| Identifier |
walsh_2020_s3_c3 |
| Title |
Undiscovered Islands - So Close, Yet So Far (Video) |
| Creator |
Magdalena Wirth; Farahna Sabiq; Mehdi Agoumi |
| Affiliation |
(MW) Department of Ophthalmology, University of British Columbia, Vancouver, Canada; (FS) Department of Radiology, University of British Columbia, Vancouver, Canada; (MA) Department of Pathology, Surrey Memorial Hospital, Surrey, Canada |
| Subject |
Metastatic Carcinoma, Orbital Tumors, Proptosis, Tumor |
| History |
A 30-year old female, visiting Canada from India, presented to ophthalmology with a 2-day history of right periorbital swelling, painful proptosis, fevers and chills. Initial examination suggested a clinical diagnosis of post-septal cellulitis with mild motility restriction, without optic nerve compromise, and patient was admitted and started on IV broad-spectrum antibiotics. Serologic analysis revealed mildly elevated CRP and white blood cell count. CT orbits revealed two ovoid-shaped ring-enhancing lesions in the right lateral and superior rectus muscles (Fig.1) and clear sinuses, atypical for infectious post-septal cellulitis, raising other considerations of the differential diagnosis. ACE, ANA, ANCA, HIV, and TB testing were negative. The patient received a course of oral steroids. As an inpatient, she was noted to have bradycardic episodes. Holter-monitor was unremarkable. Antibiotic and steroid treatment resulted in clinical improvement. MRI orbits was performed for further characterization, confirming the presence of the lesions in the right lateral and superior rectus muscles and an additional lesion in the left superior rectus muscle (Fig. 2). The largest ring-enhancing lesion in the right lateral rectus muscle did not show restricted diffusion, arguing against an abscess. Orbital biopsy was discussed, but deferred due to non-compliance. Given the bilaterality of these findings, a parasitic process, i.e. orbital cysticercosis was suspected, despite low eosinophil count and negative taenia solium serology. A course of albendazole, along with steroids was initiated, which led to the resolution of her symptoms. 8 weeks after her initial presentation, she presented to the ER with a 3-day history of nausea, vomiting, diarrhea, fevers and weakness. Abdominal sonography and CT ordered for iron deficiency and elevated liver enzymes showed a 3cm mass, likely arising from the neck of the pancreas, along with numerous lesions in kidneys, liver, T12 vertebral body, and periaortic/retroperitoneal lymphadenopathy (Fig. 3). A diagnostic test was performed. |
| Disease/Diagnosis |
Orbital involvement of metastatic pancreatic neuroendocrine tumor, grade 2. |
| Date |
2020-03 |
| References |
1. Borota et al. Carcinoid tumour metastatic to the orbit with infiltration to the extraocular orbital muscle, APMIS, 113(2):135-9,2005. 2. Das et al. The eye of the beholder: orbital metastases from midgut neuroendocrine tumors, a two institution experience, Cancer Imaging, 18(1):47, 2018. 3. Matsuo et al. Neuroendocrine tumor metastatic to orbital extraocular muscle: case report and literature review. Strabismus, 18(4):123-8, 2010. 4. Peixoto et al. Neuroendocrine tumor metastatic to the orbit treated with radiotherapy. World J Gastrointest Oncol, 5(8):177-80, 2013. 5. Riddle et al. Carcinoid tumors of the eye and orbit: a clinicopathologic study of 15 cases, with histochemical and electron microscopic observations. Hum Pathol, 13(5):459-69, 1982. 6. Turaka et al. A case series of neuroendocrine tumor metastasis to the orbit. Oman J Ophthalmol, 4(3):125-8, 2011. 7. Kozubowska et al. Neuroendocrine tumour metastasis to the orbit. Endokrynol Pol, 2019. 8. Halliday et al. Pseudocystic appearance of an orbital carcinoid metastasis. Orbit, 1-4, 2019. 9. Mehta et al. Orbital carcinoid metastases. Ophthalmology, 113(3):466-72, 2006. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
2020 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of |
NANOS Annual Meeting 2020: Frank B. Walsh Session 3 |
| Collection |
Neuro-Ophthalmology Virtual Education Library - Walsh Session Annual Meeting Archives https://novel.utah.edu/Walsh/index3.html |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5981 |
| Rights Management |
Copyright 2020. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6kd76fw |
| Setname |
ehsl_novel_fbw |
| ID |
1538219 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6kd76fw |
