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Journal of Cancer Research and Therapeutics, Vol. 7, No. 2, April-June, 2011, pp. 195-197 Case Report Metastasis of greater wing of sphenoid bone in bronchogenic carcinoma: A unusual case report Prashant K Gupta1, Mukta Mital1, Amit Dwivedi1, Kumkum Gupta2 1 Department of Radio-Diagnosis, Imaging and Interventional Radiology, N.S.C.B. Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India PMID: 21768712 Abstract Orbital metastasis in systemic cancer is known to occur and occurs in up to 7% of all systemic cancers. Orbital features typically present after the diagnosis of the primary tumor. In about 20% of cases, there is no known primary cancer at the time of presentation with orbital metastatic disease. Here we report a case of a 60-year-old male smoker, in whom proptosis, due to metastasis in greater wing of left sphenoid bone secondary to bronchogenic carcinoma, was the initial symptom. We could not find in literature metastasis to greater wing of sphenoid bone due to small cell carcinoma of lung. Keywords: Metastasis, orbit, proptosis, sphenoid bone Introduction Metastatic disease to eye and orbit is not unusual, however, statistics on orbital metastases are low because most series are based on pathological data. The radiographic finding in orbital metastases consists of nonspecific bone erosion and changes in soft tissue density on plain radiograph. Computed tomography (CT) now can have a better evaluation. A 60-year-old male presented to our hospital with proptosis as the chief complaint. Radiological and histopathological investigations revealed metastatic disease of greater wing of left sphenoid bone with primary of lung cancer. Case Report A 60-years-old male patient presented with 15 days history of pain, swelling, and progressive protrusion of the left eye and diplopia. There were no complaints suggestive of thyroid dysfunction, impairment of vision, or was there a history of trauma or any significant chest or abdominal complaints. Examination On examination there was low-grade proptosis of left eyeball with associated soft tissue swelling along the lateral margin of the left orbit. Examination of eye was normal with vision 6/6 in the right eye and 6/9 in the left eye. Funduscopy was within the limits of normal. Tonometry was not done. Systemic examination was unremarkable. Investigations Patient routine blood examination was normal. The patient was takenup for contrast-enhanced CT (CECT) scan of the orbit including both axial and coronal sections. CT scan revealed expansion of the greater wing of left sphenoid bone with erosive destruction and involvement of orbital plate of frontal bone and squamous part of temporal bone and extension into the middle cranial fossa and the infratemporal fossa with associated thickening of the temporalis muscle. The bony lesion was associated with large soft tissue density mass lesion measuring 20 × 28 mm in the extraconal space along the lateral wall of the left orbit, displacing the lateral rectus muscle and the eyeball medially [Figure - 1]. Due to short history and bony destruction, a provisional diagnosis of secondaries was made and further investigations to search the primary were carried out. Chest radiograph revealed a hilar mass with destruction of shaft of left 9 th rib [Figure - 2] and [Figure - 3]. The patient was advised CECT scan of thorax, which confirmed a left hilar mass and destruction of left 9 th rib with associated liver metastasis [Figure - 4]. The patient subsequently underwent a bronchoscopy for biopsy, which revealed poorly differentiated carcinoma, possibly intermediate type of small cell carcinoma. Fine-needle aspiration cytology from orbital soft tissue mass revealed adenocarcinoma. Discussion Metastatic disease to the eye most commonly involves the choroid. [1] By comparison, metastatic disease to the orbit is relatively uncommon, occurring in about 7% of all cancers. [2] Metastasis to the orbit accounts for less than 5% of all orbital tumors. [3] The common primary sites in adults include lung in males and the breast in females and accounts for over 50% of orbital metastases. [4] In children most orbital metastases are due to neuroblastoma and rhabdomyosarcoma. In approximately 20% of patients, orbital metastasis is the initial manifestation of systemic malignancy. [5] The orbital metastasis is more common with lung cancer rather than breast cancer. [6] Besides metastasis, in an elderly male patient presenting with short history, unilateral involvement and progressive low-grade proptosis a differential diagnosis of lymphoma and orbital pseudotumor can be kept. The majority of retrobulbar metastases are extraconal; however, as they enlarge, the intraconal compartment may also be effected. Patients complain of diplopia, ptosis, proptosis, eyelid swelling, pain, and visual loss. CT examination depicts the orbital and cranial soft tissue components of the lesion. Most lesions have associated bone involvement. This case showed involvement of greater wing of sphenoid, a unusual occurrence. In literature we could not find involvement of greater wing of sphenoid bone secondary to bronchogenic carcinoma. Conclusion Metastasis to greater wing of sphenoid bone secondary to bronchogenic carcinoma is unusual and has not been reported in the literature to the best of our knowledge. Patients with primary manifestation of orbital symptoms and suspected to have metastatic disease of orbit should be investigated for unknown primary, especially of lung and breast, the most common sites of primary, in adults. References
Copyright 2011 - Journal of Cancer Research and Therapeutics The following images related to this document are available:Photo images[cr11046f4.jpg] [cr11046f2.jpg] [cr11046f1.jpg] [cr11046f3.jpg] |
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