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Case Report

Metastatic breast cancer: an unusual cause of diplopia

Nasser Mohammed Amer , Gareth Bashir , Arikoge Ogedegbe , Ibtisam Saeed 4
3
2
1
1 Department of General Surgery, University of Dammam, Al Khobar 40262, Kingdom of Saudi Arabia.
2 Department of General Surgery, King George Hospital, Ilford IG3 8YB, UK.
3 Department of General Surgery, King George Hospital, Ilford IG3 8YB, UK.
4 Department of Pathology, Queens Hospial, Romford RM7 0AG, UK.
Correspondence to: Dr. Nasser Mohammed Amer, Department of General Surgery, University of Dammam, Al Khobar 40262, Kingdom of Saudi
Arabia. E-mail: nmamer@uod.edu.sa

A B S T R AC T
While secondary solid cancer into the eye orbit is rare, it is the most common site for primary metastasis in female breast cancer.
We report a case of a sixty-six years old woman presenting to her optician with complaints of double vision. Magnetic resonance
imaging revealed an invasive lesion in the superior and medial rectus muscles of the right orbit, biopsy of which confirmed this as an
infiltrating breast carcinoma. Investigation of the primary lesion showed an advanced invasive ductal carcinoma of the right breast.
She was then treated with radiotherapy to the orbit and a non steroidal aromatase inhibitor Anastrozol (Arimidex®). We herein review
and discuss the literature, epidemiology, mechanism of tumor spread, the “seed and soil” theory, clinical presentation, pathology, and
management of this uncommon presentation.

Key words: Metastatic breast cancer; diplopia; ocular metastasis

INTRODUCTION sparing of the lateral rectus and superior oblique muscles.
The initial diagnosis was that of a partial third cranial nerve
Cancer metastasis to the eye orbit is rare [1-4] However, palsy. A computed tomography (CT) scan revealed increased
female breast cancer is the commonest primary cancer abnormal soft tissue enhancement in the superior aspect of
metastasizing to the orbit, [2,3,5,6] followed by, lung cancer, the orbit, with involvement of superior and medial rectus
prostate cancer, melanoma, and genitourinary cancer in muscles. The patient was then referred to an oculoplastic
no particular order. Patients typically present with limited surgeon who noted that the patient had a “frozen eyeball”.
ocular mobility, [6] proptosis, blepharoptosis, palpable A magnetic resonance imaging (MRI) scan further revealed
mass, blurred or decreased vision or pain. Signs and an abnormal infiltrating lesion at the orbital apex encasing
symptoms relating to orbital metastasis are usually noted the optic nerve and involving all four rectus muscles
late in the disease progression, and treatment generally [Figures 1 and 2]. Next, a CT-guided biopsy of the lesion
consists of local radiotherapy to the orbit in addition to was performed and histology revealed a metastatic lesion,
[6]
treatment of the primary cancer, which in this case of ductal most likely from a primary breast adenocarcinoma [Figure
adenocarcinoma of the breast required hormonal therapy 3]. Thus, the patient was referred to our multidisciplinary
only. breast clinic whereupon a 10 mm palpable mass in the upper
outer quadrant of the right breast was found, clinically
CASE REPORT suspicious of cancer. A mammogram and ultrasound were
performed, followed by a core biopsy of the mass. The
A 66-year-old woman presented to her optician with latter demonstrated features consistent with an invasive
symptoms of diplopia affecting the right eye only and ductal carcinoma, histologically identical to the biopsy
was subsequently referred to an ophthalmologist. Physical from the orbit. The tumor cells were estrogen receptor
examination showed a right sided ptosis and significant
impairment in all extra-ocular muscle function with some This is an open access article distributed under the terms of the Creative
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How to cite this article: Amer NM, Bashir G, Ogedegbe A, Saeed
I. Metastatic breast cancer: an unusual cause of diplopia. J Cancer
DOI: Metastasis Treat 2016;2:123-6.
10.20517/2394-4722.2016.13
Received: 10-02-2015; Accepted: 29-12-2015.

©2016 Journal of Cancer Metastasis and Treatment ¦ Published by OAE Publishing Inc. 123