Orbital Metastases As The Initial Presentation Of The NSCLC-case Report And Literature Review

[Objectives] We analyzed a rare case, in which a patient developed the orbital metastasis as the initial presentation. Later, by reviewing the literatures in this kind home and abroad, we summarize and explore the metastatic mechanism, clinical symptoms, diagnosis and differential diagnosis, treatment and prognosis of the orbital metastases and skeletal muscular metastases.[Background]Lung cancer has become one of the most commonest malignant tumors and is a great threat for the human life and health. It is estimated that more than 1.6 million new cases of cancer will be diagnosed in 2015, America,14% of which in man is lung or bronchus cancer with 13% in women and about one-quarter of all cancer deaths due to lung cancer. More than one half of cases are diagnosed at a distant stage with the 5-year survival rate approximately 4%.1Current analysis confined to distant-stage lung adenocarcinoma provides a better understanding of the metastatic sites including bone, brain, liver, adrenal glands.2 Orbital metastasis as the initial presentation of lung adenocarcinoma is very rare, so that the absent knowledge about this phenomenon results in misdiagnosis as orbital primary tumors or benign lesions easily. Symptoms of patients resulted from the primary tumor, metastatic spread, or paraneoplastic syndrome commonly cause the medical attention. For the symptoms related to the distant metastatic spread as the first manifestation, diagnosis would be a challenge. Patients with distant metastaticdisease are usually managed with systemic therapy (chemotherapy, targeted therapy, or a combination), clinical trials, or palliative treatment.[Methods]Here, we report a rare case, in which the orbital symptom appeared firstly without any pulmonary manifestations or other systematic abnormal conditions. Our patient developed a decreasing vision in his right eye of three months duration. Then he presented with proptosis and multiple aching sites from head to back. After systemic evaluation, our patient was diagnosed as stage IV non-small cell lung cancer (NSCLC) and managed with palliative chemoradiotherapy. The final result of treatment suggests that the therapeutic efficacy of chemotherapy is uncertain to orbital metastasis and some orbital metastatic masses may have a favorable response to radiation. The incidence, diagnosis, treatment are discussed in the study.[Conclusions]The most challenging aspect of this case for diagnosis is the rarity and blank knowledge about it, but there is a real incidence of orbital metastasis as the initial presentation of lung adenocarcinoma. A large index of suspicion is essential when an orbital lesion appears. Imaging studies can be used to characterize the orbital metastases for obtaining the provisional diagnosis. The choice of a biopsy procedure should be fully weighed of the cost/benefit ratio to a patient. Novel drugs especially the TKIs draw a brightened outlook of treatment with advanced lung cancer patients, but the efficacy in orbital metastases needs stronger evidence.