Case Report: Primary Squamous Cell Carcinoma of the Orbit in a patient
with Carney’s syndrome treated with multidisciplinary approaches
Abstract
Introduction: Squamous cell carcinoma (SCC) is a rare
malignancy of invasive epithelium with keratinocyte differentiation, and
it is the most common form of eyelid malignant neoplasm, comprising
5-10% of malignancies. While SCC rarely affects the orbit, it may be
involved through local invasion from a cutaneous primary site or
extension by perineural invasion. Only 11 cases of primary orbital SCC
have been reported until now. Here, we present a case of primary
carcinoma of the right orbit with coexisting Carney’s syndrome, a rare
genetic disorder associated with multiple endocrine neoplasias (MEN)
syndromes. Case: A 62-year-old south Asian male presented with
a painful swelling in the lateral aspect of the right eyebrow and
protrusion of the eyeball in August 2020. He had a history of excision
of Right atrial Myxoma in March 2020. Orbital computerized Tomography
(CT) and Positron Emission Tomography (PET-CT) scans revealed an
enhancing soft tissue lesion in the right orbit with involvement of
frontal and ethmoid sinuses. Biopsy confirmed HPV related poorly
differentiated squamous cell carcinoma, positive for HPV-related
markers. The patient received concurrent chemo irradiation with
Cisplatin. Follow-up done PET-CT done 3 months later showed a new lesion
appeared in the right orbital region and right lobe of thyroid. Later
had surgical excision and total thyroidectomy and Histopathological
examination (HPE) from orbit was reported as invasive SCC and from the
thyroid was reported as synchronous papillary thyroid cancer. The
patient’s proptosis resolved, and subsequent PET-CT and Magnetic
Resonance Imaging (MRI) scans did not show any residual or recurrent
disease. Conclusion: Primary SCC of the orbit is an extremely
rare disease, and this case report presents the 12th reported case and
the first one associated with Carney’s syndrome. As there is no standard
treatment regimen for primary SCC of the orbit, this case highlights the
use of multimodality treatment, including surgical excision and chemo
irradiation. The findings emphasize the importance of early detection
and management of this uncommon and life-threatening condition,
providing hope for patients and aiding in the prevention of recurrence.