Unusual case of iris metastases from breast carcinoma

Abstract

A 46-year-old white woman with a history of breast carcinoma presented at our clinic with new lesions of the left iris, anterior uveitis, and headache. Imaging of the head and orbits showed metastatic breast carcinoma of the brain. Iris lesions were diagnosed as metastatic breast carcinoma based on clinical presentation. The patient was treated at an outside facility with systemic chemotherapy and radiation therapy while simultaneously being managed with steroid eyedrops for intraocular inflammation. Her condition and vision improved over a 3-month period.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. JCRS Online Case Reports 2015; 3:8-11 Q 2015 ASCRS and ESCRSBreast cancer affects approximately 1 in 8 women in the United States. A Although iris tumors represent a rare entity in ophthalmic practice, iris metastasis must be in the differential in patients with known metastatic breast cancer. One unusual case of iris metastases is discussed below as well as the most common presentation, associated findings, treatment, and prognosis. CASE REPORTA 46-year-old white woman noted a pink spot on the iris of her left eye over 4 days accompanied by an intermittent left-side headache. She had a medical history of noninsulin dependent diabetes mellitus and had been diagnosed with stage IV breast cancer 21 months earlier. A 3 cm mass in the right breast had been found to be a poorly differentiated invasive ductal carcinoma. Further testing at the time revealed satellite lesions in the right axillary and subpectoral lymph nodes as well as 2 left hepatic lobe lesions. The patient had completed 4 cycles of chemotherapy and radiation therapy with good resolution and with no complications. She had started a course of capecitabine 9 months before presentation.On examination, the corrected distance visual acuity (CDVA) was 20/20 À2 in both eyes. The left pupil was slightly irregular with pupillary peaking at 8 o'clock at the pupillary margin. There was a 1.2 mm  1.5 mm white fluffy fibrous mass of the iris stroma adjacent to the area of pupillary peaking seen by slitlamp biomicroscopy (Figure 1). Intraocular pressure (IOP) by applanation was 18 mm Hg in both eyes. Gonioscopic examination of both eyes revealed no tumor extension into the angle of the left eye but with heavier pigment than in the fellow eye ( Figure 2). Ultrasound biomicroscopy showed a solid mass infiltrating the iris.Brain magnetic resonance imaging revealed numerous new lesions in the cerebellum, pons, cerebrum, and an osseous metastatic deposit of the left greater sphenoid wing. The chemotherapeutic regimen was switched to carboplatin and gemcitabine, and external beam radiotherapy was initiated immediately. The patient's initial ophthalmic course was remarkable for waxing and waning of satellite lesions adjacent to the original metastatic iris focus that varied with chemotherapeutic cycles (Figures 3 and 4). At the 2-month follow-up, the patient noted blurred vision and eye pain in the left eye. The C...