Download PDF
Case Report  |  Open Access  |  14 Jul 2015

Orbital metastasis from anorectal carcinoma

Views: 6014 |  Downloads: 1082 |  Cited:  0
J Cancer Metastasis Treat 2015;1:104-5.
Author Information
Article Notes
Cite This Article

Abstract

Pulmonary and liver metastases are common sites of distant metastasis from the rectal carcinoma. Metastases to the head and neck region are uncommon from carcinoma of the rectum, and orbital metastases are extremely rare. Here, we describe a 27-year-old female, who was diagnosed as a case of anorectal carcinoma in April 2010. She underwent abdominoperineal resection followed by concurrent chemoradiotherapy and adjuvant chemotherapy with 5 fluorouracil and leucovorin on follow-up. In January 2012, she presented with gradually increasing swelling over the left temporal region and left sided proptosis. Fine-needle aspiration and a cell block were performed. Metastasis was confirmed histologically. Palliative radiotherapy to the left orbit at the dose of 3 Gy per fraction 10 fractions to a total dose of 30 Gy was given by cobalt-60. In patients with a history of rectal carcinoma, recent onset proptosis with temporal swelling, although rare, should raise suspicion of metastatic deposit.

Keywords

Anorectal carcinoma, distant metastasis, orbital metastasis

Introduction

Colorectal cancer is the third most common cancer with more than one million new cases each year worldwide. However, metastases from colorectal cancer to the orbit are exceedingly rare.[1,2] We report here, in the first patient from the India with such a presentation. The reason for the rarity of colorectal metastases to the eye and orbit is not clear but may be related to anatomical barriers and routes of metastasis.

Case report

A 27-year-old female initially presented in April 2010 with complaints of bleeding per rectum for 8 months, altered bowel habit and spurious diarrhea for 4 months. Rectal examination revealed a polypoidal mobile growth 3 cm from anal verge on the lateral and posterior wall of the rectum. Colonoscopy showed a friable circumferential growth in the rectum. Anorectal margin appeared to be involved by the tumor. Biopsy showed features consistent with adenocarcinoma, with surface ulceration. Contrast-enhanced computed tomography (CT) of the abdomen revealed an irregular wall thickening and enhancement involving the anorectal region with perifocal fat stranding and small volume (6 mm × 5 mm) lymph node in pelvis on left with involvement of anorectal sphincter. Permanent sigmoid colostomy and abdominoperineal resection were done. Intraoperative findings were an ulceroproliferative, circumferential growth of 6 cm × 5 cm in the lower rectum, 4 cm from anal verge; there was no evidence of lymph node involvement and no ascites. Post-operative histopathology showed well-differentiated adenocarcinoma, extending into serosa, pT3, pN2 (7/11), 5 cm × 5 cm × 1 cm, 7.5 cm from proximal margin, 4 cm from distal margin, with foci of perineural invasion, and lymphovascular invasion. Carcinoembryonic antigen (CEA) was 32.5 ng/mL (normal 4-7 ng/mL). Post-operative adjuvant chemo-radiotherapy was given to the whole pelvis in anteroposterior and posteroanterior fields 2 Gy per fraction, 25 fractions to a total dose of 50 Gy by cobalt-60. During radiotherapy, 2 cycles of concurrent chemotherapy with 5 fluorouracil plus leucovorin were given on D1-D5 and D21-D25, followed by 4 cycles of adjuvant chemotherapy, with the last cycle given in November 2010. CEA (January 8, 2011) was 3.4 ng/mL. Twenty-one months later, she presented with swelling over the left temporal region and left eye proptosis [Figure 1]. On examination, there was a 5 cm × 3 cm × 4 cm swelling over the left temporal region, with ill-defined borders on palpation, firm-to-hard in consistency and with no signs of local inflammation. Asymmetrical proptosis of the left eye was noted. The vision was normal in both eyes. No focal neurological deficit was noted. CT scan of the skull, soft tissues, and brain showed a mixed density mass along the lateral wall of the left retro-orbital area, adherent to the optic nerve [Figure 2]. Fine-needle aspiration cytology and biopsy were suggestive of metastatic adenocarcinoma [Figure 3]. Bone scan showed increased uptake in the left orbital region, right sacroiliac joint and second lumbar vertebral body, and suggestive of metastatic disease. Therefore, the patient was diagnosed with rectal carcinoma with multiple distant metastases. Palliative radiotherapy to the left orbit, lumbar spine, and right hemipelvis was given. The patient agreed to publish her pictures and signed the consent form.

