Bilateral multiple extraocular muscle metastasis from breast carcinoma

Abstract

We report a rare presentation of an initially misdiagnosed case of a pseudotumor, which on histopathology was diagnosed as bilateral breast metastases of lobular carcinoma involving multiple extraocular muscles. A 61-year-old lady presented with external ophthalmoplegia and diplopia. Incisional biopsy was performed using a lid crease approach and the patient received radiotherapy and hormonal therapy. Following prolonged hormonal therapy, complete remission was achieved, with improvement in ocular motility and resolution of diplopia, about 18 months after the initial presentation. Multiple extraocular muscle involvement by breast carcinoma metastasis is very rare and should be considered in the differential diagnosis, especially in patients with a prior history of breast carcinoma.

Figure 1

Nine gaze view at presentation revealed the presence of right upper lid retraction and limitation of ocular movements of the right eye in all directions of gaze and the left eye on depression

Figure 2

Coronal section through the orbits (T1 weighted gadolinium enhanced image) with fat suppression, showing enlargement of the right superior, lateral, and inferior recti and the left superior rectus

Figure 3

Histopathology revealed the presence of tumor cells arranged in an Indian file arrangement (bold arrow) and glandular pattern (other arrow) suggestive of lobular carcinoma of the breast, (H&E, 100×)

Figure 4

Nine-gaze view at last follow-up, there was presence of mild upper lid ptosis of the right eye and improvement of ocular movements, with the absence of any diplopia