Undiscovered Islands - So Close, Yet So Far (Slides)

The hepatic lesions were easily amenable to ultrasound-guided biopsy and three 18-gauge core biopsies of one of the lateral right lobe hepatic masses were obtained. The histopathological sections revealed a metastatic tumor composed of monomorphic cell proliferation, with insular growth pattern (Fig. 4). Based on these features, the tumor was diagnosed as a metastatic neuroendocrine tumor, grade 2. Given the positivity for CDX2 and the upper endoscopic findings of extrinsic compression of antrum/pylorus, the patient was diagnosed with a neuroendocrine carcinoma, with primary origin being pancreatic and widely metastatic (Fig. 5). Sadly, her visitor health insurance did not cover medical expenses for chemotherapy. Thus, she was transferred back to India for further care. Orbital metastases secondary to neuroendocrine carcinoma are exceedingly rare, with only 22 cases reported so far. Average age at diagnosis is reported to be 67.5 (range 42-79). Hence, this is an extremely unusual presentation for a 30-year old patient (1-8). Das et al. found that surgical biopsy of the orbital lesion is not necessary for diagnosis in the setting of a previously established diagnosis, systemic metastases and classic radiologic findings (2). In strong contrast to other primary malignancies with orbital metastases, patients with orbital involvement from neuroendocrine tumours carry an excellent prognosis with 10-year survival ratesof close to 40% (9).