Orbital metastatic tumor
Introduction
Introduction to orbital metastatic tumor Orbital metastatic cancer (orbital metastatic carcinoma) represents a group of important orbital space-occupying lesions, and its diagnosis often indicates poor prognosis for patients, thus requiring accurate diagnosis and decisive and effective treatment. basic knowledge The proportion of illness: the proportion of illness is 0.003% - 0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: eyeball retraction
Cause
Causes of orbital metastatic tumors
(1) Causes of the disease
The primary tumors of various parts of the body are mostly from the breast and prostate, and domestic reports are mostly from the respiratory and digestive tract.
(two) pathogenesis
There is no lymphatic duct in the sacral region, and the metastatic tumor must reach the eyelid through the blood. This true metastatic tumor should be differentiated from lymphocytic tumor and secondary orbital tumor. The lymphatic tumor of the eyelid can develop into a solid eyelid. The space-occupying lesion may be part of a systemic lymphoma, which traditionally extends from adjacent structures such as the eyeball, conjunctiva, eyelids, sinuses, and nasal cavity to the eyelid.
Prevention
Orbital metastatic tumor prevention
Pay more attention to the usual eating habits and find early treatment.
Complication
Orbital metastatic tumor complications Complications, eyeball retraction
The primary tumor is transferred to the lung, liver, bone, brain, subcutaneous tissue and other parts of the corresponding clinical symptoms through the bloodstream.
Symptom
Orbital metastatic tumor symptoms Common symptoms Eyeball can not be free of nasal congestion, increased intracranial pressure, conjunctival hyperemia, hyperemia, double vision
Although the ocular metastatic tumor can come from multiple primary sites, the clinical manifestations are similar, which can be summarized into the following types of ocular symptoms and signs:
1. After the blood of the cancer cells spread to the crotch, it will continue to divide and proliferate, forming a mass. When it occurs or spreads to the equator of the eyeball, it causes eyeball protrusion, which occurs and develops more benign tumors and age. The group of primary malignant tumors in the eyelids is fast, often accompanied by eyelids and conjunctival edema (Fig. 1). The anterior temporal part of the iliac crest can be seen in the iliac crest and mass, and the eyeball return in the posterior part of the iliac crest is blocked. Tumors often occur in the peripheral part of the tendon tissue, and are displaced to one side in addition to the protruding of the eyeball.
2. Invasive metastatic tumors, like other malignant tumors, show invasive growth, invading the extraocular muscles and their motor nerves, clinically appearing diplopia and ocular dyskinesia, invading the optic nerve or its blood supply vessels, decreased vision, optic disc edema or Atrophy, sputum fat infiltration causes eyeballs to protrude, but there are exceptions, such as hard breast cancer can destroy the fat in the sputum, often causing the eyeball to be invaginated and fixed, the eyeball can not be displaced backwards.
3. Inflammatory signs due to rapid tumor development, blood supply is rich, often ocular inflammatory signs, such as spontaneous pain and swelling of the tumor, local skin congestion, heat, conjunctival hyperemia and high edema, tumor necrosis, bleeding fluctuations Can be misdiagnosed as an abscess.
4. Periocular structure and metastatic cancer of the eye, intracranial metastases, increased intracranial pressure, headache, vomiting and bilateral optic disc edema, sinus metastasis spread to the sputum, nasal congestion, nose, cheek swelling and pain, eyeball forward or The anterior lateral protrusion, choroidal metastasis invades the eyelids, vision loss, intraocular mass, and the eyeball protrudes forward.
Examine
Examination of orbital metastatic tumor
1. Experimental examination of primary cancer such as some carcinoembryonic antigen (CEA) related to tumor, prostate PSA antigen, etc., radioimmunochemical examination techniques are also very common.
2. Pathological examination When clinical and imaging examinations still can not provide a positive diagnosis, timely biopsy is necessary, shallow lesions can be paralyzed, skin incisions can be obtained, deep lesions are guided by image guidance, and light microscopy is available. Reliable diagnosis, if necessary, using electron microscopy to determine the source of the tissue, radioimmunochemical examination is also a commonly used diagnostic technique.
