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Orbital Metastasis from Breast Cancer Without Significant Changes in CT Scan and MRI

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However, in patients with known metastatic cancer, CT scan or MRI of the orbits can frequently show the presence of a mass, which often involves the orbital fat or extraocular muscles... Here, we report a case of orbital metastasis in a woman with previously diagnosed metastatic breast cancer presenting with visual disturbance of the right eye which was detected by optical coherence tomography... A 53-year-old woman presented with a 2-month history of diplopia and decreased vision in her right eye... Then she traveled to England and her treatment was continued by hormone therapy... Six months later, she returned with complaints of abdominal pain, headache and unilateral visual disturbance, including diplopia and decreased visual acuity in the right eye... A repeated abdominopelvic CT scan revealed ascites and peritoneal seeding... Neurological examination failed to reveal any focal neurological deficit... However OCT (Spectralis HRA+OCT) findings were most compatible with metastatic disease in vitreous and head of the optic nerve... OCT of orbital metastasis indicates a dome shaped elevation of the neurosensory retina and retinal pigment epithelium (RPE) with adjacent subretinal fluid... It could also be associated with retinal edema, intraretinal cysts, and thickening and detachment of the RPE... We have assessed and followed up the patient by clinical and ophthalmological examinations and imaging techniques including CT scan (with or without contrast) of the abdominopelvis region, MRI (with or without contrast) of the cervical spine and orbit, and mammography, which did not detect any significant problems... Asymmetry of the posterior wall of the globes or any other changes may be visible with 1.5 or 3 Tesla MRI and complete protocols by special orbital cuts and sequences... In summary, increased vigilance on behalf of the oncologic and ophthalmologic communities is required when they observe symptoms and signs compatible with ocular disease in patients with an established diagnosis of breast cancer... In addition, if CT scan or MRI of the orbits did not show presence of a mass, use of OCT or biopsy should be considered.

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Head and orbit MRI did not show any significant change
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Mentions: A 53-year-old woman presented with a 2-month history of diplopia and decreased vision in her right eye. Her past medical history included stage 2, hormone-receptor-positive and HER2-negative left breast carcinoma approximately 3 years prior to her presentation. She underwent modified radical mastectomy and axillary lymph node dissection. She subsequently received chemoradiation followed by hormonal therapy. Two years later, she presented with dyspepsia and abdominal pain. An abdominopelvic computed tomography (CT) scan showed ascites, peritoneal seeding, mucosal thickening, and partial obstruction in the proximal and distal part of the stomach, which was confirmed by endoscopy. In addition, ascites analysis was positive for malignancy. Chemotherapy was instituted which led to complete response. Then she traveled to England and her treatment was continued by hormone therapy. Six months later, she returned with complaints of abdominal pain, headache and unilateral visual disturbance, including diplopia and decreased visual acuity in the right eye. A repeated abdominopelvic CT scan revealed ascites and peritoneal seeding. Neurological examination failed to reveal any focal neurological deficit. Ophthalmologic examination revealed that the patient’s visual acuity was approximately no light perception (NLP) in the right eye. CT scan with and without contrast and magnetic resonance imaging (MRI) of the orbits and head were performed, which indicated no significant change (Figure 1). The type of MRI machine was Philips 1Tesla intera and the MRI technique was axial proton density (PD), axial T1W before injection of contrast, axial and sagittal T1W non fat suppress after injection of contrast media. Generally, on MRI, metastatic lesions to the orbit present hypointense to fat on T1W and hyperintense to fat on T2W, which was not observed in our case. Furthermore, nuclear scan was negative for metastasis to the globe.


Orbital Metastasis from Breast Cancer Without Significant Changes in CT Scan and MRI
Head and orbit MRI did not show any significant change
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036457&req=5

fig32537: Head and orbit MRI did not show any significant change
Mentions: A 53-year-old woman presented with a 2-month history of diplopia and decreased vision in her right eye. Her past medical history included stage 2, hormone-receptor-positive and HER2-negative left breast carcinoma approximately 3 years prior to her presentation. She underwent modified radical mastectomy and axillary lymph node dissection. She subsequently received chemoradiation followed by hormonal therapy. Two years later, she presented with dyspepsia and abdominal pain. An abdominopelvic computed tomography (CT) scan showed ascites, peritoneal seeding, mucosal thickening, and partial obstruction in the proximal and distal part of the stomach, which was confirmed by endoscopy. In addition, ascites analysis was positive for malignancy. Chemotherapy was instituted which led to complete response. Then she traveled to England and her treatment was continued by hormone therapy. Six months later, she returned with complaints of abdominal pain, headache and unilateral visual disturbance, including diplopia and decreased visual acuity in the right eye. A repeated abdominopelvic CT scan revealed ascites and peritoneal seeding. Neurological examination failed to reveal any focal neurological deficit. Ophthalmologic examination revealed that the patient’s visual acuity was approximately no light perception (NLP) in the right eye. CT scan with and without contrast and magnetic resonance imaging (MRI) of the orbits and head were performed, which indicated no significant change (Figure 1). The type of MRI machine was Philips 1Tesla intera and the MRI technique was axial proton density (PD), axial T1W before injection of contrast, axial and sagittal T1W non fat suppress after injection of contrast media. Generally, on MRI, metastatic lesions to the orbit present hypointense to fat on T1W and hyperintense to fat on T2W, which was not observed in our case. Furthermore, nuclear scan was negative for metastasis to the globe.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

However, in patients with known metastatic cancer, CT scan or MRI of the orbits can frequently show the presence of a mass, which often involves the orbital fat or extraocular muscles... Here, we report a case of orbital metastasis in a woman with previously diagnosed metastatic breast cancer presenting with visual disturbance of the right eye which was detected by optical coherence tomography... A 53-year-old woman presented with a 2-month history of diplopia and decreased vision in her right eye... Then she traveled to England and her treatment was continued by hormone therapy... Six months later, she returned with complaints of abdominal pain, headache and unilateral visual disturbance, including diplopia and decreased visual acuity in the right eye... A repeated abdominopelvic CT scan revealed ascites and peritoneal seeding... Neurological examination failed to reveal any focal neurological deficit... However OCT (Spectralis HRA+OCT) findings were most compatible with metastatic disease in vitreous and head of the optic nerve... OCT of orbital metastasis indicates a dome shaped elevation of the neurosensory retina and retinal pigment epithelium (RPE) with adjacent subretinal fluid... It could also be associated with retinal edema, intraretinal cysts, and thickening and detachment of the RPE... We have assessed and followed up the patient by clinical and ophthalmological examinations and imaging techniques including CT scan (with or without contrast) of the abdominopelvis region, MRI (with or without contrast) of the cervical spine and orbit, and mammography, which did not detect any significant problems... Asymmetry of the posterior wall of the globes or any other changes may be visible with 1.5 or 3 Tesla MRI and complete protocols by special orbital cuts and sequences... In summary, increased vigilance on behalf of the oncologic and ophthalmologic communities is required when they observe symptoms and signs compatible with ocular disease in patients with an established diagnosis of breast cancer... In addition, if CT scan or MRI of the orbits did not show presence of a mass, use of OCT or biopsy should be considered.

No MeSH data available.