[Exophthalmos caused by orbital metastasis of prostatic carcinoma]

Abstract

A case of orbital metastasis from Whitmore stage D adenocarcinoma of the prostate is described. Clinically, it presented as rapidly progressing exophthalmos of the right eye with elevation (ptosis) and abduction paralysis. The associated clinical picture of a one-year history of prostatism prompted patient referral to our department. When a patient presents with an orbital tumor and a history of cancer localized to another site, the metastatic origin of the condition should be suspected and metastasis to other sites sought. A negative finding warrants performing orbital biopsy to confirm the diagnosis. Although excision of single metastatic tumors in this site has been described, coexisting metastasis to bone and lymph nodes, the hormone dependence that these present and prostatic cancer contraindicate resection of the orbital metastatic tumor. Following bilateral orchiectomy and hormone therapy with antiandrogens micturitional symptomatology improved, tumor size was reduced, and exophthalmos disappeared. The case described herein is not the first case of this type of metastatic lesion reported in the literature; 28 cases have been reported to date. This uncommon clinical presentation with extraurological manifestations gives us an idea of the broad clinical spectrum the biological behaviour of this tumor type can adopt.