Orbital Metastasis in Breast Cancer
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 (Panel A and video). 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 (Panel B, arrow). 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 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.
This seems like a rare type of metastasis. It's ashame that even with tamoxifen this has spread. Maybe it was because it's best as profilaxes women with genetic predisposition.