Solitary yet Sinister: Intraconal Orbital Metastasis from Gastric Adenocarcinoma Resected through a Frontotemporal-Orbitozygomatic Craniotomy

Orbital metastases are uncommon. They account for 1 to 13% of all orbital tumors and occur in roughly 2 to 5% of patients with systemic cancer. Often, they are the herald of disease. In 20 to 42% of cases, the orbital deposit is the first clinical sign of an occult or previously treated primary. The usual sources are breast, prostate, lung, and cutaneous melanoma. Gastric adenocarcinoma is rare. Here, we report a presentation of right axial proptosis and blurred vision with an intraconal mass that was diagnosed as gastric adenocarcinoma. A 73-year-old man presented with a history of progressive right-sided axial proptosis associated with blurred vision. Radiological imaging demonstrated an enhancing intraconal orbital mass causing displacement of the optic nerve. The patient underwent craniotomy with complete excision of the lesion. Histopathological examination revealed metastatic gastric adenocarcinoma. At the 3-month follow-up, the patient remained free of recurrence and continued under regular oncological surveillance. Solitary intraconal orbital metastasis from gastric adenocarcinoma is exceptionally rare and should be considered in any patient with a history of malignancy presenting with an intraconal orbital mass. Comprehensive metastatic evaluation, including whole-body positron emission tomography–computed tomography, and histopathological confirmation with immunohistochemistry are essential. In carefully selected patients with isolated disease, complete surgical excision may provide durable local control, supporting an individualized rather than uniformly palliative treatment approach.