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Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report
INTRODUCTION: Orbital metastases of lung cancer are rare. However, because the number of patients diagnosed with lung cancer is increasing, the probability that a physician will see a patient with an orbital metastasis is also increasing. Unfortunately, the clinical course and response of these pati...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543340/ https://www.ncbi.nlm.nih.gov/pubmed/23079208 http://dx.doi.org/10.1186/1752-1947-6-353 |
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author | Koma, Yasuko Goto, Keiko Yoshida, Chihiro Kimura, Kengo Matsumoto, Yusuke Koyama, Midori Nakashima, Nariyasu Masuya, Daiki Matsuoka, Hirofumi Yoshimatsu, Harukazu Azumi, Atsushi Suzuki, Yujiro |
author_facet | Koma, Yasuko Goto, Keiko Yoshida, Chihiro Kimura, Kengo Matsumoto, Yusuke Koyama, Midori Nakashima, Nariyasu Masuya, Daiki Matsuoka, Hirofumi Yoshimatsu, Harukazu Azumi, Atsushi Suzuki, Yujiro |
author_sort | Koma, Yasuko |
collection | PubMed |
description | INTRODUCTION: Orbital metastases of lung cancer are rare. However, because the number of patients diagnosed with lung cancer is increasing, the probability that a physician will see a patient with an orbital metastasis is also increasing. Unfortunately, the clinical course and response of these patients to cytotoxic chemotherapy are generally poor and keeping a patient’s quality of vision is difficult. In recent years, gefitinib, an epidermal growth factor receptor tyrosine kinase inhibitor, has brightened the outlook for patients with advanced non-small cell lung cancer, especially for those who carry epidermal growth factor receptor-activating mutations. CASE PRESENTATION: A 62-year-old Japanese man presented with swelling of the eyelid margin and ptosis of his right eye. A physical examination revealed double vision in his right eye and an alteration in elevator muscle mobility. A magnetic resonance image demonstrated a right intra-orbital mass (18 × 16mm). Screening examinations were carried out because this mass was suspected to be a metastasis from another organ. Chest computed tomography revealed a 42 × 37mm mass shadow on the left side of the hilum with mediastinal lymph node metastases. Adenocarcinoma with an epidermal growth factor receptor gene mutation (exon 19 deletion L747-E749; A750P) was detected in a transbronchial biopsy specimen; the patient was diagnosed with stage IV (T2N2M1) non-small cell lung cancer. Gefitinib (250mg/day) was chosen as first-line chemotherapy because there was no pre-existing interstitial shadow. After two months of treatment, the patient’s right eye opened completely and follow-up magnetic resonance imaging revealed a marked reduction of the intra-orbital mass to 14 × 13mm. Three months after treatment initiation, a follow-up computed tomography showed a marked reduction in the size of the primary lesion to 23 × 20mm. The patient is continuing gefitinib treatment without any adverse effects noted on computed tomography, physical, or laboratory examination. CONCLUSIONS: We report the case of a patient with an orbital non-small cell lung cancer metastasis with epidermal growth factor receptor-activating mutations. This metastasis, as well as the primary lesion, showed a marked response to the molecular targeting drug gefitinib, and the patient’s vision was kept without an invasive procedure. Gefitinib may be a good first choice for patients with orbital non-small cell lung cancer metastasis harboring epidermal growth factor receptor-activating mutations. |
format | Online Article Text |
id | pubmed-3543340 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-35433402013-01-14 Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report Koma, Yasuko Goto, Keiko Yoshida, Chihiro Kimura, Kengo Matsumoto, Yusuke Koyama, Midori Nakashima, Nariyasu Masuya, Daiki Matsuoka, Hirofumi Yoshimatsu, Harukazu Azumi, Atsushi Suzuki, Yujiro J Med Case Rep Case Report INTRODUCTION: Orbital metastases of lung cancer are rare. However, because the number of patients diagnosed with lung cancer is increasing, the probability that a physician will see a patient with an orbital metastasis is also increasing. Unfortunately, the clinical course and response of these patients to cytotoxic chemotherapy are generally poor and keeping a patient’s quality of vision is difficult. In recent years, gefitinib, an epidermal growth factor receptor tyrosine kinase inhibitor, has brightened the outlook for patients with advanced non-small cell lung cancer, especially for those who carry epidermal growth factor receptor-activating mutations. CASE PRESENTATION: A 62-year-old Japanese man presented with swelling of the eyelid margin and ptosis of his right eye. A physical examination revealed double vision in his right eye and an alteration in elevator muscle mobility. A magnetic resonance image demonstrated a right intra-orbital mass (18 × 16mm). Screening examinations were carried out because this mass was suspected to be a metastasis from another organ. Chest computed tomography revealed a 42 × 37mm mass shadow on the left side of the hilum with mediastinal lymph node metastases. Adenocarcinoma with an epidermal growth factor receptor gene mutation (exon 19 deletion L747-E749; A750P) was detected in a transbronchial biopsy specimen; the patient was diagnosed with stage IV (T2N2M1) non-small cell lung cancer. Gefitinib (250mg/day) was chosen as first-line chemotherapy because there was no pre-existing interstitial shadow. After two months of treatment, the patient’s right eye opened completely and follow-up magnetic resonance imaging revealed a marked reduction of the intra-orbital mass to 14 × 13mm. Three months after treatment initiation, a follow-up computed tomography showed a marked reduction in the size of the primary lesion to 23 × 20mm. The patient is continuing gefitinib treatment without any adverse effects noted on computed tomography, physical, or laboratory examination. CONCLUSIONS: We report the case of a patient with an orbital non-small cell lung cancer metastasis with epidermal growth factor receptor-activating mutations. This metastasis, as well as the primary lesion, showed a marked response to the molecular targeting drug gefitinib, and the patient’s vision was kept without an invasive procedure. Gefitinib may be a good first choice for patients with orbital non-small cell lung cancer metastasis harboring epidermal growth factor receptor-activating mutations. BioMed Central 2012-10-18 /pmc/articles/PMC3543340/ /pubmed/23079208 http://dx.doi.org/10.1186/1752-1947-6-353 Text en Copyright ©2012 Koma et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Koma, Yasuko Goto, Keiko Yoshida, Chihiro Kimura, Kengo Matsumoto, Yusuke Koyama, Midori Nakashima, Nariyasu Masuya, Daiki Matsuoka, Hirofumi Yoshimatsu, Harukazu Azumi, Atsushi Suzuki, Yujiro Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report |
title | Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report |
title_full | Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report |
title_fullStr | Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report |
title_full_unstemmed | Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report |
title_short | Orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report |
title_sort | orbital metastasis secondary to pulmonary adenocarcinoma treated with gefitinib: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543340/ https://www.ncbi.nlm.nih.gov/pubmed/23079208 http://dx.doi.org/10.1186/1752-1947-6-353 |
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