P3211 - When Cancer Takes a Flight: A Rare Case of Rectal Adenocarcinoma Metastasizing to the Orbit

Anirudh R. Damughatla, DO¹, Saivaishnavi Kamatham, MD¹, Pragna Koleti, MD², Astha Saini, DO¹, Vanessa Milan-Ortiz, MD¹, Jasdeep Bathla, DO¹, Adam M. Qazi, MBBS, MD¹, Sahalia Rashid, MD, PhD¹, Sudhir Reddy. Pasham, MD³, Saisree Reddy Adla Jala, MD⁴, Kirthi Lilley, MD¹, Mohammed Najeeb Al Hallak, MD, MS^5
1Wayne State University School of Medicine / Detroit Medical Center, Detroit, MI; ²Suburban Community Hospital, Norristown, PA; ³Guthrie Robert Packer Hospital, Sayre, PA; ⁴Centinela Hospital Medical Center, Los Angeles, CA; ⁵Karmanos Cancer Institute, Detroit, MI

Introduction: Colorectal cancer often metastasizes to the liver, lungs, and lymph nodes. Orbital metastasis from colorectal cancer is extremely rare, with only 10 cases reported in the literature across the globe. Here, we report a young patient with metastasis to the eye as an initial presentation for metastatic rectal cancer.

Case Description/Methods: A 42-year-old male with HTN & treated Hepatitis C presented to PCP with right eye pain. Initially treated with antibiotics for suspected sinusitis but with no improvement he was referred to ENT, where he had a CT scan of the sinuses that showed right eye muscle thickening. He was then treated with steroids which did not help the right eye pain. MRI of the orbits was done, which showed a 1.8 cm mass in his medial rectus muscle of the right eye (figure 1). Biopsy by Ophthalmology showed pathology consistent with adenocarcinoma of the colon with immunohistochemical stains (CK 7 -, CK 20 +, TTF1 -, P40 -, CDX-2 +, & SATB-2 focal scattered + cells) confirming colonic primary. He was referred to medical oncology for further evaluation, where a PET scan showed an FDG avid mass in the rectum consistent with primary rectal cancer. In addition, a few other metastases were seen, including a nodule in right lung, hypodense lesion in the liver, left perirectal lymph node, and paraspinal muscle to the left of L2. He was started on chemotherapy using a FOLFOXIRI regimen and had a resection of his right eye medial rectus mass to prevent vision loss. Germline genetic testing showed a variant of unknown significance in the ATM gene, and his father had a history of liver cancer. He completed 12 cycles of FOLFOXIRI, followed by a restaging scan that showed a mild increase in disease activity; he was then followed by maintenance therapy with Capecitabine and radiation therapy to the rectal lesion. The patient was enrolled in phase one clinical trial and received one dose after which he presented with a new complaint of left eye pain. Imaging confirmed disease progression with new diffuse multiorgan metastatic involvement. More recently patient was started on FOLFOX therapy and is under oncology care.

Discussion: This case presents a rare instance of rectal cancer metastasizing to the rectus muscle of the eye. It is imperative that physicians do consider a broad range of differentials when approaching unusual presentations of common medical conditions. In such cases, an accurate early diagnosis is pivotal to optimize management and improve outcomes to prevent future complications.



Disclosures:


Anirudh R. Damughatla, DO¹, Saivaishnavi Kamatham, MD¹, Pragna Koleti, MD², Astha Saini, DO¹, Vanessa Milan-Ortiz, MD¹, Jasdeep Bathla, DO¹, Adam M. Qazi, MBBS, MD¹, Sahalia Rashid, MD, PhD¹, Sudhir Reddy. Pasham, MD³, Saisree Reddy Adla Jala, MD⁴, Kirthi Lilley, MD¹, Mohammed Najeeb Al Hallak, MD, MS⁵. P3211 - When Cancer Takes a Flight: A Rare Case of Rectal Adenocarcinoma Metastasizing to the Orbit, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.