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ARTICLE
Year : 1960  |  Volume : 8  |  Issue : 3  |  Page : 69-71

Metastatic deposits in the orbit from carcinoma of gall bladder


Department of Pathology aid Bacteriology, G. R. Medica! College, Gwalior, India

Date of Web Publication5-May-2008

Correspondence Address:
B P Saxena
Department of Pathology aid Bacteriology, G. R. Medica! College, Gwalior
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Saxena B P, Darbari B S. Metastatic deposits in the orbit from carcinoma of gall bladder. Indian J Ophthalmol 1960;8:69-71

How to cite this URL:
Saxena B P, Darbari B S. Metastatic deposits in the orbit from carcinoma of gall bladder. Indian J Ophthalmol [serial online] 1960 [cited 2020 Jun 4];8:69-71. Available from: http://www.ijo.in/text.asp?1960/8/3/69/40681

The occurrence of carcinoma in the orbit from metastasis is extremely rare (Ingalls, 1953). The malignant metastatic emboli travelling by blood stream in the internal carotid artery are usually carried on past the narrow ostium of the Ophthalmic artery as It leaves the internal carotid artery at a right angle. Therefore, the emboli travelling in internal carotid artery do not enter into ophthalmic artery and lodge in brain and meninges. The size of the emboli also has a bearing on their final destination. The larger emboli by virtue of their weight and bulk travel in the slower peripheral stream and are more likely to be drift­ed into ophthalmic artery. The smaller emboli travel in the faster axial cur­rent of the artery and lodge in brain and meningcs. Ewing (1940) was of the opinion that simple mechanism of the circulation could explain the dis­tribution of metastatic tumours. Willis (1948) however believes that the final resting place of the embolus is deter­mined by the hospitality of the receiv­ing tissues and that the different degrees of tissue fertility determine whether or not the tumour cells would survive.

Primary tumours which have been observed to metastasize in the orbit are carcinomas of breast, lung, uterus, stomach, kidney & prostrate, malignant melanoma of skin, neuroblastoma of adrenal, acidophilic adenoma of pit­uitary (Davis, 1932; Friedenwald, 1952; Ingalls; Michail, 1932; Somners, 1949). We could not come across any case of Metastatic Carcinoma of orbit in literature in which the primary carcinoma was in gall-bladder, and we wish to report such a case.


  Case Report Top


Jagannath, 40 years old male, was admitted for swelling over right eye and dimness of vision of six months duration. The swelling was small in size in the beginning but steadily in­creased in size. The patient was cachectic and emaciated. There was a swelling over the right eye extending to the zygomatic bone laterally and pushing the eye forwards leading to exophthalmos. The swelling was hard in consistency and did not move on deeper structures. The pupil was reacting to light and the vision of the right eye was counting fingers at 1 foot. The left eve was normal.

Autopsy revealed a whitish, gelatin­ous growth in the gall-bladder lead­ing to diffuse thickening of the wall of gall bladder measuring 10 cms x 5 crns x 5 cms [Figure - 1] In the lumen of gall-bladder there was a yellow­black pigment stone. At places the growth was infiltrating into the liver substance which was otherwise normal. The right eye was bulging out and was comparatively smaller than the left eye. Posteriorly in the orbit there was a white gelatinous, multilocular growth measuring 10 cms, x 5 cms x 4 cms [Figure - 2]. It was infiltrating into the optic nerve, orbital muscles, the frontal process of zygomatic bone and great­er wing of sphenoid bone. The lateral wall of the orbit was a;rnost completely destroyed by the infiltrating tumour. There was a metastatic white nodule in the frontal lobe at the base, measur­ing 5 cms. x 4 cms. X 2.5 [Figure - 3]. The inner surface of the cranium had 5 pinkish white metastatic deposits measuring 1 to 3 cms in diameter [Figure - 4].


  Microscopic Features Top


The Section of the gall-bladder showed classical mucus-secretors adenocarcinoma with formation of follicles filled with mucus [Figure - 5]. Section from metastatic deposit' in orbit also showed similar histological features of mucus-secretory adeno­carcinoma. Metastatic nodule in the frontal lobe showed typical signet-ring cells arranged in papilla [Figure - 7]. There were no metastatic deposits in the eyes.


  Discussion Top


Metastatic carcinoma of orbit is relatively more common in the left orbit and left eye as compared to the right, probably due to the reason that the ostium of the left Ophthalmic artery receives greater number of tumour cells from the left internal carotid artery due to a more direct course of the latter (Ingalls, 1953). Our case is unusual as the metastatic growth occurred in the right eye while the left eye was normal. Metastatic carcinoma of the orbit is twice more common in females as compared to males due to predominence of carcino­ma breast metasttasizing to the orbit. In our case the primary carcinoma was a mucus-secreting adencarcinoma of the gall-bladder in a male. We could not come across in literature any case of carcinoma of gall-bladder mestatstasiz­ing into the orbit.

In our case there were also meta­static deposits in the frontal lobe of the brain and the cranium. Davis (1932) observed that 50% of cases with metastatic orbital carcinoma had generalized metastases and 4.7,0 had metastatic deposits in central nervous system. The prognosis in these cases is poor and most of the cases die within 9-12 months after the appearance of metastatic tumour in orbit.[7]


  Summary Top


A case of metastatic carcinoma of the right orbit from a primary mucus­secreting adenocarcinoma of gall-blad­der in a male aged 40 years has been described.

 
  References Top

1.
Davis,W.S(1932).Arch. of Ophthal, 8.226.  Back to cited text no. 1
    
2.
Ewing, J. (1940). Neoplastic 1)iseas­es. A treatise on Tumours, Ed. 4, Saunders, p. 67.  Back to cited text no. 2
    
3.
Friedeimald, J. S. (1952) ophthal­mic Pathology, Saunders Co., London, p.415.  Back to cited text no. 3
    
4.
Ingalls, R. G. (1953). Tumours of the orbit and allied pseudotumours, Charles C. Thomas, Springfield, Illinois, p. 372-383.  Back to cited text no. 4
    
5.
Michail. D. (1932). Brit. J. of Ophthal. 16. 537.  Back to cited text no. 5
    
6.
Somners, 1. C. (1949). Histology and Histopatholngv of Eve, Grunc & Straton, Inc. New York, p.662.  Back to cited text no. 6
    
7.
Willis, R. A. Pathology of Tumours, Ist Ed. St. Louis, Mosby, p. 178.  Back to cited text no. 7
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7]



 

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