Metastatic Disease In The Orbit

Metastatic tumors constitute approximately 3% of all orbital diseases and 10% of orbital neoplasms in most series.23'34-36 The prevalence of ocular and orbital metastasis in patients with cancer varies from 0.7 to 12%, depending on whether the analysis was clinical or performed in autopsy series.37-39 The frequency of the site of origin parallels the general incidence of tumors.40 The most frequent primary organs are breast in women, and lung and prostate in men, and cutaneous melanoma. However, metastases from a large variety of tumors have been reported to occur in the orbit (Table 4.2).23

Ocular and adnexal metastasis in children occurs almost exclusively in the orbit.41 Metastastic tumors of the orbit in children include neuroblastoma, mainly from an abdominal intra-adrenal primary lesion; Ew-ing sarcoma originating in long bones; and Wilms tumor, an embryonal growth of the kidney.42,43 In half of the cases, metastastic neuroblastoma affects both orbits, with compromise of the temporal orbit and adjacent bone and periosteum, resulting in bilateral periorbital hematomas.39

The spatial and tissue location of metastasis within the orbit is variable. Frequency analysis suggests that tumors from different primary sites tend to metastasize predominantly within certain tissues of the orbit. The orbit is bordered by bone and contains fat and muscle tissues. Melanoma has a strong tendency to metastasize muscle (41-76% of the cases), whereas thyroid and prostate carcinomas metastasize bone.23 Breast carcinoma usually metastasizes fat and

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