Abstract ID: 26-436
Colorectal Carcinoma Presenting as Sphenoid Wing Metastasis Mimicking Orbital Cellulitis
Author: Iman Daoud Base Hospital / Institution: Leicester university hospitals
Presentation Type: ePoster Presentation
Purpose
To report an exceptionally rare case of colorectal carcinoma presenting as sphenoid wing metastasis mimicking orbital cellulitis.
Methods
A 44-year-old man presented with acute right periorbital swelling, pain, diplopia, and painful eye movements. Examination demonstrated mild proptosis, chemosis, and restricted ocular motility. Orbital cellulitis was initially diagnosed and intravenous antibiotics commenced. CT and MRI revealed periosteal reaction and intraosseous involvement of the greater wing of the sphenoid with orbital and limited intracranial extension. In view of atypical imaging findings, normal inflammatory markers, and absence of sinus disease, urgent systemic staging was performed.
Results
CT and PET-CT demonstrated extensive metastatic disease involving the skull base, lungs, liver, adrenal gland, and bone, with a hypermetabolic rectal primary lesion. Colonoscopic biopsy confirmed moderately differentiated colorectal adenocarcinoma. The patient underwent diverting colostomy, systemic chemotherapy, and palliative orbital radiotherapy. Orbital metastases from colorectal carcinoma are rare, with fewer than 20 reported cases. Sphenoid wing involvement is exceptionally uncommon, with only two previously reported cases, both similarly presenting as orbital cellulitis.
Conclusion
Sphenoid wing metastasis from colorectal carcinoma may closely mimic orbital cellulitis, risking delayed oncologic diagnosis. Focal bony involvement, normal inflammatory markers, and absence of sinus disease should prompt suspicion for malignancy. To our knowledge, this represents only the third reported case of colorectal carcinoma metastatic to the sphenoid wing presenting in this manner, underscoring the importance of early imaging and systemic investigation in atypical orbital inflammatory presentations.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Vincent | Lam | Leicester University Hospitals |
| Mario | Farrugia | Leicester university hospitals |
| Raghavan | Sampath | Leicester University hospitals |