primary tumor site with variable incidences.

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The second most common primary cancer reported in the literature varies in different series. Shields et al 9 published the largest study on orbital metastasis which included patients. The actual incidence of primary tumors metastasizing to the orbit is difficult to ascertain in a clinical series compared to autopsy series. For example, patients with bronchogenic carcinoma are usually markedly affected by their disease by the time an orbital metastasis has occurred. These patients can therefore be underrepresented in comparison with patients of breast cancer, who show a much slower disease course and may stay mobile and healthy enough to get an eye examination.

Orbital Eosinophilic Granuloma

In this study, HCC was found to be the second primary tumor site The incidence of HCC noticeably increased — from approximately 4. Diagnosis of orbital metastasis is a challenging task.

Kuo et al noted that a cancer patient is a candidate for metastasis for the rest of their life. Even known cancer patients may not give a history of cancer for various reasons including denial, embarrassment, or forgetfulness. Cancer may also be omitted from the history because patients may not think it is relevant to their ocular condition. They reported that the infiltrative lesion is most common although mixed presentations exist as well. CT may be more beneficial in patients with prostatic carcinoma which has a tendency to metastasize to bone with development of osteoblastic orbital lesions.

They may range from a diffuse infiltrative pattern to a focal lesion. Enlargement of one or more of the extraocular muscles may be found in patients with metastatic cutaneous melanoma. The definitive diagnosis of an orbital metastasis requires tissue diagnosis. Fine needle aspiration biopsy has been advocated as a good diagnostic modality. Orbital metastasis can display a wide variety of clinical and imaging features. A high index of suspicion is required, as A high incidence of orbital metastasis from HCC was found, which, as far as we are aware, has not been reported by any previous study; this can be explained on the basis of the increased incidence of HCC in the Egyptian population.

Finger PT. Radiation therapy for orbital tumors: concepts, current use, and ophthalmic radiation side effects. Surv Ophthalmol. Tumor metastasis to the eye. Incidence in adult patients with generalized malignancy.

Clinical and imaging characteristics of orbital metastatic lesions among Egyptian patients

Am J Ophthalmol. Bloch RS, Gartner S. The incidence of ocular metastatic carcinoma. Arch Ophthalmol. Ahmad SM, Esmaeli B. Metastatic tumors of the orbit and ocular adnexa. Curr Opin Ophthalmol. Tumors metastatic to the orbit. Ophthal Plast Reconstr Surg. Tumors metastatic to the orbit: a changing picture. Metastatic tumors to the orbit — management and prognosis. Graefes Arch Clin Exp Ophthalmol. Metastatic carcinomas. In: Henderson JW. Types of invasive breast carcinoma include ductal, lobular, and mixed. To date, the basis for breast carcinoma as the most common primary metastatic process to the orbit is unclear.

Given the lack of lymphatics in the orbit, hematogenous spread is required for the development of metastasis. The diagnosis of metastasis to the orbit is suggested by clinical history, ophthalmological examination, and imaging studies, and is confirmed by biopsy. Orbital imaging with CT or MRI is helpful in guiding the biopsy in order to determine the appropriate surgical approach and to minimize injury to vital orbital structures. Almost all orbital metastases evaluated with MRI show some degree of enhancement with contrast agents.

Breast carcinoma metastatic to the orbit tends to localize in the orbital muscle and fat both intraconal and extraconal. A history of a progressive course of symptoms with possible motor and sensory deficits is often elicited. A thorough medical history should be obtained for possible history of known breast cancer, or symptoms suggestive of systemic malignancy. A complete eye exam, including assessment of ocular motility, orbital palpation, and exophthalmometry, as well as palpation of regional lymph nodes, including axillary and supraclavicular lymph nodes, should be performed. The diagnosis is confirmed by obtaining an open orbital incisional biopsy and examining the histopathology.

Immunohistochemical evaluation of the orbital biopsy specimen for estrogen and progesterone receptor and oncoprotein expression is important not only for diagnostic purposes but also in guiding treatment plans. The hormone receptor status in metastatic lesions may vary from that seen in the primary malignancy. Laboratory studies to exclude the diagnosis of granulomatous, vasculitic, endocrine, and immunologic disorders are appropriate and may include: complete blood count with differential, antineutrophil cytoplasmic antibody ANCA , erythrocyte sedimentation rate ESR , C-reactive protein CRP , thyroid profile, angiotensin-converting enzyme ACE , lysozyme, antinuclear antibody ANA , and quantitative immunoglobulins.

Chest radiography to evaluate for hilar adenopathy associated with sarcoidosis may also be considered.

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Orbital metastases originating from breast carcinoma predicts widespread metastatic disease in other organs.