Metastatic orbital mucoepidermoid carcinoma and primary tumor-associated lymphangiogenesis

Abstract

A 21-year-old female patient presented with blurry vision and proptosis in the right eye (OD). Past medical history included a high-grade mucoepidermoid carcinoma of the left parotid gland 3 years ago. Her visual acuity was 20 / 20 in the OD and 20 / 20 in the left eye (OS). Ishihara’s test revealed a total absence of color perception in the OD and normal color perception in the OS. The Hertel exophthalmometry was 20 mm in the OD and 17 mm in the OS. Computed tomographic scans and magnetic resonance imaging showed an intraconal, oval-shaped, and heterogeneous mass. The patient underwent an eyelid-sparing orbital exenteration and was also treated with radiation therapy and chemotherapy. The postoperative positron emission tomography scanning was normal. Clinical examination, histopathological evaluation, and immunohistochemistry were consistent with metastatic high-grade mucoepidermoid carcinoma of the right orbit following a high-grade mucoepidermoid carcinoma of the contralateral parotid gland. The patient had a local recurrence with orbital apex mass 3 years after the first orbital exenteration and underwent a new surgery with en bloc bony resection of orbital apex and orbital wall reconstructive surgery. The patient remains disease-free with no local or distant metastasis 5 years after the last surgery.

Keywords

• lymphatic metastasis
• lymphatic vessels
• mucoepidermoid carcinoma
• orbit
• orbital neoplasms