Signet ring adenocarcinoma of the colon presenting
as an orbital metastasis
Charlotte R. Foster
Adam J. Cohen
Received: 26 February 2016 /Accepted: 29 June 2016 / Published online: 15 July 2016
Springer-Verlag Berlin Heidelberg 2016
Abstract A67-year-oldwomanwas referred after MRI
imaging revealed an infiltrative, diffusely enhancing left
intraconal lesion. Ophthalmic examination revealed a left
proptosis, resistance to globe retropulsion, and restriction
of extraocular motility in all fields of gaze. The result of a
biopsy via an orbitotomy was consistent with signet ring
adenocarcinoma. PET scanning was significant for lytic
vertebral and rib lesions and activity within the cecum.
Colonoscopy confirmed the diagnosis of stage 4 colonic
adenocarcinoma. Although colon carcinoma presenting as
an extraconal orbital metastasis has been reported, this is
the first reported case of signet ring adenocarcinoma of
the colon presenting as an intraconal orbital metastasis
without eyelid involvement. Orbital metastatic disease
from known primary malignancies is uncommon and in
particular from carcinomas arising from the gastrointesti-
nal tract. When metastatic orbital disease is found, studies
have reported that as high as 42 % of these patients have
an undiagnosed primary malignancy. This allows orbital
surgery to play a role detecting as yet undiagnosed
Level of Evidence: Level V, diagnostic study.
Keywords Orbit metastases
Signet ring adenocarcinoma
Orbital metastatic lesions are rare and represent 10 to 12 % of
all orbital neoplasms . It has been reported that between 35
and 42 % of patients who present with orbital metastatic le-
sions have undiagnosed primary carcinomas [1, 2]. Breast
metastases account for nearly half of all metastatic orbital
disease at 42 %, followed by the lung, and prostate .
Metastasis from the gastrointestinal neoplasia to the eye and
orbit account for approximately 4 % of total cases [3, 4].
These lesions typically are found in the superolateral quadrant
of the orbit .
We believe that this is the first case of colonic signet ring
presenting as a purely intraconal process.
A 67-year-old female was referred with a history of painless,
worsening binocular diplopia over several months. She denied
visual or color vision loss, headache, or facial paresthesias.
Her medical and surgical history included treated hyperten-
sion, hyperlipidemia, hypothyroidism, and total abdominal
hysterectomy and oophorectomy. There was no history of to-
bacco or alcohol abuse.
Examination found normal left visual and color acuities.
A left relative afferent pupil defect was present with 4 mm
of the left relative proptosis with increased resistance to
* Adam J. Cohen
St. Georges University, London, UK
Private Practice Eyelid and Facial Plastic Surgery, Glenview,
Chicago, IL, USA
Department of Ophthalmology, Rush University Medical Center,
Chicago, IL, USA
Eur J Plast Surg (2016) 39:459–462