Orbital Metastases as Presenting Sign of Lung Carcinoma: Detection of Primary Malignancy and Disease Burden by F-18 FDG
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CASE REPORT
Orbital Metastases as Presenting Sign of Lung Carcinoma: Detection of Primary Malignancy and Disease Burden by F-18 FDG PET/CT Kuruva Manohar & Bhagwant Rai Mittal & Anish Bhattacharya & Amod Gupta
Received: 29 September 2011 / Revised: 28 November 2011 / Accepted: 29 November 2011 / Published online: 4 January 2012 # Korean Society of Nuclear Medicine 2011
Abstract Metastases to orbit occur rarely but are the most common form of malignant orbital tumors. Usually the orbital metastases occur in disseminated disease. Very rarely orbital metastases can be the presenting feature of systemic malignancy. We report here a case with orbital metastases as the presenting feature of lung malignancy and describe the utility of FDG PET/CT as one-stop-shop imaging modality in this setting.
useful in identifying the primary tumor and demonstrating total disease burden in these cases. We report here a case of lung adenocarcinoma presenting as an orbital metastasis and usefulness of FDG PET/CT for diagnosing the primary malignancy and demonstrating the disease burden.
Keywords FDG PET/CT . Orbital metastases . Lung carcinoma
A 60-year-old female presented with diplopia and pain in the left eye for a period of 1 month. Magnetic resonance imaging (MRI) was performed with both T1 and T2 sequences, which revealed a relatively well defined mass lesion in the orbital cone of the left eye. The mass was homogenous and hypointense on T1 sequences and hyperintense on T2 sequences (Fig. 1). The differential diagnosis was a benign tumor of the orbit or a metastatic lesion. However the patient did not have any systemic symptoms or signs on clinical examination suggestive of malignancy. Excision biopsy was performed keeping in mind the high probability of a benign tumor, but histopathological examination of the excised mass revealed metastatic adenocarcinoma. Subsequently the patient was subjected to FDG PET/CT for diagnosis of the occult primary tumor. FDG PET/CT study was performed on a hybrid PET/CT scanner 60 min after intravenous injection of FDG. Scan findings revealed intense FDG uptake (SUV018.5) in a soft tissue mass in the middle lobe of the right lung (Fig. 1). In addition, intense FDG uptake was also noted in the bilateral mediastinal, cervical, and abdominal lymph nodes and in a hypodense lesion in the spleen and wall of stomach. Multiple mixed lytic and sclerotic bone metastases with intense FDG uptake were also seen in the pelvic bones and T6, T12, C6 vertebrae and left sixth rib. A provisional diagnosis of primary malignancy in the lung with widespread metastases
Introduction Orbital metastases, although the most common form of malignant orbital tumors, are rarely encountered in the clinical practice [1]. Usually orbital metastases occur in disseminated disease. Rarely, however, orbital metastasis can be the presenting feature of systemic malignancy. Extensive work-up using various imaging modalities such as contrast-enhanced computed tomography (CeCT) of chest and abdomen and skeletal scintigraphy is required t
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