Metastatic tumors of the orbit: clinical and instrumental diagnosis

Abstract

Purpose: to assess the clinical course of metastatic orbital tumors (MOT) and the results of instrumental examination of patients. Material and methods. 50 MOT patients aged 5–84 years (ave. 56.9 ± 14.3), including 41 women (82 %) and 9 men (18 %), were examined for the clinical signs, the laterality of the lesion, the size and shape of the tumor, the presence of oncology in the clinical history and its duration. All patients underwent ultrasound examination with color Doppler imaging (CDI), plus computer tomography (CT) or magnetic resonance imaging (MRI) of the orbits. In all cases, the diagnosis of MOT was confirmed morphologically. Results. 32 (64 %) patients had an oncology history, which lasted from 9 months to 23 years (median 5 years). The most frequently observed metastases were those of breast cancer (27 cases, 54 %), while other types occurred much less frequently: metastases of kidney cancer (4 cases) and stomach (3 cases), cancers of the reproductive systems (2 cases), melanoma (3 cases), thyroid cancer (1 case), and sarcomas (4 cases). The primary focus could not be detected in 3 patients (6 %). OD/OS orbit damages were observed in 23 patients (46 %)/ 21 patients (42 %), while 6 patients (12 %) had bilateral damages. Clinical symptoms included exophthalmos (35 cases, 70 %), enophthalmos (6 cases, 12 %), eye movement impairment (35 cases, 70 %), ptosis (35 cases, 70 %), eyelid edema (24 cases, 68 %), pain in the orbit (7 cases, 14 %), chemosis (12 cases, 24 %), difficulty in eye repositioning (32 cases, 64 %). Decreased visual acuity was noted in 13 cases (26 %). CT symptoms included infiltrative nature of the lesion (43 patients, 86 %), and solid tumors with clear and even contours (7 patients, 14 %). Bone wall changes were detected in 7 patients (14 %). Ultrasound data revealed a heterogeneous structure and an increased acoustic density of MOT. CDI detected own vessels in the projection of the tumor (15 patients). Conclusion. Orbital metastases present a multidisciplinary problem, which requires mandatory monitoring by physicians of various specialties, as only 36% of patients have no oncology in their clinical histories. Specific history features, the patient’s complaints, typical clinical symptoms, CT (MRI) and ultrasound data should alert the ophthalmologist about a possible MOT. A mandatory examination of patients with malignant neoplasms by an ophthalmologist is necessary to exclude ocular metastases.

Keywords

• metastasis
• orbit
• neoplasm of the orbit