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Background Breast cancer is the most common malignancy to spread to the orbit and periorbit, and the invasive lobular carcinoma (ILC) histologic subtype of breast cancer has been reported to form these ophthalmic metastases (OM) more frequently than invasive ductal carcinomas (IDC). We herein report our single academic institution experience with breast cancer OM with respect to anatomical presentation, histology (lobular vs. ductal), treatment, and survival. Methods We employed the natural language processing platform, TIES (Text Information Extraction System), to search 2.3 million de-identified patient pathology and radiology records at our institution in order to identify patients with OM secondary to breast cancer. We then compared the resultant cohort, the “OM cohort,” to two other representative metastatic breast cancer patient (MBC) databases from our institution. Histological analysis of selected patients was performed. Results Our TIES search and manual refinement ultimately identified 28 patients who were diagnosed with breast cancer between 1995 and 2016 that subsequently developed OM. Median age at diagnosis was 54 (range 28–77) years of age. ER, PR, and HER2 status from the 28 patients with OM did not differ from other patients with MBC from our institution. The relative proportion of patients with ILC was significantly higher in the OM cohort (32.1%) than in other MBC patients in our institution (11.3%, p  = 0.007). Median time to first OM in the OM cohort was 46.7 months, and OM were the second most frequent first metastases after bony metastases. After diagnosis of the first distant metastasis of any kind, median survival of patients with ILC (21.4 months) was significantly shorter than that of patients with IDC (55.3 months, p  = 0.03). Nine patients developed bilateral OM. We observed a significant co-occurrence of OM and central nervous system metastases ( p  = 0.0053). The histological analysis revealed an interesting case in which the primary tumor was of a mixed ILC/IDC subtype, while only ILC was present in the OM. Conclusions OM from breast cancer are illustrative of the difference in metastatic behavior of ILC versus IDC and should be considered when treating patients with ILC, especially in those with complaints of visual acuity changes.

Chromophobe renal cell carcinoma (ChRCC) is a rare subtype of renal cell carcinoma (RCC). We present a case of a 61-year-old male with ChRCC who exhibited unusual metastasis to the retro-orbital area, a site rarely affected by RCC. The patient experienced diplopia and proptosis, prompting treatment with sunitinib and palliative radiotherapy. Remarkably, rapid improvement in ocular symptoms was observed following radiotherapy. Despite this localized response, the patient’s overall condition deteriorated, highlighting the aggressive nature of ChRCC. This case underscores the importance of considering ChRCC in metastatic presentations and the potential efficacy of local palliative interventions.

Orbital metastases are a rare site of spread for most malignancies. Here, we present an unusual case of an orbital mass as the first presenting sign of metastatic gallbladder and biliary tract cancer. MRI, positron emission tomography and tumour biopsy were used to establish the diagnosis. Treatment was started with chemoimmunotherapy, and radiation was deferred. Subsequent imaging showed tumour response to treatment.

Orbital metastasis is a rare manifestation of systemic malignancy, accounting for approximately 2%–5% of orbital tumours. The most common primary cancers associated with orbital metastases include breast carcinoma, malignant melanoma and prostate carcinoma. Hepatocellular carcinoma (HCC) is an uncommon source of all reported orbital metastases. We report the case of a man in his mid-50s with a history of alcoholic cirrhosis who presented with an acute onset of left periorbital pain, conjunctival injection, proptosis and restrictive ophthalmoplegia, in addition to abdominal discomfort. Orbital CT demonstrated a heterogeneously enhancing mass in the superolateral left orbit, associated with osseous erosion and displacement of adjacent orbital structures. Further imaging revealed multifocal hepatic lesions with evidence of portal vein invasion. A biopsy of the orbital mass confirmed metastatic HCC. The patient experienced rapid clinical deterioration before initiating treatment and ultimately passed away. This case highlights the importance of considering metastatic liver malignancy in the differential diagnosis of orbital masses, particularly in patients with risk factors for HCC.

