Título

METASTATIC MUCOEPIDERMOID CARCINOMA OF THE ORBIT

Objetivo

To report a rare case of metastatic mucoepidermoid carcinoma of the orbit following a high-grade mucoepidermoid carcinoma of the contralateral parotid gland.

Relato do Caso

A 21-year-old female patient presented with blurred vision and proptosis in the right eye (OD). Past medical history included high-rade mucoepidermoid carcinoma of the contralateral parotid gland three years ago. His visual acuity was 20/20 both eyes. The Ishihara test revealed total absence of color perception OD and normal color perception in the left eye (OS). The Hertel exophthalmometry was 20 mm OD and 17 mm OS. Afferent pupillary defect was observed in the OD. Computed tomographic scans and magnetic resonance imaging showed an intraconal, oval-shaped and heterogeneous mass with ill-defined margins in the right orbit. The patient underwent lateral orbitotomy with excisional biopsy and surgical debulking. Histologic examination revealed high-grade mucoepidermoid carcinoma with perineural infiltration, angiolymphatic invasion, mitotic activity of 5/10 high power field, and necrosis. Immunohistochemical profile was positive for p63, Muc-5AC, Muc-2, Ki-67 (20%), cytokeratin 5, cytokeratin 7, AE1/AE3 and D2-40. The patient underwent orbital exenteration and has remained free of disease after twelve-month follow-up.

Conclusão

The ocular adnexa involvement with mucoepidermoid carcinoma is rare and includes the eyelids, the conjunctiva, the lacrimal drainage system, and the lacrimal gland. The D2-40 Immunohistochemical Markers positivity suggests lymphatic metastasis. Ophthalmologists and pathologists must remember that the orbit can be affected with metastatic high-grade tumor, such as mucoepidermoid carcinoma.