Rodrigues Alves Nuno, Duarte Ana Filipa, Ribeiro David Fernandes, Silva Rita Sousa, Carvalho Bruno Almeida, Alpuim Costa Diogo
Department of Ophthalmology, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
Department of Ophthalmology, Unidade Local de Saúde de São José, Lisbon, Portugal.
Front Oncol. 2024 Jan 23;14:1286910. doi: 10.3389/fonc.2024.1286910. eCollection 2024.
Breast cancer is a significant global health concern, contributing to substantial morbidity and mortality among women. Hormone receptor-positive (HR+)/HER2-negative (HER2-) breast cancer constitutes a considerable proportion of cases, and significant advancements have been made in its management. CDK4/6 inhibitors (CDK4/6is) are a new targeted therapy that has demonstrated efficacy in adjuvant, advanced and metastatic settings. The propensity of lobular breast carcinomas for estrogen-rich sites, such as periocular tissues and orbital fat, may explain their tendency for orbital metastases. Current treatment strategies for these cases are predominantly palliative, and the prognosis remains poor. This article presents a unique case of a 51-year-old female with progressive right periorbital edema, pain, and limited ocular motility. An imaging work-up showed bilateral intra and extraconal orbital infiltration, which was biopsied. The histopathologic analysis disclosed mild chronic inflammatory infiltrate with thickened fibrous tissue and moderately differentiated lobular carcinoma cells, positive for GATA3 and CK7 markers, with 100% of tumor nuclei expressing estrogen receptors (ER+). A systemic evaluation showed a multicentric nodular formation in both breasts. Further diagnostic assessments unveiled an HR+/HER2- bilateral lobular breast carcinoma with synchronous bilateral orbital metastases. Systemic treatment was initiated with abemaciclib 150mg twice daily and letrozole 2.5mg once a day. However, this regimen was interrupted due to toxicity. After two weeks, treatment was resumed with a reduced abemaciclib dose (100mg twice daily) alongside letrozole, with a reasonable tolerance. Nearly two years after the initial diagnosis of inoperable metastatic cancer, the patient remains on the same systemic treatment regimen with no signs of invasive disease. This case report is the first of a patient presenting with bilateral orbital metastases from bilateral lobular breast cancer, showing an impressive and sustained response to a first-line treatment regimen combining abemaciclib and letrozole. A literature review on bilateral orbital metastases from breast cancer is also presented.
乳腺癌是一个重大的全球健康问题,导致女性中出现大量发病和死亡情况。激素受体阳性(HR+)/人表皮生长因子受体2阴性(HER2-)乳腺癌在病例中占相当大的比例,并且在其治疗方面已经取得了重大进展。细胞周期蛋白依赖性激酶4/6抑制剂(CDK4/6is)是一种新的靶向治疗方法,已在辅助、晚期和转移性环境中显示出疗效。小叶乳腺癌倾向于富含雌激素的部位,如眼周组织和眶脂肪,这可能解释了它们发生眶转移的倾向。这些病例目前的治疗策略主要是姑息性的,预后仍然很差。本文介绍了一例独特的病例,一名51岁女性,出现进行性右侧眶周水肿、疼痛和眼球运动受限。影像学检查显示双侧眶内和眶锥外浸润,并进行了活检。组织病理学分析显示轻度慢性炎症浸润,纤维组织增厚,以及中度分化的小叶癌细胞,GATA3和CK7标记物呈阳性,100%的肿瘤细胞核表达雌激素受体(ER+)。全身评估显示双侧乳房有多中心结节形成。进一步的诊断评估揭示了HR+/HER2-双侧小叶乳腺癌伴同步双侧眶转移。开始全身治疗,使用阿贝西利150mg每日两次和来曲唑2.5mg每日一次。然而,由于毒性,该方案被中断。两周后,以减少剂量的阿贝西利(100mg每日两次)和来曲唑恢复治疗,耐受性良好。在初次诊断为不可手术的转移性癌症近两年后,患者仍采用相同的全身治疗方案,没有侵袭性疾病的迹象。本病例报告是首例双侧小叶乳腺癌出现双侧眶转移的患者,显示出对阿贝西利和来曲唑联合一线治疗方案令人印象深刻且持续的反应。本文还对乳腺癌双侧眶转移的文献进行了综述。
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