Orbital metastasis from anorectal carcinoma

Figure 1. 5 cm × 3 cm × 4 cm swelling over left temporal region

Orbital metastasis from anorectal carcinoma

Figure 2. Computed tomography scan showing a mixed density mass along lateral wall of left retro-orbital area, adherent to optic nerve

Orbital metastasis from anorectal carcinoma

Figure 3. Morphology showing papillae and acinar pattern of columnar cells with moderate cytoplasm, oval nucleus, increased nuclear-cytoplasmic ratio

Discussion

Rectal carcinoma in the young is increasing in incidence. This may be associated with familial adenomatous polyposis and hereditary non-polyposis colorectal cancer (Lynch) syndrome. Metastatic tumors to the orbit are rare and most commonly are from lung, breast, prostate, and kidney primaries. Only 5% are from the gastrointestinal tract.[3,4] A review of the literature revealed only 6 cases reported of primary colorectal malignancy metastasizing to the orbit, with only three showing histopathology.[5] When gastrointestinal cancers metastasize to the orbit, this is usually combined with multiple disseminated metastases.[6] Management of metastatic orbital tumors requires a multidisciplinary team approach including radiotherapy, chemotherapy, and surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

1. Chekrine T, Hassouni A, Hatime M, Jouhadi H, Benchakroun N, Bouchbika Z, Tawfiq N, Sahraoui S, Benider A. Orbital metastasis from mucinous adenocarcinoma of the rectum. J Fr Ophtalmol 2013;36:e73-5.

2. Ezra E, Vardy S, Rose G. Metastatic colonic adenocarcinoma of the orbit with intraneural extension from the brow to the brainstem. Eye (Lond) 1995:371-2.

3. Shields JA, Shields CL, Brotman HK, Carvalho C, Perez N, Eagle RC Jr. Cancer metastatic to the orbit: The 2000 Robert M. Curts Lecture. Ophthal Plast Reconstr Surg 2001;17:346-54.

4. Goldberg RA, Rootman J, Cline RA. Tumors metastatic to the orbit: a changing picture. Surv Ophthalmol 1990;35:1-24.

5. Charles NC, Ng DD, Zoumalan CI. Signet cell adenocarcinoma of the rectum metastatic to the orbit. Ophthal Plast Reconstr Surg 2012;28:e1-2.

6. Chen SF, Yii CY, Chou JW. Colon cancer with orbital metastasis. Clin Gastroenterol Hepatol 2011;9:e76-7.

Cite This Article

Case Report
Open Access
Orbital metastasis from anorectal carcinoma
Pavan Kumar Lachi, ... Kotiyala V. Jaganadha Rao Naidu

How to Cite

Lachi, P. K.; Uppin M. S.; Irukulla M.; Naidu K. V. J. R. Orbital metastasis from anorectal carcinoma. J. Cancer. Metastasis. Treat. 2015, 1, 104-5. http://dx.doi.org/10.4103/2394-4722.158434

Download Citation

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click on download.

Export Citation File:

Type of Import

Tips on Downloading Citation

This feature enables you to download the bibliographic information (also called citation data, header data, or metadata) for the articles on our site.

Citation Manager File Format

Use the radio buttons to choose how to format the bibliographic data you're harvesting. Several citation manager formats are available, including EndNote and BibTex.

Type of Import

If you have citation management software installed on your computer your Web browser should be able to import metadata directly into your reference database.

Direct Import: When the Direct Import option is selected (the default state), a dialogue box will give you the option to Save or Open the downloaded citation data. Choosing Open will either launch your citation manager or give you a choice of applications with which to use the metadata. The Save option saves the file locally for later use.

Indirect Import: When the Indirect Import option is selected, the metadata is displayed and may be copied and pasted as needed.

About This Article

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License (http://creativecommons.org/licenses/by-nc-sa/3.0/), which allows others to remix, tweak and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Data & Comments

Data

Views
6014
Downloads
1082
Citations
0
Comments
0
29

Comments

Comments must be written in English. Spam, offensive content, impersonation, and private information will not be permitted. If any comment is reported and identified as inappropriate content by OAE staff, the comment will be removed without notice. If you have any queries or need any help, please contact us at support@oaepublish.com.

0
Download PDF
Share This Article
Scan the QR code for reading!
See Updates
Contents
Figures
Related
Journal of Cancer Metastasis and Treatment
ISSN 2454-2857 (Online) 2394-4722 (Print)

Portico

All published articles are preserved here permanently:

https://www.portico.org/publishers/oae/

Portico

All published articles are preserved here permanently:

https://www.portico.org/publishers/oae/