Periocular breast carcinoma metastases: correlation of clinical, radiologic and histopathologic features

To describe presenting patterns of breast cancer metastases to the orbit and eyelids.

To provide clinical, radiographic and pathologic correlations of breast metastases to the orbit or eyelids and evaluate radiographic volumetric orbital changes.

Retrospective review in an academic centre.

Ten female patients with periocular metastatic breast carcinoma who were seen at the Massachusetts Eye and Ear Infirmary Oculoplastics Clinic.

Retrospective review of patient records, imaging and pathology findings.

Presenting clinical characteristics, radiographic findings and histopathological features were assessed and correlated to discover distinctive presenting patterns. Volumetric measurements of the tumours and orbital soft tissue structures were made on magnetic resonance imaging studies.

The breast cancer metastases included eleven orbital lesions and one eyelid lesion. Two distinct clinical presentations were observed. The first consisted of seven patients who had either enophthalmos or euphthalmos, a radiographically indistinct intraconal lesion and a histologically classic invasive lobular breast carcinoma with a prominent fibrotic stroma. The second group consisted of two proptotic patients with discrete mass lesions on imaging and an atypical invasive lobular breast carcinoma pathological subtype (pleomorphic or alveolar). One patient had diffusely indurated eyelid fullness. Volumetric analyses demonstrated variable tumour sizes with an inconsistent impact on the orbital volume and fat.

This correlative study provides the clinical-radiographic-histopathologic basis for separating two overarching phenotypic presentations of metastatic breast carcinoma to the orbit. Previously postulated mechanisms for the distinctive finding of tumour-induced enophthalmos are re-examined in the light of the foregoing conclusions.