A female patient in her sixth decade of life presented with a 7-day history of progressive diminution of vision and restricted ocular motility associated with fever, headache and vomiting. On general examination, she was febrile (temperature 100.4°F) and had enlarged submandibular lymph nodes, along with multiple nodules on the scalp and upper back. At baseline, ocular examination revealed visual acuity of 20/30 in the right eye and hand movements close to the face in the left eye. A relative afferent pupillary defect was noted in the left eye. The Hirschberg test revealed left esotropia (15°°) with an abduction deficit, suggestive of left sixth cranial nerve paresis. Fundus examination was unremarkable. A provisional diagnosis of left orbital apex syndrome (OAS) was made. A comprehensive work-up in neurology and dermatology was performed. Contrast-enhanced MRI of the brain and orbit suggested an asymmetrically enhancing lesion of the cavernous sinus, soft tissue involvement of the left orbital apex and a nodule involving the white matter of the left parietal lobe. Hormone analysis suggested a decreased level of thyroid-stimulating hormone, follicular-stimulating hormone and luteinising hormone. Fine needle aspiration cytology of a submandibular lymph node and nodules of the scalp and upper back was suggestive of metastatic mucin-secreting adenocarcinoma. Tumour marker analysis revealed raised CEA and CA 125. Further, a positron emission tomography scan revealed active lesions in the lungs with multiorgan spread, supporting the diagnosis of primary lung carcinoma with disseminated metastases manifesting as OAS. In view of the poor prognosis, the patient refused further treatment and succumbed to her condition 1 month following her diagnosis.This case highlights the importance of recognising subtle ocular signs, as they can be indicative of underlying life-threatening conditions. Early detection and thorough investigation of such symptoms are crucial, as they can lead to the identification of serious systemic diseases, such as metastatic cancer, that may otherwise be overlooked.

Orbital metastases are very rare, particularly as an initial presentation feature of occult breast cancer. This is a case of orbital metastasis from an occult lobular breast carcinoma in a woman in her mid-70s, who presented with symptoms of gradual visual deterioration. Prompt and extensive investigations led to the diagnosis of metastatic orbital lobular carcinoma in the absence of clinically or radiologically evident primary breast cancer. This occurred independent of a previously treated ductal breast carcinoma history.

Incidental orbital masses that are asymptomatic and appear benign are often observed without surgical intervention unless there is a clinical or radiographic change in the mass. There is a burgeoning population of cancer patients with incidental masses that have been detected while under surveillance for metastasis. This population of patients is growing due to a number of reasons, including more extensive imaging, an aging population, and more effective cancer treatments. Closer scrutiny should be applied to these patients, due to the possibility of the mass being an orbital metastasis. In addition, the approach to these patients may have implications regarding the adult patient without a cancer history who presents with a symptomatic orbital mass. The purpose of this paper is to explore the approach to the patient with and without a cancer history who presents with an orbital mass.

Orbital metastasis of systemic cancer is exceedingly rare. This is a case report of a patient treated for locally recurrent vulvar melanoma who later presented with unilateral proptosis and was found to have an isolated biopsy-proven extraocular muscle metastasis. A 94-year-old female with locally recurrent vulvar melanoma presented with eye discomfort and blurry vision. Patient underwent histopathological, genetic, and imaging studies. All prior work-up, including brain MRI and PET/CT, was negative for disease elsewhere from local recurrence. Orbital MRI demonstrated a mass involving the extraocular muscle, and immunohistochemistry staining of biopsy was consistent with metastasis. The patient underwent radiation therapy and tolerated treatment well. This is the first reported case of vulvar melanoma with extraocular muscle metastasis. The absence of findings on imaging as part of the staging work-up underscores the importance of considering extraocular muscle (EOM) metastasis as a differential for patients with vulvar melanoma who present with proptosis.

Background Orbital metastasis is a possible complication of small cell lung cancer and a pattern of bilateral invasion of the extraocular muscles has rarely been reported in literature. Case presentation A 46-year-old white male with a past medical history of smoking and stage IV small cell lung carcinoma presented with loss of vision and pain in the left eye. Examination revealed bilateral proptosis and left afferent pupillary defect, and visual acuity was hand motion on the left eye and 4/10 on the right eye. An orbital computed tomography scan showed a compression of the left optic nerve between the extraocular muscles at the apex, and a lateral canthotomy was performed for a new-onset compressive optic neuropathy, with residual visual improvement. There was also significant enlargement of the extraocular muscles in the right orbit. The patient was maintained in palliative treatment with both chemotherapy and local medical and surgical (amniotic membrane cover for exposure keratopathy) ophthalmological treatments until he eventually died 5 months after. Conclusion Bilateral metastasis to the extraocular muscles is a very rare manifestation of small cell lung cancer and the palliative treatment in these cases is challenging.