Rare case of Orbital Metastasis in Breast Cancer appears in NEJM

Dr Alejandro Salinas-Botrán and Dr Maria J. Guarín-Corredor at Hospital de Denia, Denia, Spain and colleagues have reported a rare case of orbital Metastasis in Breast Cancer. The case has appeared in the New England Journal of Medicine.

Breast cancer can metastasize to many sites, but the orbit is an infrequent location and a comparatively rare site of distribution among the ocular area structures. Longer survival of patients with metastatic disease as well as advances in diagnostic imaging may explain the increasing frequency of ocular involvement that occurs in up to one third of breast cancer patients.Bone metastases as a sole metastatic site in breast cancer portend a good prognosis as opposed to visceral disease. In most cases of metastases to the orbit, there is a previous history of breast cancer that has been previously treated or the patient presents with an orbital mass in the setting of active malignancy affecting multiple organ systems.

A 60-year-old woman presented to the emergency department with a 2-month history of blurry vision in her left eye. Three years earlier, she had received a diagnosis of estrogen receptor– and progesterone receptor-positive, human epidermal growth factor receptor 2 (HER2)–negative invasive ductal carcinoma of the right breast. She had undergone lumpectomy, axillary-node dissection, and adjuvant radiation therapy, followed by therapy with tamoxifen at a dose of 20 mg daily.

At the time of the current presentation, examination revealed proptosis and an inability to look up with the left eye. There was no axillary lymphadenopathy, and no masses were noted on breast examination. Magnetic resonance imaging of the head revealed a mass, measuring 19 mm by 15 mm by 17 mm, involving the inferior rectus muscle of the left eye.

Biopsy revealed metastasis of hormone receptor-positive, HER2-negative breast cancer. The patient began treatment with fulvestrant and palbociclib, followed by radiation therapy. At follow-up 6 months after the initiation of treatment, she had a resolution of the proptosis and blurry vision; imaging showed that the mass was no longer present and there were no new sites of metastatic disease.