Orbital metastasis from adenocarcinoma of the colon.

To The Editor: Orbital metastases from malignant neoplasms are rare, accounting for between 2.5% and 8.1% of all orbital space-occupying lesions that can originate from anywhere in the body. (1,2) Here we report a patient with a history of colon adenocarcinoma who had recurrence in the orbit.

A 55-year-old male patient was referred to our center after enucleation of the left eye because of an orbital mass. He was operated on for colon carcinoma 5 years ago. 5-fluorouracil and levamisole treatment was given postoperatively in an adjuvant manner. He had no evidence of recurrence until 4 years later, when he had pain and visual loss in his left eye. Orbital magnetic resonance imaging disclosed a crescent-shaped mass infiltrating the bulbus oculi in the left orbit (Fig. 1). Enucleation of the left eye was performed and pathologic examination of the mass demonstrated metastatic adenocarcinoma. He was referred to our center for further evaluation and treatment. He had multiple lung and bone metastases as well. The patient underwent 4 cycles of FOLFIRI (folinic acid, 5-FU, and irinotecan), attaining a partial response as determined by computed tomography.

A patient with a history of cancer should be evaluated for orbital metastases if proptosis, diplopia, visual loss or globe displacement develops. In adults, the primary tumor is almost always a carcinoma, with breast, prostate and lung carcinoma accounting for the vast majority of orbital metastases. Our patient is important because he presented with eye metastases 4 years after the completion of the adjuvant treatment. Gastrointestinal malignancies rarely metastasize to the orbit and if they do, this usually follows lung metastases. (3) Our patient also had multiple metastatic nodules in both lungs.

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Differentiation between metastatic disease and a primary choroidal melanoma, the most common primary intraocular tumor in adults, can be difficult. Diagnosis of orbital masses rarely necessitates enucleation or an open biopsy, and fine needle aspiration biopsy is generally sufficient for patients known to have a primary cancer.

Generally, orbital metastasis is associated with an ominous prognosis. The management of orbital metastases is dependent on the patient's general health, the presence of other metastases, and chemotherapy and radiotherapy status. Observation, enucleation, chemotherapy, and external beam irradiation are the treatment options. Although local control may be achieved with enucleation and/or orbital irradiation, the systemic prognosis is usually poor. (4)

Omer Dizdar MD

Sercan Aksoy MD

Saadettin Kilickap MD

Suayib Yalcin MD

Departments of Internal Medicine and Medical Oncology

Hacettepe University Faculty of Medicine

Ankara, Turkey

References

1. Shields JA, Bakewell B, Augsburger JJ, et al. Classification and of space-occupyinglesions of the orbit: a survey of 645 biopsies. ArchOphthalmol 1984;102:1606-1611.

2. Henderson JW. Orbital Tumors, New York, Raven Press, 1994, ed 3.

3. Peyster RG, Shapiro MD, Haik BG. Orbital metastases: role of magnetic resonance imaging and computed tomography. Radiol Clin North Am 1987;25:647-662.

4. Shields JA, Shields CL, Brotman HK, et al. Cancer metastatic to the orbit; The 2000 Robert M. Curts Lecture. Opthalmic Plastic and Reconstructive Surgery 2001;17:346-354.