title: Bilateral acute ptosis leading to the diagnosis of a presumed metastatic gastric adenocarcinoma.
abstract: We report the case of a 57 year old diabetic Indian male with no history of malignancy, who presented with severe bilateral upper lid acute aponeurotic ptosis, following intravitreal bevacizumab for diabetic retinopathy. Brain MRI revealed lesions in the vault of the skull, both superior recti and an intraorbital lesion on the lateral aspect of the right optic nerve.   PET-CT revealed multiple metabolically active lesions in both the lobes of the liver, cervical vertebrae and in the lesser curvature of the stomach. A biopsy taken from the lesion in the lesser curvature of the stomach showed poorly differentiated adenocarcinoma. The patient was treated with palliative chemotherapy (Epirubicin, Oxaliplatin and Capecitabine), but had progressive disease after two cycles and died 8 weeks after diagnosis. Gastric carcinoma is a quiescent carcinoma wherein metastatic manifestations often lead to the diagnosis of the primary tumor.
authors.affiliation: Department of Orbit and Oculoplasty, Narayana Nethralaya, Bangalore, India. mvinathi@gmail.com
authors.forename: Vinathi
authors.initials: V
authors.lastname: Mutyala
authors.forename: Sukhdeep
authors.initials: S
authors.lastname: Bains
authors.forename: Channappa
authors.initials: C
authors.lastname: Patil
authors.forename: Bhanumathi
authors.initials: B
authors.lastname: Madhavarao
mesh_terms: D000208:Acute Disease; D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001763:Blepharoptosis / Q000175:diagnosis / Q000209:etiology*; D000069287:Capecitabine; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D015251:Epirubicin / Q000008:administration & dosage; D017809:Fatal Outcome; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009918:Orbital Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D049268:Positron-Emission Tomography; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D015251:Epirubicin; D000069287:Capecitabine; D005472:Fluorouracil