Al Tawil Layan, Alkatan Hind M, Alnuman Rawand, Malaikah Rawan H, Arafah Maria A, Al-Faky Yasser H
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Int J Surg Case Rep. 2023 Sep;110:108669. doi: 10.1016/j.ijscr.2023.108669. Epub 2023 Aug 23.
Orbital metastasis from breast cancer may be infrequently noted after the management of the primary lesion. It is rare in such cases to present with unilateral mechanical blepharoptosis without ophthalmoplegia.
We present a case of unilateral acquired blepharoptosis of the left upper eyelid without ophthalmoplegia or exophthalmos three years after the onset of a suspicious breast mass. The patient did not disclose a history of breast cancer nor any positive family history to the ophthalmologist and anesthesiologist. The radiology images revealed an ill-defined enhanced lesion at the superior medial aspect of the left orbit. The orbital biopsy of the lesion showed poorly differentiated carcinoma as per the initial histopathology report. Vigilant history-taking enabled us to get information about a previous breast lesion and to correlate this with specific histopathological findings.
Management of orbital lesions might be challenging, and the approach should include detailed history and assessment. Biopsy and radio imaging are further needed to aid in providing the proper diagnosis. The clinicopathological correlation in our case has led to the final diagnosis of orbital metastatic breast cancer.
Ophthalmologists should be aware of variable ocular presentations of malignancy and adopt a team approach to obtain a carefully detailed history from patients presenting with orbital diseases and communicate adequately with the ocular pathologists who are handling the biopsy. Long-term follow-up and enhancement of patients' awareness of possible late orbital metastasis are recommended in all patients with breast masses.
乳腺癌的眼眶转移在原发灶治疗后可能并不常见。在这类病例中，罕见出现单侧机械性上睑下垂而无眼肌麻痹的情况。
我们报告一例患者，在出现可疑乳腺肿块三年后，出现左侧上睑单侧后天性上睑下垂，无眼肌麻痹或眼球突出。患者未向眼科医生和麻醉医生透露乳腺癌病史或任何阳性家族史。影像学检查显示左眼眶内上侧有一个边界不清的强化病灶。根据最初的组织病理学报告，该病灶的眼眶活检显示为低分化癌。通过仔细询问病史，我们得以了解到之前的乳腺病变情况，并将其与特定的组织病理学发现相关联。
眼眶病变的处理可能具有挑战性，处理方法应包括详细的病史询问和评估。还需要活检和影像学检查以协助做出正确诊断。我们病例中的临床病理相关性最终确诊为眼眶转移性乳腺癌。
眼科医生应意识到恶性肿瘤的多种眼部表现，采用团队协作的方法，从患有眼眶疾病的患者那里获取详细的病史，并与处理活检的眼科病理学家进行充分沟通。建议对所有乳腺肿块患者进行长期随访，并提高患者对可能出现的晚期眼眶转移的认识。
