CASE 3560 Published on 20.06.2005
0

Ocular metastasis from breast carcinoma

Section

Breast imaging

Case Type

Clinical Cases

Authors

Valeria Toro MD, Marzia Muzi MD, Peter Angelo Mattei BA.

Connected authors
Patient

62 years, female

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Clinical History
A 62-year-old woman with irreducible, painful exophthalmos presented at the ofthalmology clinc with double vision. Orbitonometric parameters were near the upper limits.
Imaging Findings
The mammography showed diffuse increased left breast density due to trabecular thckening with associated ill-defined mass (diameter of 2,5 cm) localized in the omolateral upper-outer quadrant. Enlarged round axillary lynfonodes with increased density and loss of lucent fatty hilum were observed in the left axillary cavum; another lynfonode was noted in the controlateral axillary cavum. Malignant-type microcalcifications were not observed. The sonographic examination was performed with a superficial probe (10 Mhz). The examination showed in the left upper-outer quadrant an irregular and heterogenous hypoechoic mass of 2,5 cm. Near the mass were noted three solid round hypoechoic nodules (0,5 cm); one localized in the cranial portion of the left upper outer quadrant (1 cm). US scans showed marked dilated lymphatic channels, skin thickening and multiple round hypoecoic lynfonodes in the left axillary cavum (0,5 cm to 2 cm) consistent with axillary lymphadenopthy. Lynfonode in the right axillary cavum with a high longitudinal-transverse axis ratio and iperchogenic hilum consistent with flogistic node.
Discussion
A total body multi-layer spiral CT (4 detector row CT) was performed in order to evaluate the stage. The cranial CT indicated that the right exophthalmos was due to an oval mass located in the retrobulbare space with a density comparable to soft tissue (Fig 8). The biopsy report indicated that this mass was a metastasis probably to an extrinsic ocular muscle (Ref 3). No other organs were involved. Ocular metastasis from breast carcinoma is usually located in the choriodea. Breast carcinoma rarely metastasizes to the extrinsic ocular muscles. The incidence of choriodal ocular metastases from breast carcinoma is approximately 26-37% while the incidence of other malignant systemic neoplasms is approximately 10%. Other neoplasms that can give ocular metastases are pulmonary neoplasms, melanoma, gastro-intestinal tumors, maxillary sinus neoplasms and lymphomas. Reports of the presence of ocular metastases in breast cancer in literature are rare. Specifically, only one case reporting the diagnosis of a non-palpable breast cancer after observation of a choriodal metastasis has been published (Ref 3).
Differential Diagnosis List
Mucinous breast carcinoma with retrobulbar metastases to the right eye.
Final Diagnosis
Mucinous breast carcinoma with retrobulbar metastases to the right eye.
Case information
URL: https://www.eurorad.org/case/3560
DOI: 10.1594/EURORAD/CASE.3560
ISSN: 1563-4086
Figure 1

Figura 1

Figura 1
normal breast
Figure 2

Figura 2

Figura 2
high-density mass, with irregular margins, partially superimposed by breast parenchyma, located between the two inferior quadrants. Polymorphic microcalcifications are present.
Figura 2
polymorfic microcalcifications within the high-density mass
Figure 3

Figura 3

Figura 3
normal breast
Figure 4

Figura 4

Figura 4
The breast mass, seen in the left oblique projection, extends posteriorly to the pectoral muscle.
Figure 5

Figura 5

Figura 5
high-density and irregular mass in the inferior quadrants
Figure 6

Figura 6

Figura 6
hypoechoic and heterogeneous mass with polilobulated and irregular margins and posterior acoustic shadowing.
Figura 6
Unorganized vascular structure within the lesion. Spectral anaysis gave an arterial-type signal
Figura 6
A small hypoechoic nodule in the left inferior-external quadrant in the periareolar area
Figure 7

Figura 7

Figura 7
skin thickening, ectasic lymph vessels and hyperechogenic aspect of the subcutaneous fat
Figura 7
rounded hypohechoic lynfonode in the left axillary cavum
Figure 8

Figura 8

Figura 8
oval mass located in the right retrobulbare space with a density comparable to soft tissue.