Breast Cancer Metastases to the Paranasal Sinuses Mimicking Inflammatory Sinus Disease

Abstract

Introduction: Breast cancer is one of the most common cancers in women. Metastatic disease is a leading cause of morbidity and mortality. It frequently metastasizes to bone, lungs, regional lymph nodes, liver and brain. Metastasis to the orbit and paranasal sinuses is uncommon. Patients presenting with sinus pain, nasal congestion, or visual disturbance can be misdiagnosed with an infectious process. Methods: The authors describe 2 patients with metastatic breast cancer to the paranasal sinuses presenting with signs and symptoms of sinusitis and orbit pathology unresponsive to antibiotics. The authors discuss diagnostic strategy and perform a literature review. Both patients had biopsy-proven metastatic breast adenocarcinoma lesions, and subsequently underwent various treatment options. Results: A literature review reveals that metastatic breast adenocarcinoma lesions to the paranasal sinuses are a rare entity that commonly denotes a very poor prognosis. These lesions can significantly affect one's quality of life, and can cause blurry vision, diplopia, proptosis, sinus pressure and pain, nasal congestion, mandibular misalignment or difficulty with mastication. However, early diagnosis and treatment of these lesions can lead to prolonged survival and improved quality of life. If the lesion is surgically resectable, endoscopic sinus surgery is generally considered to be the optimal treatment. However, radiotherapy, chemotherapy, and immunotherapy can potentially play a role in controlling the symptomatology. Conclusion: Metastatic lesions to the paranasal sinuses are a rare entity that should be considered in the appropriate clinical setting in order to expedite the proper treatment modality for improved morbidity and mortality

Clinical Features and Prognosis of Uncommon Metastatic Breast Cancer: A Retrospective Analysis of 82 Cases

“…Different from bone marrow metastasis and pericardial metastasis, 22 , 23 when the rare metastatic sites involve the skin or solid/hollow organs (especially an isolated uncommon metastatic site), local radiotherapy or complete resection can be performed for local intensive treatment on the basis of systemic therapy. 24 – 27 Different treatment patterns may lead to different prognoses for these patients with metastatic breast cancer. For selected patients with solitary adrenal metastases, laparoscopic adrenalectomy can provide a survival benefit.…”

“…Palliative chemoradiotherapy and immunotherapy are considered for unresectable disease, which is associated with high rates (60%-80%) of clinical improvement of local symptoms and vision. 24 , 27 The same decision is applicable to parotid metastasis of breast cancer, but attention should be paid to the protection of the facial nerve during operation. 28 , 29 For digestive system metastasis, some researchers advocated that systemic treatment should be used as a first-line clinical decision 30 and surgical resection should be applicated only when presenting with obstruction symptoms.…”