Paranasal sinus metastasis of breast cancer

Abstract

A 76-year-old woman presented with symptoms suggestive of acute sinusitis. Previously, her breast carcinoma was treated with right lumpectomy, adjuvant chemotherapy and breast radiotherapy. She remained free from recurrence for the following 8 years. After initial treatment with antibiotics, the local symptom worsened with exophthalmos, eye blindness and development of an ulceration of the hard palate. MRI showed irregular enhancement of the nasal cavity extended to the maxillary sinus and ethmoidal lamina and concomitant infiltration of the orbit and skull base. A biopsy of the palatal ulcer showed a poorly differentiated adenocarcinoma and was compared with the histology of the primary breast tumour and it was concluded for the same morphology. After discussion at the multidisciplinary team, a specific chemotherapy has been activated with an initial local response. Further surgical resection was not thought appropriate and the patient has subsequently undergone palliative radiotherapy to the right paranasal lesions to improve local disease control.

Figure 1

(A) Histological examination of the 2004 breast cancer revealed trabecular and solid aggregates of cells with abundant cytoplasm and prominent nuclei. Glandular differentiation was focally evident. (B) The 2012 nasal biopsy showed a proliferation of cells organised in a more solid pattern but with the same morphology as observed in the 2004 breast carcinoma. Mitoses were also evident. (C) The tumour was intensively positive for HER2 (score 3+).

Figure 2

The palatal ulcer preimmunochemotherapy and postimmunochemotherapy.

Figure 3

Radiation therapy field.

Figure 4

CT scan before chemoimmunotherapy with paclitaxel and trastuzumab (December 2012).

Figure 5

MRI before chemoimmunotherapy with paclitaxel and trastuzumab (January 2013).

Figure 6

MRI after chemoimmunotherapy with paclitaxel and trastuzumab (July 2013).

Figure 7

MRI after maintenance therapy with trastuzumab (October 2013).