전이안와종양의 임상양상 = Clinical Characteristics of Metastatic Orbital Tumors: Our Experience with 27 Cases

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the clinical characteristics of metastatic orbital tumors.
Methods: The medical records of patients who were diagnosed with metastatic orbital tumors at Asan Medical Center, Seoul, Republic of Korea, from May 2010 to May 2017, were retrospectively reviewed.
Results: A total of 27 patients were studied, including 14 (51.9%) males. The mean age at diagnosis was 54.1 years and the mean follow-up period was 12.7 months. The most common primary tumor site was the breast (six patients, 46.2%) in females and the liver (five patients, 35.7%) in males. Proptosis (12 patients, 44.4%) was the most common complaint, with the other complaints including periorbital swelling, palpable masses and diplopia. Orbital imaging studies showed that the most common sites of orbital involvement were the orbital wall (nine patients, 33.3%) and the extraocular muscle (nine patients, 33.3%). Pathological diagnoses were performed in 10 patients (37.0%), 3 of these whom underwent a fine needle aspiration biopsy for intraconal lesions. Local and systemic therapies were conducted using a multidisciplinary approach, but the size of orbital tumors increased in 12 (44.4%) of 27 patients. Eight (29.6%) patients died because of systemic metastasis, seven (25.9%) patients were referred to other institutions for palliative treatment, and five (18.5%) patients showed malignant progression despite treatment.
Conclusions: Based on the varying clinical features of metastatic orbital tumors, it is important to carefully diagnose patients, especially those with a history of cancer. Breast cancer is the most common primary cancer, and liver cancer is also common because of the high prevalence of hepatocellular carcinoma in the Republic of Korea. Clinical diagnosis may be possible using patient history and/or imaging study data, but pathological confirmation may be necessary in some cases. The treatment options can be determined by the type of primary cancer and the general condition, but the overall prognosis is poor.

국문 초록 (Abstract)

목적: 저자들이 경험한 전이안와종양의 임상적 양상에 대해 알아보고자 하였다.
대상과 방법: 2010년 5월부터 2017년 5월까지 서울아산병원 안과에 내원하여 전이안와종양으로 진단받은 환자 27명의 의무기록을 후향적으로 분석하였다.
결과: 전체 27명 중 남자는 14명(51.9%)이었고 진단 당시 평균 나이는 54.1세였으며 평균 추적 관찰 기간은 12.7개월이었다. 전이안와종양의 가장 흔한 원발 병소는 여성에서는 유방(6명, 46.2%), 남성의 경우 간(5명, 35.7%)이었다. 초진 시 주소로는 안구돌출(12명, 44.4%)이 가장 흔하였고, 안와주위 부종, 촉지되는 종괴, 복시 등의 증상을 호소하였다. 영상검사를 통해 전이안와종양의 침범 범위를 확인하였을 때, 침범된 안와 구조물 중 안와벽과 외안근이 각각 9명(33.3%)으로 가장 흔하였고 시신경 침범이 1명(3.7%) 있었다. 병리학적 진단은 총 10명(37.0%)에서 시행되었고, 그중 3명은 안와원뿔 내에 위치한 병변에 대해 세침흡인생검을 시행 받았다. 전이안와종양 진단 후 다학제적 접근을 통해 치료가 진행되었으나 전체 27명 중 12명(44.4%)은 안와종양의 크기가 더욱 커졌다. 전신적 예후에서는 8명(29.6%)이 원발암의 전신적 전이에 의해 사망하였으며, 7명(25.9%)은 완화치료를 위해 타 기관으로 전원되었고, 5명(18.5%) 은 치료에도 불구하고 진행하는 경과를 보였다.
결론: 전이안와종양은 다양한 임상양상으로 나타날 수 있으므로 그 가능성을 염두에 두고 의심하는 것이 중요하다. 유방이 가장 흔한 원발 병소였고 간암과 같이 국내에서 비교적 유병률이 높은 원발암에 대해서도 전이안와종양의 빈도가 높은 것으로 나타났다. 환자의 병력과 임상양상, 영상검사 소견들을 종합하여 임상적 진단이 가능한 경우가 많지만 감별진단이 어려울 경우 병리학적 진단이 필요할 수 있다. 원발암의 종류와 다른 침범 부위를 포함한 전신적인 상태 등에 따라 치료 방침을 결정하게 되지만 전반적인 예후는 나쁜 편으로 평가된다.

참고문헌 (Reference)

1 사호석, "세침 흡인 생검을 이용한 안와 후반부 종양의 진단" 대한안과학회 46 (46): 1435-1440, 2005

2 Gupta S, "Unilateral orbital pain and eyelid swelling in a 46-year-old woman: orbital metastasis of occult invasive lobular carcinoma of breast masquerading orbital pseudotumour" 2011 : 2011

3 Goldberg RA, "Tumors metastatic to the orbit: a changing picture" 35 : 1-24, 1990

4 Shields CL, "Tumors metastatic to the orbit" 4 : 73-80, 1988

5 Albert DM, "Tumor metastasis to the eye. I. Incidence in 213 adult patients with generalized malignancy" 63 : 723-726, 1967

6 Chong VF, "The orbits in cancer imaging" 6 : S27-S31, 2006

7 Bloch RS, "The incidence of ocular metastatic carcinoma" 85 : 673-675, 1971

8 Shields JA, "Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery Lecture, part 1" 111 : 997-1008, 2004

9 Finger PT, "Radiation therapy for orbital tumors: concepts, current use, and ophthalmic radiation side effects" 54 : 545-568, 2009

10 Shikishima K, "Pathological evaluation of orbital tumours in Japan: analysis of a large case series and 1379 cases reported in the Japanese literature" 34 : 239-244, 2006

11 Valenzuela AA, "Orbital metastasis: clinical features, management and outcome" 28 : 153-159, 2009

12 Papathanassiou M, "Orbital metastasis secondary to breast cancer mimicking thyroid-associated ophthalmopathy" 93 : 368-369, 2010

13 Tomizawa Y, "Orbital metastasis as the initial presentation of invasive lobular carcinoma of breast" 51 : 1635-1638, 2012

14 Civit T, "Orbital metastasis" 56 : 148-151, 2010

15 Oberg K, "Neuroendocrine bronchial and thymic tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up" 23 (23): vii120-vii123, 2012

16 Tijl J, "Metastatic tumors to the orbit--management and prognosis" 230 : 527-530, 1992

17 Ahmad SM, "Metastatic tumors of the orbit and ocular adnexa" 18 : 405-413, 2007

18 Yan J, "Metastatic orbital tumors in southern China during an 18-year period" 249 : 1387-1393, 2011

19 Gunalp I, "Metastatic orbital tumors" 39 : 65-70, 1995

20 Kennerdell JS, "Fine-needle aspiration biopsy. Its use in orbital tumors" 97 : 1315-1317, 1979

21 Goldberg RA, "Clinical characteristics of metastatic orbital tumors" 97 : 620-624, 1990

22 Kong BD, "Clinical analysis of metastatic intraocular malignancy" 40 : 2928-2934, 1999

23 Font RL, "Carcinoma metastatic to the eye and orbit III. A clinicopathologic study of 28 cases metastatic to the orbit" 38 : 1326-1335, 1976

24 Shields JA, "Cancer metastatic to the orbit: the 2000 Robert M. Curts Lecture" 17 : 346-354, 2001

25 Green S, "Bilateral orbital metastases from prostate carcinoma: case presentation and CT findings" 16 : 417-419, 1995

26 Abbruzzese JL, "Analysis of a diagnostic strategy for patients with suspected tumors of unknown origin" 13 : 2094-2103, 1995