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CASE REPORT
Year : 2011  |  Volume : 7  |  Issue : 2  |  Page : 195-197

Metastasis of greater wing of sphenoid bone in bronchogenic carcinoma: A unusual case report


1 Department of Radio-Diagnosis, Imaging and Interventional Radiology, N.S.C.B. Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India
2 Department of Anaesthesiology and Critical care, N.S.C.B. Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India

Date of Web Publication12-Jul-2011

Correspondence Address:
Prashant K Gupta
108, Chanakyapuri, Shastri Nagar, Meerut - 250 004, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.82921

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 > Abstract 

Orbital metastasis in systemic cancer is known to occur and occurs in up to 7% of all systemic cancers. Orbital features typically present after the diagnosis of the primary tumor. In about 20% of cases, there is no known primary cancer at the time of presentation with orbital metastatic disease. Here we report a case of a 60-year-old male smoker, in whom proptosis, due to metastasis in greater wing of left sphenoid bone secondary to bronchogenic carcinoma, was the initial symptom. We could not find in literature metastasis to greater wing of sphenoid bone due to small cell carcinoma of lung.

Keywords: Metastasis, orbit, proptosis, sphenoid bone


How to cite this article:
Gupta PK, Mital M, Dwivedi A, Gupta K. Metastasis of greater wing of sphenoid bone in bronchogenic carcinoma: A unusual case report. J Can Res Ther 2011;7:195-7

How to cite this URL:
Gupta PK, Mital M, Dwivedi A, Gupta K. Metastasis of greater wing of sphenoid bone in bronchogenic carcinoma: A unusual case report. J Can Res Ther [serial online] 2011 [cited 2019 Sep 16];7:195-7. Available from: http://www.cancerjournal.net/text.asp?2011/7/2/195/82921


 > Introduction Top


Metastatic disease to eye and orbit is not unusual, however, statistics on orbital metastases are low because most series are based on pathological data. The radiographic finding in orbital metastases consists of nonspecific bone erosion and changes in soft tissue density on plain radiograph. Computed tomography (CT) now can have a better evaluation. A 60-year-old male presented to our hospital with proptosis as the chief complaint. Radiological and histopathological investigations revealed metastatic disease of greater wing of left sphenoid bone with primary of lung cancer.


 > Case Report Top


A 60-years-old male patient presented with 15 days history of pain, swelling, and progressive protrusion of the left eye and diplopia. There were no complaints suggestive of thyroid dysfunction, impairment of vision, or was there a history of trauma or any significant chest or abdominal complaints.

Examination

On examination there was low-grade proptosis of left eyeball with associated soft tissue swelling along the lateral margin of the left orbit. Examination of eye was normal with vision 6/6 in the right eye and 6/9 in the left eye. Funduscopy was within the limits of normal. Tonometry was not done. Systemic examination was unremarkable.

Investigations

Patient routine blood examination was normal. The patient was takenup for contrast-enhanced CT (CECT) scan of the orbit including both axial and coronal sections. CT scan revealed expansion of the greater wing of left sphenoid bone with erosive destruction and involvement of orbital plate of frontal bone and squamous part of temporal bone and extension into the middle cranial fossa and the infratemporal fossa with associated thickening of the temporalis muscle. The bony lesion was associated with large soft tissue density mass lesion measuring 20 × 28 mm in the extraconal space along the lateral wall of the left orbit, displacing the lateral rectus muscle and the eyeball medially [Figure 1].
Figure 1: Axial and coronal contrast-enhanced CT scan orbit showing destruction of greater wing sphenoid with soft tissue (left)

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Due to short history and bony destruction, a provisional diagnosis of secondaries was made and further investigations to search the primary were carried out. Chest radiograph revealed a hilar mass with destruction of shaft of left 9 th rib [Figure 2] and [Figure 3].
Figure 2: Chest radiograph showed mass in the left hilar region

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Figure 3: Radiograph shows destruction of the left 9th rib

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The patient was advised CECT scan of thorax, which confirmed a left hilar mass and destruction of left 9 th rib with associated liver metastasis [Figure 4].
Figure 4: Contrast-enhanced CT scan of chest and upper abdomen showing left hilar mass and liver secondaries

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The patient subsequently underwent a bronchoscopy for biopsy, which revealed poorly differentiated carcinoma, possibly intermediate type of small cell carcinoma. Fine-needle aspiration cytology from orbital soft tissue mass revealed adenocarcinoma.


 > Discussion Top


Metastatic disease to the eye most commonly involves the choroid. [1] By comparison, metastatic disease to the orbit is relatively uncommon, occurring in about 7% of all cancers. [2] Metastasis to the orbit accounts for less than 5% of all orbital tumors. [3] The common primary sites in adults include lung in males and the breast in females and accounts for over 50% of orbital metastases. [4] In children most orbital metastases are due to neuroblastoma and rhabdomyosarcoma. In approximately 20% of patients, orbital metastasis is the initial manifestation of systemic malignancy. [5] The orbital metastasis is more common with lung cancer rather than breast cancer. [6]

Besides metastasis, in an elderly male patient presenting with short history, unilateral involvement and progressive low-grade proptosis a differential diagnosis of lymphoma and orbital pseudotumor can be kept. The majority of retrobulbar metastases are extraconal; however, as they enlarge, the intraconal compartment may also be effected. Patients complain of diplopia, ptosis, proptosis, eyelid swelling, pain, and visual loss. CT examination depicts the orbital and cranial soft tissue components of the lesion. Most lesions have associated bone involvement.

This case showed involvement of greater wing of sphenoid, a unusual occurrence. In literature we could not find involvement of greater wing of sphenoid bone secondary to bronchogenic carcinoma.


 > Conclusion Top


Metastasis to greater wing of sphenoid bone secondary to bronchogenic carcinoma is unusual and has not been reported in the literature to the best of our knowledge. Patients with primary manifestation of orbital symptoms and suspected to have metastatic disease of orbit should be investigated for unknown primary, especially of lung and breast, the most common sites of primary, in adults.

 
 > References Top

1.De Potter P. Ocular manifestations of cancer. Curr Opin Ophthalmol 1998;9:100-4.  Back to cited text no. 1
[PUBMED]    
2.Macedo JE, Machado M, Araújo A, Angélico V, Lopes JM. Orbital metastasis as a rare form of clinical presentation of non-small cell lung cancer. J Thorac Oncol 2007;2:166-7.  Back to cited text no. 2
    
3.Mena A, Pardo J. Orbital metastasis as the initial manifestation of small cell lung cancer. Acta Ophthalmol 2002;80:113-5.  Back to cited text no. 3
    
4.Wolstencroft SJ, Hodder SC, Askill CF, Sugar AW, Jones EW, Griffiths AP. Orbital metastasis due to interval lobular carcinoma of the breast. Arch Ophthalmol 1999;117:1419-21.  Back to cited text no. 4
[PUBMED]    
5.Shields JA, Shields CL, Brotman HK, Carvalho C, Perez N, Eagle RC Jr. Cancer metastatic to the orbit. Ophthal Plast Reconstr Surg 2001;17:346-54.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Char DH, Miller T, Kroll S. Orbital metastasis: Diagnosis and Course. Br J Ophthalmol 1997;81:386-90.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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