A Rapidly Progressive Proptosis, a Case Report
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39
via the cavernous sinus into the apex causing proptosis
and muscle paralysis. [2] less commonly, the direct
spread may be via the nasolacrimal duct and in such
cases epiphora is common [6].
The relationship between NPC and Epstein-Barr virus
was first observed in 1966 , when the sera of patients with
the cancer were found to show precipitating antibodies
against cells infected with the virus [7]. Later studies
revealed elevated levels of IgG and IgA antibodies di-
rected against components of Epstein-Barr virus in pa-
tients with NPC [8]. The high antibody titres to EBV
antigens in NPC patients can serve as a marker for the
diagnosis of NPC especially if the patients have signs of
NPC but no NPC is seen during endoscopic examination.
However, elevated EBV titers may also be associated
with other disease entities, such as sinonasal undifferen-
tiated carcinoma (SNUC), sinonasal lymphoma, and
tongue cancer.(MAL) Circulating EBV-DNA has been
shown to improve prognostication and monitoring of
NPC patients [9] .
Orbital metastases, even with newer diagnostic tech-
niques can be difficult to diagnose. [10] in a study,
showed that either CT or MRI provide essential info rma-
tion in documen ting orbital invasion and de termining the
pathway of tumor spre ad [11].
An immunohistochemical panel of poorly differenti-
ated orbital metastases is helpful in the identification of
the primary tumor site. In a study, Immunohistochemis-
try was performed to detect cytokeratin (CK) 7, CK 20,
thyroid transcription factor-1 (TTF-1), BRST1, BRST2,
carcinoembryonic antigen (CEA) and prostate-specific
antigen (PSA) in seven cases of poorly differentiated
orbital metastases. And the association of seven markers
with the patient’s clinical histor y allowed for the positive
identification of the primary tumor in the majority of
these cases [12].
The aim in treating orbital metastases is to relieve dis-
comfort. Radiotherapy is the mainstay treatment for the
disease [9]. Surgical removal of the mass is not recom-
mended. Prognosis is poor, because these patients are
usually at an advanced stage of the disease. In one report,
the median survival time was 1.3 years, and the two-year
survival rate is 27% [13].
3. Conclusions
Although NPC, rarely metastases to the orbit, but should
be considered in every rapidly progressing proptosis,
especially in elderly.
Imaging and immunohistochemichal panel can be
helpful in differentiating and rule out of other diagnoses.
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