Metastatic Adenocarcinoma Presenting as an Orbital Mass with Orbital Apex Involvement: Application of Immunohistochemistry in Diagnostic Ophthalmic Pathology

Abstract

Objective: To report a case of orbital apex syndrome due to metastatic adenocarcinoma of the orbit in an adult male.

Methods: This is a case report.

Results: A 52-year-old male presented with a subacute onset of ophthalmoplegia, ptosis, and vision loss secondary to an optic neuropathy. Orbital apex syndrome was the primary consideration. Laboratory workup ruled out infectious and inflammatory etiologies. Neuroimaging revealed an irregular, intraconal mass in the left orbit. During the disease course, a new supraorbital mass lesion was noted. Incisional biopsy, histopathology and immunohistochemistry (IHC) revealed positive Cytokeratin 7 and negative Cytokeratin 20 expression, suggestive of metastatic adenocarcinoma.

Conclusion: Diagnosis of orbital apex syndrome requires careful integration of clinical evaluation, laboratory testing, and imaging. When a mass lesion is present, biopsy and IHC staining can be critical in determining the primary origin of a malignancy.