| Identifier |
walsh_2022_s1_c1 |
| Title |
Hydrocephalus Appetizer, TED Entrée, Side of Bipolar Disease. Would You Like a Meatball With That? |
| Creator |
Eric Caskey, Bradley Katz, Bhupendra Patel, Roger Harrie, Meagan Seay, Benjamin Witt, Yoshimi Anzai, Alison Crum, Judith Warner, Kathleen Digre |
| Subject |
Proptosis; Extraocular Muscles; Metastatic Carcinoma |
| History |
A 74-year-old man presented with a one year history of progressive, asymmetric proptosis. His past medical history by bilateral optic neuropathy, thyroid eye disease complicated by lithium treatment for bipolar disease, benign prostatic included hydrocephalus associated with aqueductal stenosis, status-post ventriculoperitoneal shunt at age 44 complicated hyperplasia with elevated prostate specific antigen, and tubular adenomas status-post resection via colonoscopy. On exam two decades prior, he was noted to have bilateral lid retraction and proptosis with exophthalmometry of 21 mm bilaterally and mild gaze limitations in all directions. He was lost to follow up for twenty years. When he returned, he reported progressive exophthalmos and lid retraction worse on the right compared to the left. He also reported conjunctival injection and eye discomfort on awakening. His vision had remained unaffected until one week prior to presentation when he began to notice decreased vision in the right eye. Best corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye without afferent pupillary defect. Extraocular movements were reduced in all gaze positions bilaterally, but right eye and symmetric optic disk pallor. Exophthalmometry now measured 30 mm on the right, 27 mm on the left. TSH, free T4, and thyroid stimulating antibody were normal. PSA was 19.5 ng/mL from 9.4 six months earlier. Orbital ultrasound showed an enlarged muscle consistent with Graves disease or possible tumor. MRI orbits revealed marked enlargement of the right superior rectus muscle belly with sparing of the muscle tendon. MRA was normal. The patient underwent a diagnostic procedure. |
| Disease/Diagnosis |
Neuroendocrine tumor metastasis to the right superior rectus |
| Date |
2022-02 |
| References |
1. Zimmerman LE, Stangl R, Riddle PJ. Primary Carcinoid Tumor of the Orbit: A Clinicopathologic Study with Histochemical; and Electron Microscopic Observations. Arch Ophthalmol. 1983;101(9):1395-1398.; 2. Sackstein PE, et al. Epidemiologic trends in neuroendocrine tumors: An examination of incidence rates and survival of; specific patient subgroups over the past 20 years. Semin Oncol. 2018;45(4):249-258.; 3.Thyparampil PJ, et al. Primary Neuroendocrine Tumor of the Orbit Presenting with Acute Proptosis. Ophthal Plast; Reconstr Surg. 2018;34(1):e17-e19.; 4. Kamieniarz L, et al. Orbital metastases from neuroendocrine neoplasms: clinical implications and outcomes. Endocrine.; 2020;67(2):485-493.; 5. Das S, et al. The eye of the beholder: Orbital metastases from midgut neuroendocrine tumors, a two institution; experience. Cancer Imaging. 2018;18(1).; 6. Mustak H, et al. Carcinoid Tumors of the Orbit and Ocular Adnexa. Ophthal Plast Reconstr Surg. 2021;37(3):217-225. |
| Format |
application/pdf |
| Type |
Text |
| Source |
54th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting 2022: Walsh Session I |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2022. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6f93t56 |
| Contributor Primary |
Eric Caskey, MD |
| Contributor Secondary |
Bradley Katz, Bhupendra Patel, Roger Harrie, Meagan Seay, Benjamin Witt, Yoshimi Anzai, Alison Crum, Judith Warner, Kathleen Digre |
| Setname |
ehsl_novel_fbw |
| ID |
2100229 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6f93t56 |
