Metastases to extraocular muscles from breast cancer: case report and up-to-date review of the literature

Abstract

BackgroundUnilateral or bilateral metastases to extraocular muscles are very rare in breast cancer.Case presentationWe describe a case of inferior rectus extraocular muscle involved by ductal luminal B/Her-2 neu negative breast cancer, observed in a cohort of 580 patients. Our patient had received chemotherapy and hormonal therapy (tamoxifen for 3 years and letrozole in the following 3 years) for her primary cancer and developed an orbital metastasis while she was under aromatase inhibitor-based therapy. Diagnosis was confirmed by MRI and biopsy. Orbital radiotherapy, combined with fulvestrant, resulted in shrinking of the secondary mass. A third line hormonal therapy using palbociclib was then started. Twelve-months later, MRI showed no residual tumor mass. Currently, the patient is alive and in good general conditions after 20 months.ConclusionsLiterature review yielded 57 patients with extraocular muscle metastases from breast cancer, mostly due to the invasive lobular subtype of carcinoma. In addition to the present case, only 4 other extraocular muscles metastases from invasive ductal carcinoma has been reported, pointing out to the rarity of ductal type spread to the orbit in the natural history of breast cancer. Surgery may be used as a single treatment, despite no improvement of symptoms. Radiotherapy alone or combined with chemotherapy, or with chemotherapy plus hormonal therapy are available options. Results are, however, missing or poor. The present case is the first one with complete and stable response after 20 months to radiotherapy, antiestrogen drug fulvestrant and selective inhibitor of CDK4 /CDK6 palbociclib. In this subset of patients, with unusual metastatic sites and frequent multi-organ metastatic impairment, a multidisciplinary approach is indicated in order to achieve the best therapeutic management and long-term surveillance.

Patient treatment and outcome after breast cancer orbital and periorbital metastases: a comprehensive case series including analysis of lobular versus ductal tumor histology

“…In 4 of these cases, the metastasis originated from an IDC breast primary tumor. We are aware of only 5 such cases previously reported in the English literature [30] and thus believe that the TIES search for OM at our institution allowed for an extremely high degree of sensitivity for identification of these rare cases.…”

Adipose Tissue from Lean and Obese Mice Induces a Mesenchymal to Epithelial Transition-Like Effect in Triple Negative Breast Cancers Cells Grown in 3-Dimensional Culture

“…The primary cause of morbidity and death among BC patient is tumor metastasis [9]. The most common sites of BC metastasis include the bone, brain, lungs, and liver [10]; although rare, the tumor can also spread to the extraocular muscle [11] and to the urinogenital regions of the body [12][13][14]. Tumor metastasis is a highly complex and multistep event.…”

Orbital metastases from breast cancer: A single institution case series

“…Recently, Framinio‐Dei‐Malatesta et al 7 analyzed the prevalence and outcomes of these unusual metastases by literature review. Prompted by their study, we present our experience dealing with patients affected by orbital metastases from breast cancer, to assess characteristics and clinic‐pathological data of patients suffering from this rare occurrence and to find features and indexes associated with their survival.…”