ORBITAL METASTASES OF SOLID TUMORS. DIAGNOSTIC PROBLEMS

Rationale: Orbital metastases comprise about 15% of all orbital malignancies. An orbital metastasis is to be suspected if there is a mass in the orbit of a cancer patient. Nevertheless, a non-tumor process in the orbit of cancer patients is also possible, as well as occurrence of a second cancer of the primarily multiple tumor type.
Aim: To identify characteristic signs of a metastatic tumor of the orbit to perform differential diagnosis with other tumor and non-tumor orbital disorders and to establish an algorithm for a correct diagnosis and perform an adequate treatment of an orbital disease.
Materials and methods: We retrospectively analyzed case histories of 81 patients with malignant tumors of various organs and an orbit abnormality. Seventy four (74) of them had orbital metastases (64 women and 10 men aged from 18 to 87 years; median age, 45 years); the second malignant orbital tumor was represented by a non-Hodgkin's lymphoma in 5 patients (4 women and 1 men aged from 55 to 78 years, median age 61 year). Two men of 64 and 66 years had orbital inflammation imitating a metastatic tumor. In addition to ophthalmological assessment and orbital CT, assessment of visceral organs and systems was performed in all patients to exclude any relapse of primary tumors and metastases in other organs.
Results: The most prevalent among orbital metastases was a focal form of the tumor growth adjacent to the orbital wall (mainly, the upper one), with gradual development of a non-painful exophthalmos and abnormalities of eye movements. The same clinical manifestation was typical also for a non-Hodgkin's lymphoma of the orbit. An acute inflammation of orbital tissues in cancer patients did not have a clear clinical manifestation and simulated an orbital metastasis.
Conclusion: For a nearly diagnosis of orbital metastasis it is necessary to perform a combined analysis of past history, clinical manifestation and results of morphological assessment of a tumor biopsy sample.