Left Orbital Metastasis as the First Clinical Manifestation of Lung Adenocarcinoma

Lung adenocarcinoma is the most common sub type of lung cancer that metastasis to other site. Orbital metastasis from primary lung tumor is a rare entity, with incidence approximately 7 %. The rareness of presentations would invariably lead to a delay in the correct diagnosis, thereby increasing the risk of loss of vision, which decreases patients quality of life. Herein, we report a case, a 64 years old man who presented with left orbital swelling, pain, and blur of vision and was firstly diagnosed with glaucoma. In the next visit to hospital, patient had chest pain, cough, low back pain, tingling and weakness in his both lower extremities. Detailed examination and investigations revealed a mass in the right lung and left retro bulbar that metastasis to brain, liver, costae, and vertebrae. The patient had left orbital exenteration and microscopic examination found the tumor consists of proliferation of neoplastic cells with cribriform and tubular pattern infiltrating the choroid and retina. We also found the neoplastic cells infiltrate to intraneural and intravassa. This patient had mutation epidermal growth factor receptor (EGFR), deletions in exon 19. The patient had a targeted therapy with tyrosine kinase inhibitor (gefitinib).