Bilateral orbital metastasis as an initial presentation of hepatocellular carcinoma

  • Kay Thi Myint Faculty of Medicine, SEGi University https://orcid.org/0000-0003-3763-3496
  • Ko Ko Thant University of Medicine 2 Yangon Myanmar
  • Moe Thazin Hlaing Thar Yar General Hospital, Myanmar
Keywords: bilateral proptosis, hepatocellular carcinoma, orbital metastasis, ocular oncology, ocular pathology

Abstract

Purpose: To describe a case of biopsy-confirmed bilateral orbital metastasis of previously undiagnosed hepatocellular carcinoma, presenting with bilateral proptosis.

Case description: A 57-year-old man presented with painless bilateral proptosis over 2 months. At presentation, the best-corrected visual acuity was 20/60 in the right eye and 20/20 in the left eye. Ocular examination revealed bilateral asymmetrical non-axial proptosis with Hertel exophthalmometer reading of 24 mm in the right eye and 22 mm in the left eye. There was mild inferior displacement in both eyes. Apart from mild exposure keratopathy in the right eye, both anterior and posterior segment examinations were not remarkable. Orbital computerized tomography (CT) scan showed soft tissue masses in the superotemporal quadrants of both orbits associated with lytic bone lesions. An orbital biopsy confirmed that it was metastatic hepatocellular carcinoma (HCC). Ultrasound abdomen revealed multifocal HCC with underlying cirrhosis. We planned for further investigations such as hepatitis serology, alfa-fetoprotein, and CT abdomen, but he refused to proceed with investigations and treatment.

Conclusion: Orbital metastasis, more so as a bilateral involvement, is a rare phenomenon. It may present as an initial manifestation of undiagnosed systemic cancer. Orbital metastasis should be considered when diagnosing patients with bilateral proptosis, and orbital biopsy is crucial for histopathological diagnosis.

Author Biographies

Kay Thi Myint, Faculty of Medicine, SEGi University

Associate Professor

Ko Ko Thant, University of Medicine 2 Yangon Myanmar

Retired Professor 

Department of Ophthalmology

Moe Thazin, Hlaing Thar Yar General Hospital, Myanmar

Consultant Ophthalmologist

Department of Ophthalmology

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Published
2020-12-31
How to Cite
Myint, K., Thant, K., & Thazin, M. (2020). Bilateral orbital metastasis as an initial presentation of hepatocellular carcinoma. Asian Journal of Ophthalmology, 17(3), 302-310. https://doi.org/10.35119/asjoo.v17i3.708
Section
Case Reports/Case Series