Orbital Metastasis as the Initial Manifestation of Lung Adenocarcinoma - 18F-FDG PET-CT Findings

Sep 29, 2026

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Orbital metastases from malignant tumors are uncommon and may represent the first sign of an undiagnosed cancer, occurring in about 25% of cases. This report describes a 65-year-old patient with orbital metastasis originating from lung adenocarcinoma, initially presenting with right eye pain and reduced visual acuity that was overlooked. 18F-FDG PET/CT revealed hypermetabolism in a left lung mass and intense retro-orbital uptake, confirmed by cerebro-orbital MRI. The case highlights 18F-FDG PET/CT’s value for detecting primary malignancy when orbital metastasis is the initial manifestation.

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Abstract

Introduction

Case Report

Discussion

Article published online: 2025-04-25 360 Case Report THIEME Orbital Metastasis as the Initial Manifestation of Lung Adenocarcinoma: 18F-FDG PET-CT Findings Oueriagli Nabih Salah 1 Aboussabr Meryem 1 Ait Sahel Omar 1 Doudouh Abderrahim 1 1 Department of Nuclear Medicine, Med V Military Teaching Hospital, BP, Rabat, Morocco World J Nuclear Med 2025;24:360–362. Address for correspondence Oueriagli Nabih Salah, PhD, Department of Nuclear Medicine, Med V Military Teaching Hospital, BP 10045, Rabat, Morocco (e-mail: [Salah. nabihoueriagli@gmail.com](Salah. nabihoueriagli@gmail.com)). Abstract Keywords ► 18F-FDG ► lung adenocarcinoma ► orbital metastasis ► PET/CT Orbital metastases from malignant tumors are uncommon. In 25% of cases, they are the ﬁrst sign of an undiagnosed cancer, and they account for approximately 7 to 12% of lung cancer cases. A lack of awareness about this condition can lead to misdiagnosis, distinguishing malignant from benign lesions. We present the case of a 65-year-old patient with orbital metastasis from lung cancer. 18F-ﬂuorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was crucial in diagnosing this, revealing hypermetabolism in the left lung mass as well as intense uptake in the right retro-orbital region, which was conﬁrmed as orbital metastasis through cerebro-orbital magnetic resonance imaging. For 2 months, our patient had right eye pain and decreased visual acuity and no attention was paid to these symptoms. Through this clinical case, the authors highlight the utility of 18F-FDG PET/CT in the diagnosis of primary malignancy in lung cancer patients, who presented with orbital metastasis as the ﬁrst sign. Introduction Orbital metastases are relatively uncommon, with breast and lung cancers being the most common primary tumors, accounting for 0.7 to 12% of cases. 1,2 The choroid is the ocular tissue most frequently affected by metastatic disease, followed by the iris and ciliary body.3,4 In 25% of cases, orbital metastases represent the ﬁrst manifestation of an unknown primary carcinoma (UPC), where 18F-ﬂuorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) plays a critical role. We present a case of a patient with orbital metastasis incidentally detected by an 18F-FDG PET/CT with lung cancer. Case Report A 65-year-old male, a chronic smoker, presented with right eye pain and decreased visual acuity. Initially, this symptom article published online April 25, 2025 DOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1808247 . ISSN 1450-1147. was overlooked. Two months later, the patient developed a chronic cough with hemoptysis, diffuse bone pain, and weight loss. A whole-body CT scan revealed a left pulmonary mass measuring 32mm 􀀁 25mm, along with suspicious mediastinal lymph nodes. A biopsy of the lung mass conﬁrmed invasive, moderately differentiated adenocarcinoma, with immunohistochemical markers (TTF1þ ) and an epidermal growth factor receptor (EGFR) mutation (L858R), indicating a bronchopulmonary origin. An 18F-FDG PET/CT scan showed intense uptake in the left lung mass (maximum standardized uptake value [SUVmax] ¼6.5), multiple FDG-avid lymph nodes, and lesions in the liver, adrenal glands, and bones ( ►Fig. 1A). Notably, there was also intense and suspicious retro-orbital uptake in the right eye (SUVmax ¼ 10.5)( ►Fig. 1B and C). Ophthalmological examination revealed retinal detachment, suggestive of a tumoral origin. Magnetic resonance © 2025 . The Author(s) . This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited.([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)) Thieme Medical and Scientiﬁc Publishers Pvt. Ltd. , A-12, 2nd Floor, Sector 2, Noida-201301

FAQs

Why can orbital metastasis be mistaken for benign disease?

Orbital metastases are uncommon, and the condition may lead to misdiagnosis when awareness is limited, making malignant lesions harder to distinguish from benign ones.

What role did 18F-FDG PET/CT play in this case?

18F-FDG PET/CT was crucial, showing hypermetabolism in the left lung mass and intense uptake in the retro-orbital region, which supported the diagnosis of orbital metastasis.

How was the primary lung cancer confirmed?

A biopsy of the lung mass confirmed invasive, moderately differentiated adenocarcinoma, supported by immunohistochemical markers and an EGFR mutation (L858R).

Sep 29, 2026

Uploaded by dawugda