J Breast Cancer.  2018 Sep;21(3):339-342. 10.4048/jbc.2018.21.e46.

Extraocular Muscles Involvement as the Initial Presentation in Metastatic Breast Cancer

• Coutinho I
• Marques M
• Almeida R
• Custódio
• Simões Silva T
• Águas F

• KMID: 2421376
• DOI: http://doi.org/10.4048/jbc.2018.21.e46

Abstract

Orbital metastasis is a rare event, and metastatic disease affecting the extraocular muscles is an even less frequent complication of solid tumors. Herein, we report an unusual case of ptosis as the initial presentation of an invasive breast cancer. A 68-year-old woman presented with III and VI partial nerve paresis, secondary to a compressive retrobulbar mass. Magnetic resonance imaging revealed an infiltrative lesion involving the extraocular muscles. Tissue biopsy yielded a result compatible with metastasis to the orbit, with immunohistochemistry analysis suggesting breast as the primary organ. Mammography identified an area of architectural distortion; stereotactic wire-guided biopsy confirmed the result of the previous orbital biopsy. A positron emission tomography scan demonstrated disseminated disease. Palliative chemotherapy with bone-modulating agents and subsequent hormonal therapy was proposed. Unfortunately, the patient did not respond to therapy and died 38 months after diagnosis.

Keyword

Breast neoplasms; Neoplasm metastasis; Oculomotor muscles; Orbital neoplasms

MeSH Terms

Aged
Biopsy
Breast Neoplasms*
Breast*
Diagnosis
Drug Therapy
Female
Humans
Immunohistochemistry
Magnetic Resonance Imaging
Mammography
Muscles*
Neoplasm Metastasis
Oculomotor Muscles
Orbit
Orbital Neoplasms
Paresis
Positron-Emission Tomography

Figure

• 

  Figure 1 Magnetic resonance imaging of the orbit and brain. (A) T1 coronal without fat suppression revealing an intraorbital infiltrative process with homogeneous signal equal to the upper rectus, lateral and upper oblique muscles (arrow). (B) T1 coronal exposing a left intraconal mass (arrow), after intravenous administration of gadolinium (homogeneous contrast uptake).

• 

  Figure 2 Histopathologic examination of the left orbital biopsy. (A) Connective tissue with diffuse and cordonal infiltrate of round and plasmacytoid neoplastic cells (H&E stain, ×200). (B) Epithelial nature confirmed by positivity for pankeratin mouse monoclonal cytokeratin antibody 116 (MNF116) (immunohistochemistry [IHC] for MNF116, ×100). (C) Neoplastic cells expressing E-cadherin (IHC for E-cadherin, ×200). (D) Strong and diffuse positivity for estrogen receptors (ER) (IHC for ER, ×200). (E) Neoplastic cells expressing GATA-binding protein 3 (GATA3) (IHC for GATA3, ×200).

• 

  Figure 3 Histopathologic examination of the breast biopsy. (A) Invasive ductal carcinoma formed by tubular structures and isolated neoplastic cells with a hyalinized stroma (H&E stain, ×200). (B) Strong and diffuse positivity for estrogen receptors (ER) (immunohistochemical staining ER, ×200).

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