Intraorbital metastasis from adenocarcinoma of unknown primary of the upper gastrointestinal tract

This is a report of a 73-year-old female patient. The first consultation at the Department of Neurology was due to progressive retroorbital pain, ptosis and a complete visual loss on the left side for several weeks.

An external cerebral MRI and a CSF examination were conducted without pathological results. On suspicion of Tolosa-Hunt syndrome, a high-dose steroid therapy was initiated, but did not resolve the symptoms. Therefore, cerebral MRI and CT scan were repeated and revealed a new mass of the orbital apex, primarily located in the inferior and medial rectus muscle, with bony arrosion of the lamina papyracea. Endoscopic transethmoidal biopsy on the left side was performed.

Histopathological examination showed a poorly differentiated carcinoma with clear-cell morphology, matching with a metastasis from an adenocarcinoma of the upper gastrointestinal tract. Additional staging imaging revealed further lesions in liver, kidney, subcutaneous and intramuscular tissue as well as various osteolyses, which were suspicious for malignancy. Furthermore, pathologically enlarged lymph nodes could be detected in the cervical, mediastinal, hilar and abdominal region. A definite primary tumor could not be identified. The patient was subsequently transferred to a hospital close to her home for systemic palliative oncological therapy.

Orbital processes are of malignant origin in a third of all cases. In patients of advanced age, lymphomas and metastases, which account for 1 to 13 % of all orbital tumors, are most common. The primary tumor is often located in breast, lung or prostate gland, more rarely in the gastrointestinal tract or the kidneys. Since disease usuallly is already disseminated, treatment is limited to a palliative approach.

Publication History

Article published online:
10 June 2020