Northern Ireland Cancer Centre , Belfast , UK.
Department of Histopathology, Royal Group of Hospitals Trust , Belfast , UK.
Front Oncol. 2014 Jun 5;4:136. doi: 10.3389/fonc.2014.00136. eCollection 2014.
Orbital metastases are an uncommon finding, being present in just 9% deceased patients with metastatic cancer. Only a quarter of patients with choroidal metastases have bilateral disease. Parotid cancer is not a common form of head and neck malignancy. Bilateral multifocal metastases from adenocarcinoma ex pleomorphic of parotid gland have been documented just once before in the literature. We present a similar case where palliative EBRT was used to gain local control with minimal toxicity.
The case of a 45-year-old Caucasian gentleman who presented to his general practitioner with otalgia and weight loss. Imaging revealed a mass in the deep lobe of the left parotid gland, invading into the medial pterygoid muscle. PET-CT revealed locoregional and distant lymphatic involvement plus disseminated skeletal metastases. Lymph node examination revealed adenocarcinoma ex pleomorphic histology. Within weeks of this diagnosis, the patient developed rapidly progressive visual impairment. Ophthalmologists found multifocal uveal masses bilaterally. Palliative fractions of external beam radiotherapy were delivered to the orbits before combination chemotherapy. We discuss the patient's presentation, histopathology, and management, with support from the literature regarding applied and related therapies.
In this rare presentation of disseminated malignancy affecting the choroid bilaterally, the authors demonstrate the application of palliative EBRT to good local effect. Given the nature of this treatment and that of the metastases, in the setting of incurable disease orbital morbidity is likely to occur again before the patient's death. Awareness of the initial symptoms is important to provide prompt care and maintain quality of life.
眼眶转移较为罕见，仅存在于 9%患有转移性癌症的已故患者中。仅有四分之一的脉络膜转移患者存在双侧疾病。腮腺癌并不是一种常见的头颈部恶性肿瘤。在文献中，仅记录过一次来自腮腺多形性腺癌的双侧多灶性转移。我们呈现了一个类似的病例，使用姑息性 EBRT 获得局部控制，同时毒性最小。
一名 45 岁的白种男性，因耳痛和体重减轻就诊于他的全科医生。影像学检查显示左侧腮腺深叶有一个肿块，侵犯了内侧翼状肌。PET-CT 显示局部和远处淋巴结受累以及广泛的骨骼转移。淋巴结检查显示多形性腺癌组织学。在诊断后的几周内，患者的视力迅速恶化。眼科医生发现双侧脉络膜有多发性葡萄膜肿块。在联合化疗之前，对眼眶进行了姑息性分次外照射放疗。我们讨论了患者的表现、组织病理学和治疗，同时参考了有关应用和相关治疗的文献。
在这种罕见的双侧脉络膜弥漫性恶性肿瘤的表现中，作者展示了姑息性 EBRT 的良好局部效果。鉴于这种治疗和转移的性质，在无法治愈的疾病背景下，在患者死亡之前，眼眶发病率可能再次发生。了解初始症状很重要，可以提供及时的护理并维持生活质量。
