Ipsilateral ethmoid sinuses metastasis and proptosis: Rare presentation of metastatic prostate cancer.
Metastatic paranasal sinuses and orbital cancer is very rare. The patient with sinusitis and orbital symptoms warrants a detailed history, complete physical examination and serial radiological tests (sinus radiographs and CT scan) to rule out any metastatic disease and prompt treatment. We present a case of 65 years old patient with metastatic prostate cancer who presented to us with left ethmoid sinuses and orbital metastasis causing ipsilateral proptosis.
KEY WORDS: Metastatic Prostate Cancer, Ethmoid Sinuses, Proptosis.
How to cite this article:
Tunio MA, Rafi M, Mohsin R, Hashmi A, Raza S, Mubarak M. Ipsilateral ethmoid sinuses metastasis and proptosis: Rare presentation of metastatic prostate cancer. Pak J Med Sci 2011;27(1):212-213
The bone is the most common site for metastasis secondary to prostate cancer. Orbital and paranasal sinuses metastases from prostate cancer are very rarely documented.1-5 Our patient was a 65 years old male resident of Baluchistan already established case of metastatic prostate cancer with bone metastasis presented with one month history of nasal conges-tion and obstruction intermittent type. He had been treated by local physician with antibiotics, antihista-mines and nasal decongestants but without any improvement. Over the next week, the patient de-veloped rapid onset of nasal obstruction, unilateral left sided proptosis and diplopia and was referred to department of oncology. Physical examination findings were left unilateral proptosis with orbital cellulitis and chemosis (Fig-1). On palpation there was mild tenderness. Pupils were round, reactive to light while accommodating vision was slightly blurred in left eye.
The nasal examination revealed slightly hypertrophied inferior and middle turbinates. No plpable lymph nodes were found. Systemic examination was unremarkable.
Baseline hematology and chemistry tests were within normal limits. Computed tomography (CT) scan showed opacification of left ethmoid sinuses and retro-orbital mass pushing the left eye ball forward
The patient was started on palliative radiotherapy that consisted of 3000 cGy in ten fractions mixed beams of 6MV photons and 15MeV electrons over two weeks. His pain resolved during the course of radiotherapy but persistent peri-orbital edema. Currently patient is alive and receiving hormonal therapy and intravenous bisphosphonates for bone metastasis.
The orbital and paranasal sinuses metastases are extremely rare. Renal cell carcinoma has been found the most common malignancy that is metastasized to paranasal sinuses and orbit.6 However metastasis to paranasal sinuses and orbit from prostate cancer is very rare; metastasis to ethmoid sinuses is further rarest only few case reports have been published so far.7 Orbital and paranasal sinuses metastasis present with symptoms of nasal obstruction, pain, epistaxis and proptosis. Our patient also presented with simi-lar symptoms however he did not complaint of epistaxis. The possible route of spread to these sites in prostate cancer is by hematogenous spread through vertebral veins.8
The diagnosis of metastatic carcinoma to paranasal sinuses and orbit may not be easy. The differential diagnosis may include sinusitis, orbital cellulitis, Wegener's granulomatosis, midline granuloma and primary malignant neoplasms.9 Failure to respond to antibiotics, antihistamines, decongestant shows alarming sign for the physician and warrants sinus radiographs and CT scan. The treatment of choice for metastatic paranasal sinuses and orbit is the radiotherapy with or without chemotherapy.10 The role of surgery is limited only to get tissue diagnosis or debulking. Our patient was treated with mixed beam photons and electrons with good results.
Authors wish to thank Prof. Dr. Adibul Hasan Rizvi, Director Sindh Institute of urology and Trans-plantation (SIUT) for his constant support and for providing state of art radiotherapy department which is serving poor patients with dignity.
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1. Mutahir A. Tunio, MBBS, FCPS, Assistant Professor, Department of Radiation Oncology.
2. Mansoor Rafi, MBBS,
3. Rehan Mohsin, MBBS, FCPS, Assistant Professor, Department of Urology.
4. Altaf Hashmi, MBBS, MS, MCPS, Professor, Department of Urology.
5. Shoaib Raza, MBBS, M.Phil, Department of Pathology.
6. Muhammad Mubarak, MBBS, FCPS, Department of Pathology.
1-6: Sind Institute of Urology & Transplantation (SIUT), Karachi, Pakistan.
Mutahir A. Tunio, MBBS, FCPS (Radiation Oncology)
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|Author:||Tunio, Mutahir A; Rafi, Mansoor; Mohsin, Rehan; Hashmi, Altaf; Raza, Shoaib; Mubarak, Muhammad|
|Publication:||Pakistan Journal of Medical Sciences|
|Article Type:||Clinical report|
|Date:||Mar 31, 2011|
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