Imaging of an orbital metastasis of a small-interstinal carcinoid by meansof octreotide scintigraphy. A critical evaluation of the methodalogy

Background: An orbital carcinoid metastasis can be specifically imaged by o ctreotide scintigraphy. Orbital metastases of carcinoid tumors are rare. In the current literature only 27 cases have been published. Case report: We report on a 59 year-old woman who presented with diplopia 6 years after resection of a carcinoid tumor of the ileum. She also complain ed about flush and diarrhea. The diplopia was caused by limited extensibili ty of the right inferior muscle. Computed tomography with contrast revealed an enhancing tumor in the area of the right inferior rectus muscle,which a ppeared in the MRT as an isointense structure in the T1-weighted image. On staging, we found a contrast-enhancing nodular hepatic lesion. In octreotid e scintigraphy, enhancement of the liver, thoracic and abdominal para-aorti c lymph nodes and of the right inferior orbit was found. Conclusion: The survival times of patients with orbital metastasis of carci noid tumors range between 7 months and 11 years. No specific treatment is a vailable. Surgical excision is indicated for a symptomatic solitary metasta sis. Octreotide is helpful in two ways: (1) as a radiolabeled tracer to det ect extraabdominal and extrahepatic secondary tumors; (2) as a treatment mo dality for flush and diarrhea,which is successful in over 60% of patients ( life expectancy uninfluenced). Our patient is presently being treated with 200 mu g of octreotide three times a day subcutaneously. Flush episodes and diarrhea have been reduced, but her ophthalmologic symptoms remain unchang ed,and she has recently developed cardiac insufficiency.