Orbital Metastasis from Verrucous Carcinoma of the Oral Cavity: Case Report and Review of the Literature

A rare case of metastatic verrucous carcinoma (VC) of the oral cavity is presented. The patient was referred to the Ophthalmology Department due to diplopia. The patient reported history of diagnosis of verrucous squamous carcinoma in the oral cavity occuring 6 years earlier that although excised presented several recurrences. The lesion metastasized to local lymph nodes and after being characterized as inoperable the patient underwent thirty-seven sessions of radiation therapy. Two months after completion of radiation therapy, the patient underwent an orbital CT scan that revealed a mass with morphological features consistent with secondary involvement of the orbit from the known VC. Although treated with chemotherapy, the patient died 5 months later. No other case of this entity, which usually presents as a slow-growing lesion enlarging with direct extension rather than frank invasion, metastasizing to the orbit has been reported in relevant literature. Oral verrucous carcinoma (VC) is a well defined type of well- differentiated squamous cell carcinoma, characterized by silent clinical and pathological features (1). The reported rate of VC among all types of squamous cell carcinoma is 2-9% (2-5), while it comprises approximately 3% of all primary invasive carcinomas of the oral mucosa (6). It occurs more frequently among Caucasian men between the sixth and eighth decade. Tobacco use has been shown to be a significant etiological agent for its development (7). Reported sites of origin include the skin, male and female genitalia, anal tract, uterine cervix and bladder. The majority of cases occur in the oral cavity and less frequently in the larynx (4, 8). The histological diagnosis may be difficult, especially if the biopsy specimen is small. Nevertheless, correct diagnosis is very important for the correct treatment of the patient. Lymph node and distant metastasis are rare during all stages of this tumour (1, 9). VCs present as slow-growing lesions that enlarge with direct extension rather than frank invasion. There have been observations that they tend to recur in the form of less-differentiated carcinomas (10). Our search in the literature for previous reports of oral VC metastasizing to the eye revealed no results. Case Report