Unilateral Proptosis Due to Orbital Malignancy and Synchronous Carcinoma Elsewhere
Journal Title: Ophthalmology Research: An International Journal - Year 2014, Vol 2, Issue 2
Abstract
Introduction: Unilateral proptosis is usually a diagnostic challenge to an ophthalmologist. Mass lesions constitute a common cause of unilateral proptosis in elderly individuals in which lymphoproliferative lesions account for 11% and metastasis up to 2- 9% of cases. Literature review showed various tumors metastasizing to the orbit but simultaneous presence of two unrelated tumors in a person are extremely uncommon. The authors wish to report the same to highlight the importance of systemic examination in an elderly patient presenting as unilateral proptosis. Case Presentation: A 52 year old man presented with complaints of painless, gradually progressing prominence of his right eye (OD) for 8 months. OD showed about 15 degrees of exotropia. Examination revealed an axial proptosis of 6mm by Hertel’s exophthalmometry. It was non-tender and non - pulsatile. CT scan of the orbit revealed OD proptosis with enhancing soft tissue attenuation lesion involving extraconal and intraconal compartments in superolateral aspect of the right orbit abutting proximal portion of the right optic nerve. Lacrimal gland could not be distinguished separately from the lesion Lacrimal gland biopsy revealed stratified squamous epithelium with subepithelial infiltration by monomorphic population of small lymphoid cells and few immunoblasts suggesting a low grade lymphoproliferative lesion. Immunohistochemical study confirmed a diagnosis of small lymphocytic lymphoma. Abdominal ultrasound performed for assessment of intraabdominal lymph nodes or visceral enlargement showed diffuse thickening. An endoscopic antral biopsy revealed gastric adenocarcinoma on histopathological examination. Conclusion: Diagnosis of two synchronous neoplasms of different etiopathogenesis at two sites and exclusion of metastasis is a significant and under-recognized clinical problem. This case highlights the importance of high index of clinical suspicion and thorough systemic examination in the evaluation of a case of unilateral proptosis in an elderly male.
Authors and Affiliations
Shashi Ahuja, K. Praveen Kumar, N. G. Rajesh, Praveen Seth, Debadutt Basu
Keywords
Related Articles
- EP ID EP338933
- DOI 10.9734/OR/2014/5564
- Views 80
- Downloads 0
Immune Reconstitution Inflammatory Syndrome (IRIS) Presenting as Bilateral Severe Granulomatous Sclerouveitis in a HIV-Infected Patient with Mycobacterium Tuberculosis Infection: A Case Report
Aim: To report a case of tuberculosis (TB) associated immune reconstitution inflammatory syndrome (IRIS) presenting as rapid progressive bilateral severe granulomatous sclerouveitis. Presentation of Case: A 26-year-old H...
Central Cornea Thickness in Glaucoma and Non-Glaucoma African Population
Aim: To determine the pattern of central cornea thickness (CCT) in an indigenous African population attending the glaucoma clinic at University College Hospital (UCH), Ibadan, Nigeria and identify its relationship to spe...
Traumatic Cataract
Traumatic cataract is more common in younger individuals. Traumatic cataract is an important cause of uniocular visual loss and is often sudden in onset. Traumatic lens damage may be caused by mechanical or non-mechanica...
Anterior Migration of the Encircling Band: A Report of Two Cases
Aim: To reiterate the clinical course and management of the cases with anteriorly migrated encircling band. Report of the Cases: We describe two patients with the migration of a solid silicone encircling band through t...
Relationship of Hemoglobin A1C and Outcomes of Treatment of Diabetic Macular Edema
Aims: To evaluate the relationship between Hemoglobin A1c (HbA1c) and visual and anatomical outcomes in eyes following treatment with intravitreal anti vascular endothelial growth factor (VEGF) agents and corticosteroids...