Metastatic gastric cancer with suspected spread to an extraocular muscle

What happened, in summary

A 54-year-old Japanese woman had been diagnosed 2 years earlier with poorly differentiated gastric adenocarcinoma that had already spread to the ovary and mesentery. She received 4 chemotherapy regimens, but the cancer continued to progress and her care became palliative. By 3 months before the featured eye problem, metastatic disease was also present in the subcutaneous tissue of her neck and thoracic bone marrow.

She then developed sudden left-eye swelling, protrusion, double vision and pain. CT showed marked enlargement of the left medial rectus muscle. Earlier scans showed that the muscle had been enlarging over several months, while the other orbital tissues remained normal. In the setting of her advanced gastric cancer, spread to the extraocular muscle was considered highly likely, although it was not pathologically confirmed.

Palliative radiation was delivered to the left orbit. Within days, the swelling, redness and pain improved, and the eye protrusion decreased over the following weeks. The treatment helped preserve comfort and quality of life despite the advanced cancer. She died 3 months after her first ophthalmology visit, more than 2 years after the original gastric-cancer diagnosis.