Orbital metastases from malignant mesothelioma

Our plain-English summary of Orbital metastases from malignant mesothelioma, by I. Mian, E. Padiernos, R. Hassan, et al (The Lancet. Oncology, 2020).

The study

• Authors: I. Mian, E. Padiernos, R. Hassan, A. Ghafoor
• Journal: The Lancet. Oncology
• Published: 2020;21(2):e117
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This short case report describes one patient, so it shows what happened to one person, not how often this occurs. A 74-year-old man with unresectable right-sided malignant pleural mesothelioma, epithelioid type, diagnosed 18 months earlier, came to the National Cancer Institute clinic in Bethesda, Maryland, USA, in February 2019. He had sudden blurry vision and double vision that had worsened over 2 weeks. His disease had progressed despite carboplatin and pemetrexed chemotherapy. He had also received ipilimumab and nivolumab, and for 2 months had been taking a clinical trial study drug (a PARP inhibitor). MRI showed a 3.7 × 1.8 cm mass in the left eye socket that encased the left optic nerve. After emergency surgery, tissue from the mass confirmed epithelioid mesothelioma. Remaining tumour was irradiated (reported as 5 Gy over 5 days), and his vision improved within 4 weeks. He then started gemcitabine and was still on treatment at 5 months. The authors noted that orbital metastases are very uncommon in mesothelioma. The article does not mention asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (Lancet Oncology 'Clinical Picture' item describing a single patient)
• Who was studied: One 74-year-old man with unresectable right-sided malignant pleural mesothelioma, epithelioid type, diagnosed 18 months earlier. He was seen at the thoracic oncology clinic of the Clinical Center of the National Cancer Institute, Bethesda, MD, USA, in February 2019. At the time he was taking part in a phase 2 clinical trial of a PARP inhibitor.
• Exposure: The article does not report any asbestos exposure, fiber type or occupational history for the patient.
• Main results:
  • The patient presented with acute-onset blurry vision and diplopia (double vision) that had worsened over the previous 2 weeks.
  • Before this, his pleural disease had progressed despite six cycles of carboplatin and pemetrexed. He had also received ipilimumab and nivolumab 3 months earlier, and had been on the trial study drug for 2 months.
  • MRI of the orbits showed a 3.7 × 1.8 cm left orbital mass within the inferior rectus muscle that encased the left optic nerve.
  • He had emergency cytoreductive eye surgery (orbitotomy) to save the optic nerve. Pathology of the mass confirmed epithelioid mesothelioma (keratin AE1/AE3 positive, WT1 positive, CK 5/6 negative, with loss of BAP1 expression).
  • Residual tumour on the optic nerve was treated with conventional radiotherapy, reported as 5 Gy over 5 days. His vision improved within 4 weeks of treatment.
  • He then started gemcitabine and was continuing on treatment at 5 months.
• The authors' conclusion: The authors stated that orbital metastases are very uncommon in mesothelioma, with only a few reported cases. They said such metastases usually occur in very advanced disease and that affected patients have a poor prognosis. They described radiotherapy as the mainstay of treatment, with surgery to relieve symptoms and for emergencies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma.

Related studies

• Solitary fibrous tumor of the nasal cavity and orbit — M. Fukunaga, S. Ushigome, et al. (1995)
• Solitary fibrous tumour of the orbit — R. Sciot, J. Goffin, et al. (1996)
• Solitary fibrous tumor of the orbit: CT and pathologic correlation — S. Festa, H.J. Lee, et al. (1999)
• A case of malignant pleural mesothelioma with metastasis to the orbit — K. Kubota, K. Furuse, et al. (1996)
• Retroperitoneal fibrosis associated with orbital pseudotumor without evidence of IgG4: A case report with review of literature — M.T. Pérez-Sanz, E. Cervilla-Muñoz, et al. (2019)
• I feel it in my bones: a rare presentation of idiopathic sclerosing orbital inflammation with hyperostosis — S.T. Ho, M. Lakey, et al. (2013)

Browse more research in The Lancet. Oncology, or return to medical research.