Orbital metastases from uterine or adrenal leiomyosarcoma: case reports and literature review.

Leiomyosarcomas (LMSs) are malignant smooth-muscle tumors that most commonly arise in the uterus, retroperitoneum, or gastrointestinal tract, and only rarely originate in the adrenal gland. Orbital metastases from LMS are exceptionally rare. Two patients with histologically-confirmed orbital metastatic leiomyosarcoma arising from different primary sites are described: The first had uterine LMS with a destructive sphenoid lesion extending into the orbit, anterior and middle cranial fossae. The second developed bilateral metastases within extra-ocular muscles, several years after resection of an adrenal LMS - a source from which orbital spread has not previously been described. Both patients were managed within multidisciplinary teams: one underwent serial orbital debulking to relieve the mass effect, whilst the other received palliative orbital radiotherapy. These cases highlight the potential for late and atypical metastatic spread in LMS and emphasize the importance of considering metastatic smooth-muscle sarcoma in patients presenting with new orbital lesions and a relevant oncological history.