PMC6091225_01
A. left proptosis and redness in her left eye. B&C. The orbital CT scan showed a soft tissue tumor in the fronto-naso-superomedial region of the left orbital with suspicion of infiltration of medialis rectus muscle, left bulbus oculi, lamina papyracea, and left frontal sinus wall which causes proptosis and a soft tissue tumor in the left temporal region with suspicion of infiltration of the left sphenoid wing may still be a metastasis.
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Ophthalmic examination of the left eye showed visual acuity of no light perception, protruding eyeball (Fig. 1A), corneal opacity, conjunctiva bulbi: chemosis, camera oculi anterior: pupil, iris, and lens which could not be identified. A physical examination found a decreasing visual acuity, left proptosis (Fig. 1A). The orbital CT scan showed a soft tissue tumor in the fronto-naso-superomedial area of the left orbital with suspicion of infiltration of medialis rectus muscle, left bulbus oculi, lamina papyracea, and left frontal sinus wall which causes proptosis and soft tissue tumor in the left temporal region with suspicion of infiltration in the left sphenoid wing may still be a metastasis (Fig. 1B and C).
A. The chest CT scan showed isodense mass with a relatively firm limit lobulated with solid and half solid components and had a size of +-7 x 4 x 5 cm in the 4th, 5th, 8th segment of the left lung. Half of the mass edge was seen attached to the left pleural wall in which the pleural tail was attached to the pericardium while the other half was seen attached to the large blood vessel. Multiple nodules with a diameter of +-1.1 cm were seen in the 4th, 5th, 8th segment of the right lung. There was a minimal pleural effusion in the left lung. B. A fine needle aspiration biopsy (FNAB) was done in the enlargement of supraclavicular lymph nodes, temporal, and intra-orbital region, and the same result was found namely metastatic adenocarcinoma.
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There was also an image of ground glass opacity in both lungs, especially in the right lung (Fig. 2A). All specimens showed metastatic adenocarcinoma with cell-tumor clusters, a group of palisaded columnar cells, and rosette/acinus-like structures (Fig. 2B).