3. X-ray examination of the tumor metastasis transferred to the bone marrow of the tibia or invading the iliac wall.
4. Ultrasonic exploration can be found in irregular shape, low or medium internal echo, uneven distribution or uniformity, abnormal echo zone with strong sound attenuation, necrosis in lesions, and dark area in hemorrhage area.
5. CT scan is more important, you can find irregularly shaped medium-density mass and secondary edema, extraocular muscle hypertrophy caused by infiltration, can be limited thickening, irregular shape, internal rectus muscle compared with other eyes The muscle is more susceptible, the eye ring is thickened, the edge of the infiltrating mass is unclear or nodular, uniform or uneven enhancement, the optic nerve is thickened, the tibia is involved, and the osteolytic phenomenon can be found by CT. Brain scan, because the internal structure of the iliac crest and the intracranial structure are supplied by the internal carotid artery, and the blood supply to the brain is more abundant, and the possibility of metastatic cancer is greater.
Magnetic resonance imaging has higher resolution for intra-orbital and intracranial soft tissue. It is found that tumor and differential diagnosis are superior to CT, and the shape of the tumor is irregular, low signal in T1WI and high signal in T2WI.
7. Radionuclide whole-body scintigraphy is not very useful for the diagnosis of ophthalmologic diseases, but it is very important for the discovery of metastatic tumors, because the primary disease and the lesions that are transferred to various parts, including the orbital lesions, can be found.
Diagnosis
Diagnosis and differentiation of orbital metastatic tumor
diagnosis
Symptoms and signs of the primary site of orbital metastases are often neglected, and should be paid attention to. Breast cancer is one of the common metastatic tumors of the eyelids. The tumor is transferred into the sputum through the bloodway. The primary disease can be seen after one year of eyelid metastasis, about 20 % of patients with bilateral eyelid metastasis, the disease is more common in women 40 to 60 years old, breast mass found, nipple retraction, local skin is orange peel, generally have a history of breast cancer surgery or breast cancer treatment, bronchial lung cancer eyelid metastasis The symptoms of the primary site often have cough, hemoptysis, chest tightness, chest pain. Unlike breast cancer, half of the eyelid metastasis is found earlier or at the same time as the lung lesions. The main symptom is eyeball protrusion, the incidence rate is about 80%. Axial or non-axial, depending on the location of tumor infiltration, there may be ptosis, eyelid edema, ophthalmoplegia, eyelid pain or sensory paralysis in the area of the trigeminal nerve. Because some tumors are located in front, about 20% of cases can be Touching the anterior mass of the palate, the metastatic foci of the ankle may be accompanied by choroidal metastasis, manifested as loss of vision, retinal detachment or glaucoma, and urinary frequency caused by prostate cancer. Line dysuria, neuroblastoma occurs in the adrenal medulla and sympathetic ganglia of the abdominal wall in childhood, often palpable abdominal mass, the primary site and the signs and symptoms of orbital should be linked to a comprehensive analysis.
The history of previous cancer and the symptoms of the primary site are helpful for the diagnosis of orbital metastases, and the images may indicate malignant tumors.
Differential diagnosis
It is mainly used for differential diagnosis of primary tumors to develop different surgical plans.
Orbital primary tumors, especially benign tumors, have a long history and slow development. Imaging studies are generally easy to diagnose. Orbital primary malignant tumors are most common with lacrimal gland epithelial tumors. Clinical and imaging examinations are more characteristic, orbital metastasis. Tumors have a short history, rapid progress, and often associated with pain. Eyelid imaging studies can find a large range of lesions, bone destruction, or multifocal lesions. If patients have a history of systemic malignant tumors, they should first consider metastatic tumors of the eyelids. Therefore, the history of the diagnosis and the general condition of the patient are particularly important.
