Orbital metastasis: Clinical presentation and survival in a series of 11 cases.

BACKGROUND AND OBJECTIVE: Orbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20%-42%. The clinical presentation and survival is presented in a series of 11 cases of orbital metastasis corresponding to 10 patients. MATERIAL AND METHODS: Descriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastasis involving the orbit was included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established. RESULTS: One-half (50%) of the patients were women. Mean age at diagnosis was 60.9 years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases); followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%). The most common signs were resistance to ocular retropulsion (60%), presence of a mass on orbital palpation, and ocular dystopia (50%), and bulbar hyperaemia and proptosis (40%). The most employed management modality was clinical observation (5 patients). In 3 patients radiotherapy was administered, combining chemotherapy plus hormonal therapy in one case, and orbital exenteration in another one. In 2 cases, chemotherapy was administered as an isolated regime. Median survival time was 4.8 months since the diagnosis. There was a statistically significant difference between the survival time in the observation group (median 2.5 months) and in the active treatment group (median 29.2 months), p=.034. CONCLUSIONS: In the series presented, 27% of the cases established the clinical debut of the malignant neoplasm. The ophthalmologist plays an essential role when this condition is suspected, diagnosing it, and proposing its management together with the Oncology Service.

Metástasis orbitarias: presentación clínica y supervivencia en una serie de 11 casos / Orbital metastasis: Clinical presentation and survival in a series of 11 cases

Antecedentes y objetivoLas metástasis orbitarias son una entidad infrecuente y pueden suponer la presentación de un tumor maligno desconocido previamente; según las series, el porcentaje de metástasis orbitarias como primera manifestación de una enfermedad maligna es del 20-42%. Describimos la presentación clínica y la supervivencia en una serie de 11 casos de metástasis orbitarias correspondientes a 10 pacientes.Material y métodosEstudio descriptivo retrospectivo de una serie de 10 pacientes adultos diagnosticados de metástasis orbitarias de tumores sólidos durante un periodo de 9años. Se incluyeron metástasis que afectasen a la órbita, excluyendo linfomas e invasiones por contigüidad. Se especificó si la clínica fue la primera manifestación del tumor. Se registraron los síntomas y signos en el debut clínico, la localización del tumor primario, si existía extensión a distancia, las estructuras orbitarias afectas y el tiempo de supervivencia desde el diagnóstico.ResultadosLa mitad de los pacientes fueron mujeres. La edad media al diagnóstico fue de 60,9años (rango 42-82). En 9casos (90%) la metástasis fue unilateral, mientras que en el restante la afectación fue bilateral. La localización más frecuente del tumor primario fue la mama (36% de los casos), seguida por la vejiga (27%), el pulmón (18%), el ovario y el cavum (9%). El 70% de los pacientes tenían enfermedad neoplásica diagnosticada previamente; en 3casos la metástasis fue la primera manifestación del tumor.

Background and objectiveOrbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20-42%. The clinical presentation and survival are presented in a series of 11 cases of orbital metastasis corresponding to 10 patients.Material and methodsDescriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastases involving the orbit were included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established.ResultsOne-half (50%) of the patients were women. Mean age at diagnosis was 60.9years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases), followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%).

Orbital metastasis: Clinical presentation and survival in a series of 11 cases. / Metástasis orbitarias: presentación clínica y supervivencia en una serie de 11 casos.

BACKGROUND AND OBJECTIVE: Orbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20-42%. The clinical presentation and survival are presented in a series of 11 cases of orbital metastasis corresponding to 10 patients. MATERIAL AND METHODS: Descriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastases involving the orbit were included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established. RESULTS: One-half (50%) of the patients were women. Mean age at diagnosis was 60.9years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases), followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%). The most common signs were resistance to ocular retropulsion (60%), presence of a mass on orbital palpation and ocular dystopia (50%), and bulbar hyperaemia and proptosis (40%). The most employed management modality was clinical observation (5 patients). In 3 patients radiotherapy was administered, combining chemotherapy plus hormonal therapy in one case, and orbital exenteration in another one. In 2 cases, chemotherapy was administered as an isolated regime. Median survival time was 4.8months since the diagnosis. There was a statistically significant difference between the survival time in the observation group (median 2.5months) and in the active treatment group (median 29.2months), P=.034. CONCLUSIONS: In the series presented, 27% of the cases established the clinical debut of the malignant neoplasm. The ophthalmologist plays an essential role when this condition is suspected, diagnosing it, and proposing its management together with the Oncology Service.

12-lipoxygenase activity plays an important role in PAR4 and GPVI-mediated platelet reactivity.

Following initial platelet activation, arachidonic acid is metabolised by cyclooxygenase-1 and 12-lipoxygenase (12-LOX). While the role of 12-LOX in the platelet is not well defined, recent evidence suggests that it may be important for regulation of platelet activity and is agonist-specific in the manner in which it regulates platelet function. Using small molecule inhibitors selective for 12-LOX and 12-LOX-deficient mice, the role of 12-LOX in regulation of human platelet activation and thrombosis was investigated. Pharmacologically inhibiting 12-LOX resulted in attenuation of platelet aggregation, selective inhibition of dense versus alpha granule secretion, and inhibition of platelet adhesion under flow for PAR4 and collagen. Additionally, 12-LOX-deficient mice showed attenuated integrin activity to PAR4-AP and convulxin compared to wild-type mice. Finally, platelet activation by PARs was shown to be differentially dependent on COX-1 and 12-LOX with PAR1 relying on COX-1 oxidation of arachidonic acid while PAR4 being more dependent on 12-LOX for normal platelet function. These studies demonstrate an important role for 12-LOX in regulating platelet activation and thrombosis. Furthermore, the data presented here provide a basis for potentially targeting 12-LOX as a means to attenuate unwanted platelet activation and clot formation.