Critical diagnostic delay associated with unusual presentation of hepatocellular carcinoma (HCC) with orbital metastases: a case report

: Orbital metastases are an extremely rare finding in patients with hepatocarcinoma (HCC), especially as its first presentation. Therefore, the risk of misdiagnosis is high, well that drastic delays therapeutic algorithm. Here we report a 71-year-old man presenting orbital initial sign HCC, whose led to impossibility start life-saving cancer treatment. The patient’s history has begun on March 2018 growing tumefaction right orbit initially treted antibiotics and corticosteroids without benefit. Subsequently, facial CT scan showed voluminous intra-orbital mass, eroding roof. Tissue biopsy documented differentiated malignant epithelial tumor cells. Under suspect primitive lachrymal gland tumor, patient was admitted head neck Unit surgical intent. However, subsequent 18F-FDG-PET presence liver lesions multiple sites metastasis. A new biopsy, this time nodules, carried out diagnosis HCC finally made. Samples from were then reviewed judged consistent Unfortunately, resulted six-month delay approach. During time, general conditions got worse, making him unable afford antiblastic died three months after definitive diagnosis. This case suggests intraorbital lesion requires multimodal approach starting Performing complete staging since tumor’s clinical onset mandatory, preferably before carrying tissue biopsy. Even though represents cause intraocular metastasis, it needs be ruled when mass documented, short median survival frequently poor make timely crucial.