|Year : 1985 | Volume
| Issue : 3 | Page : 191-193
Metastatic orbital carcinoma of thyroid
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi-110029, India
S M Betharia
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, A.I.I.M.S., New Delhi-110029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Betharia S M. Metastatic orbital carcinoma of thyroid. Indian J Ophthalmol 1985;33:191-3
Metastatic orbital tumors are rare. They constitute 5% to 6.5%, of the total orbital neoplasms. Out of the reported large series the breast carcinoma in female and lung carcinoma in male commonly metastasize, in the orbit. Orbital metastasis due to thyroid carcinoma is extremely rare. Only 1 case out of a series of 227 patients had a orbital metastasis due to thyroid carcinoma. We are reporting a case of metastatic thyroid carcinoma of the orbit with intracranial extension in a young girl.
| Case report|| |
G.D., 16 years female came with the complaints of diplopia, gradual protrusion of the right eye along with progressive diminution of vision. In 1973 she was diagnosed to be having toxic adenoma of the thyroid for which she was put on antithyroid treatment. She underwent hemithyroidectomy in 1975 when the swelling increased in spite of the treatment. In 1978 she developed a swelling in the right temporal region and a diagnosis of extradural mass in the right middle cranial fossa was made. Craniotomy was done for the same. The histopathology of this mass revealed the diagnosis of metastatic thyroid carcinoma. In 1981 she was operated for total thyroirdectomy.
Patient was anxious with a sleeping pulse rate of 100/min. Examination of the skull region revealed a bony defect in the right fronto-parietal region and pulsations of the brain were felt due to craniotomy. Scar mark in the neck was present due to previous thyroid surgery [Figure - 1]. There was no hepatospenomelagy and bony tenderness. Other systemic examination did not reveal any abnormality.
The left eye was essentially normal. The right eye had perception of light with accurate projection. There was right axial proptosis of 26 mm. (Hertle's exophthalmometry) which was non-pulsatile and nonreducible. Ocular movements were restricted in all directions. A hard mass was felt along the upper temporal and lower temporal part of the right orbit which was non tender and its posterior limit could not be reached. Lagophthalmos was present. The pupil was semidilated and reacting sluggishly to light. Intraocular tension was normal. Fundus examination revealed optic atrophy.
The routine haemogram and urine examination was normal. The radioactive iodine uptake (P 31) was 59 percent. The protein bound iodine (PBI) was 8.5 microgramme per cent. The thyroid scan revealed a hot thyroid nedule in the neck showing an increased thyroid activity. The scan of the head showed increased thyroid activity in the right orbit [Figure - 2]. Radiological examination showed enlargement of the right orbit with bony destruction of the sphenoidal wings and the lateral orbital margins [Figure - 3]. There was an extensive new bone formation in the right orbit consistent with the thyroid metastasis. The X-ray skull showed evidence of craniotomy in the right Pronto-parietal region. The chest and skeletal survey revealed nothing abnormal. The C.A.T. scan showed a mass in the right orbit with intracranial extension.
Patient was put on palliative treatment. Tarsorraphy was done in RE to protect the globe. Patient was then referred for treatment with radiostopes and supervoltage irradiation.
| Discussion|| |
Metastatic thyroid carcinoma of the orbit is an extremely rare condition and that too in the younger age group. The diagnosis of the primary site was missed initially in this case. Misdiagnosis among metastatic carcinoma to the eye and orbit are regrettably all too prevalent. This case had an unusual presentation as there was absence of lid edema, chemosis of conjunctiva and orbital pain which are reported to be the usual signs. Instead, she presented with gradual painless proptosis with diminution of vision due to optic atrophy. Most of the metastatic tumors involve the left orbit due to direct origin of the left common carotid artery from the aorta whereas in our case the right orbit was involved.
Our patient also had metastasis to the right middle cranial fossa and infact the diagnosis was clinched after histopathological examination of the craniotomy specimen. In the previous series of 91 cases reported from India only one case had metastatic thyroid carcinoma which involved orbit alone without involvement of any other site. Lung metastasis is usually associated with the metastatic thyroid carcinoma as the spread is through vascular route. Absence of lung metastasis in our case and involvement of the right middle cranial fossa and the right orbit, indicates that the route of spread in our patient was through Batson vertebral system thereby escaping the pulmonary filtration. This patient illustrates the significance of recording relevant clinical information about the past operations as in majority of the metastatic lesions of the orbit it is present., Bony destruction and rapid clinical course as present in our patient are important points leading to the diagnosis. The patient was put on palliative therapy as the reported life span of such patients is very small.
| Summary|| |
A rare case of metastatic thyroid carcnoma of right orbit with involvement of right middle cranial fossa is reported. The various problems in the diagnosis are highlighted. The clinical and radiological signs giving a clue to the diagnosis are stressed.
| References|| |
Jones, LS , Jacobiec, F.A., 1979, Diseases of orbit. Harper Row, New York,
Mohan, H., and Sen, D.K., 1971, Orbital tumors. Proceedings of All Ind Ophthalmol. Soc., 31 : 31
Ferry, A., and Font, R., 1974, Arch. Ophthalmol., 92: 278.
Duke Elder, S., 1971, System of Ophthalmology, Kimpton, London : 13: 1144
Henaerson, J.W., 1,980, Orbital tumors, 2nd ed. Brian Decker, New York 467-471.
[Figure - 1], [Figure - 2], [Figure - 3]