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Journal of Cancer Research and Therapeutics, Vol. 7, No. 3, July-September, 2011, pp. 357-358 Letter to the Editor - Documenting a Case Carcinoma cervix with metastasis to the orbit: A case report and review of literature Karuna Singh, Vinay Kumar, Suman Bhasker, Bidhu Kalyan Mohanti Department of Radiotherapy and Oncology, All India Institute of Medical Sciences, New Delhi, India Sir, Carcinoma of cervix is the third most common malignancy in women, and the seventh overall, with an estimated 529,000 new cases, and is responsible for 275,000 deaths in year 2008. According to the global cancer statistics, in the year 2008 about 88% of deaths due to cancer of the cervix, occured developing countries. [1] with the most common histology being the squamous cell carcinoma (80%). Orbital metastasis have been documented from different sites and the common being breast, lung and prostate. [2] Orbital metastasis from carcinoma cervix is rare. After literature search, we could find only four such cases till date. We hereby report a case of 50 year old woman presented with carcinoma cervix metastasizing to orbit. A 50 year old female presented with the chief complaints of postmenopausal bleeding, foul smelling discharge per vaginum and low backache of 5 months duration and painless swelling over the medial aspect of left eye of 2 month duration to our institution. On examination she was found to have a 5 cm mass destroying cervix and extending to involve lower one-third of vagina and bilateral parametrium up to lateral pelvic wall [Figure - 1]. On ophthalmologic examination a 2 cm hard, nontender, fixed mass involving left medial canthus [Figure - 2] and dorsum of nose was found. Visual acuity was 6/24, diplopia was present on downward gaze and all ocular movements were restricted. Fine needle aspiration cytology from the orbital swelling revealed the same histology as the cervical primary that is squamous cell carcinoma and diagnosed with keratinizing squamous cell carcinoma cervix stage IVB. Contrast enhanced computerized tomography of orbit showed 2 cm lesion on the medial side of left orbit involving the medial rectus, nasal wall and maxillary sinus [Figure - 3]. Patient was started on paclitaxel and carboplatin based palliative chemotherapy in view of advanced stage at presentation. She has received only one cycle till preparation of this manuscript. Palliative radiation therapy also has been planned for her. Metastasis to distant site from the primary generally follows the hematogenous route. Orbital metastasis have been documented from different sites and the common being breast, lung and prostate. A small percentage of patients presents with unknown primary site. Carcinoma of cervix is a common malignancy in our country but metastasis to the soft tissue of orbit is a rarity. Ours is one such case in the list. The age range reported for cervix carcinoma with orbital metastasis in case reports is 29 to 46 years. [3] Proptosis and restriction of eye mobility are the commonest symptoms and signs at presentation. [2] According to the various reports, the onset is rapid and progressive and most of the patients die within a year of diagnosis. The treatment options available for such patients are generally meagre. Ophthalmologic intervention can be done in patients who have a vision threatening episode due to mass effect. Chemotherapy being a systemic therapy can be prescribed in these advanced stage diseases, and radiotherapy is reserved for palliative purposes. A significant number of patients present with ocular symptoms first without any evidence of other systemic complaints. [4] A high index of suspicion on the part of clinician is therefore required to detect such case at earliest stage. Screening for carcinoma cervix might be useful as a part of systemic evaluation in patients who presented with orbital metastasis with unknown primary in females. [5] Orbital mass can originate from cervical malignancy and a high index of suspicion and good judgment is required to pick up patients at early stage who presents with orbital mass with occult primary. References
Copyright 2011 - Journal of Cancer Research and Therapeutics The following images related to this document are available:Photo images[cr11089f1.jpg] [cr11089f3.jpg] [cr11089f2.jpg] |
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