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Case Report

Orbital metastasis from anorectal carcinoma

1
2
Pavan Kumar Lachi , Megha S. Uppin , Monica Irukulla , Kotiyala V. Jaganadha Rao Naidu 1
1
1 Department of Radiation Oncology, Nizam’s Institute of Medical Sciences, Hyderabad 500082, Telangana, India.
2 Department of Pathology, Nizam’s Institute of Medical Sciences, Hyderabad 500082, Telangana, India.
Correspondence to: Dr. Pavan Kumar Lachi, Department of Radiation Oncology, Nizam’s Institute of Medical Sciences, Hyderabad 500082,
Telangana, India. E-mail: drpavan.lachi@gmail.com

ABSTRACT
Pulmonary and liver metastases are common sites of distant metastasis from the rectal carcinoma. Metastases to the head and neck
region are uncommon from carcinoma of the rectum, and orbital metastases are extremely rare. Here, we describe a 27-year-old
female, who was diagnosed as a case of anorectal carcinoma in April 2010. She underwent abdominoperineal resection followed
by concurrent chemoradiotherapy and adjuvant chemotherapy with 5 fl uorouracil and leucovorin on follow-up. In January 2012,
she presented with gradually increasing swelling over the left temporal region and left sided proptosis. Fine-needle aspiration and a
cell block were performed. Metastasis was confi rmed histologically. Palliative radiotherapy to the left orbit at the dose of 3 Gy per
fraction 10 fractions to a total dose of 30 Gy was given by cobalt-60. In patients with a history of rectal carcinoma, recent onset
proptosis with temporal swelling, although rare, should raise suspicion of metastatic deposit.
Key words: Anorectal carcinoma, distant metastasis, orbital metastasis

Introduction anorectal sphincter. Permanent sigmoid colostomy and
abdominoperineal resection were done. Intraoperative
Colorectal cancer is the third most common cancer with fi ndings were an ulceroproliferative, circumferential
more than one million new cases each year worldwide. growth of 6 cm × 5 cm in the lower rectum, 4 cm
However, metastases from colorectal cancer to the orbit from anal verge; there was no evidence of lymph node
are exceedingly rare. [1,2] We report here, in the fi rst patient involvement and no ascites. Post-operative histopathology
from the India with such a presentation. The reason for showed well-differentiated adenocarcinoma, extending
the rarity of colorectal metastases to the eye and orbit is into serosa, pT3, pN2 (7/11), 5 cm × 5 cm × 1 cm,
not clear but may be related to anatomical barriers and 7.5 cm from proximal margin, 4 cm from distal margin,
routes of metastasis. with foci of perineural invasion, and lymphovascular
invasion. Carcinoembryonic antigen (CEA) was
Case Report
32.5 ng/mL (normal 4-7 ng/mL). Post-operative
A 27-year-old female initially presented in April 2010 adjuvant chemo-radiotherapy was given to the whole
with complaints of bleeding per rectum for 8 months, pelvis in anteroposterior and posteroanterior fi elds 2 Gy
altered bowel habit and spurious diarrhea for 4 months. per fraction, 25 fractions to a total dose of 50 Gy by
Rectal examination revealed a polypoidal mobile growth cobalt-60. During radiotherapy, 2 cycles of concurrent
3 cm from anal verge on the lateral and posterior wall of chemotherapy with 5 fl uorouracil plus leucovorin
the rectum. Colonoscopy showed a friable circumferential were given on D1-D5 and D21-D25, followed by
growth in the rectum. Anorectal margin appeared to 4 cycles of adjuvant chemotherapy, with the last cycle
be involved by the tumor. Biopsy showed features given in November 2010. CEA (January 8, 2011) was
consistent with adenocarcinoma, with surface ulceration. 3.4 ng/mL. Twenty-one months later, she presented
Contrast-enhanced computed tomography (CT) of with swelling over the left temporal region and left
the abdomen revealed an irregular wall thickening eye proptosis [Figure 1]. On examination, there was
and enhancement involving the anorectal region with a 5 cm × 3 cm × 4 cm swelling over the left temporal
perifocal fat stranding and small volume (6 mm × 5 mm) region, with ill-defi ned borders on palpation, fi rm-to-hard
lymph node in pelvis on left with involvement of in consistency and with no signs of local infl ammation.
Asymmetrical proptosis of the left eye was noted. The
vision was normal in both eyes. No focal neurological
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defi cit was noted. CT scan of the skull, soft tissues,
Quick Response Code: and brain showed a mixed density mass along the
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www.jcmtjournal.com lateral wall of the left retro-orbital area, adherent to
the optic nerve [Figure 2]. Fine-needle aspiration
cytology and biopsy were suggestive of metastatic
DOI:
10.4103/2394-4722.158434 adenocarcinoma [Figure 3]. Bone scan showed increased
uptake in the left orbital region, right sacroiliac joint
104 Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 2 ¦ July 15, 2015 ¦