J Breast Cancer.  2014 Mar;17(1):88-90.

Metastatic Breast Cancer Presenting as a Subconjunctival Mass

• Park YM
• Park JH
• Lee SU
• Lee JS

Abstract

Breast cancer is the most common primary source of orbital metastasis. Metastasis occurs through hematogenous spread and predominantly involves the choroid. We present a case of a metastatic subconjunctival mass associated with primary breast cancer. To our knowledge, this is the first reported case of its kind. A 41-year-old woman presented with complaints of conjunctival injection and a foreign body sensation in the left eye. She had a history of breast cancer and had been treated 2 years previously with modified radical mastectomy followed by adjuvant radiotherapy and chemotherapy. Slit-lamp examination showed a cystic mass under the temporal bulbar conjunctiva, associated with dilated overlying conjunctival vessels. An excisional biopsy revealed a poorly differentiated adenocarcinoma. Positron emission tomography examination for systemic malignancy revealed multiple systemic metastasis. Metastatic disease should be considered in the differential diagnosis of subconjunctival lesions, and ophthalmic manifestations can play an important role in the detection of metastatic spread of a known primary breast cancer.

Keyword

Adenocarcinoma; Breast neoplasms; Conjunctival neoplasms; Subconjunctival neoplasms

MeSH Terms

Adenocarcinoma
Adult
Biopsy
Breast Neoplasms*
Breast*
Choroid
Conjunctiva
Conjunctival Neoplasms
Diagnosis, Differential
Drug Therapy
Female
Foreign Bodies
Humans
Mastectomy, Modified Radical
Neoplasm Metastasis
Orbit
Positron-Emission Tomography
Radiotherapy, Adjuvant
Sensation

Figure

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  Figure 1 The slit lamp bi-microscopic finding of subconjunctival mass. A cystic mass was discovered under the temporal bulbar conjunctiva, associated with dilated overlying conjunctival vessels.

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  Figure 2 Histopathologic examination of the biopsy specimen. (A) Section of biopsy specimen lined by adjacent sclera (H&E stain, ×40). Sclera stromal vessels containing red blood cells were also noted (arrow). (B) Increased nuclear size with increased nuclear/cytoplasmic ratio. Increased pleomorphism. Lack of differentiation (H&E stain, ×400). (C) Immunohistochemical staining of tumor cells, suggesting a metastatic adenocarcinoma from breast cancer (immunohistochemical staining for carcinoembryonic antigen, ×200). (D) Immunohistochemical staining of tumor cells, suggesting a metastatic adenocarcinoma from breast cancer (immunohistochemical staining for p53, ×200). (E) Immunohistochemical staining of tumor cells, suggesting a metastatic adenocarcinoma from breast cancer (immunohistochemical staining for gross cystic disease fluid protein 15, ×200). (F) Immunohistochemical staining of tumor cells, suggesting a metastatic adenocarcinoma from breast cancer (immunohistochemical staining for estrogen receptor, ×200).

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