Orbital and Meningeal Metastases Secondary to Breast Adenocarcinoma: A Case Report

Orbital metastasis and meningeal carcinomatosis (MC) are uncommon complications of breast cancer and typically indicate advanced disease with poor prognosis. While breast cancer is the most frequent primary tumor associated with orbital metastases in women, the simultaneous occurrence of orbital metastasis and MC is exceedingly rare. We present the case of a 51-year-old female patient diagnosed with stage IV breast adenocarcinoma, previously diagnosed with controlled HIV infection, who presented with posterior cervical pain, progressive bilateral visual loss, and left blepharoptosis. Ophthalmic examination revealed decreased visual acuity, bilateral optic disc edema, and macular exudates. Contrast-enhanced MRI demonstrated an infiltrative orbital lesion involving intraconal fat and extraocular muscles, as well as pachymeningeal thickening. Infectious etiologies were excluded. CSF analysis confirmed markedly elevated intracranial pressure and revealed malignant cells consistent with adenocarcinoma, establishing the diagnosis of MC. Histopathological and immunohistochemical studies of orbital tissue confirmed metastasis of breast origin. Despite the initiation of radiotherapy to address orbital involvement, intrathecal chemotherapy was not pursued due to the dismal prognosis. The patient's condition deteriorated rapidly, and she died within days, reflecting the aggressive course of advanced breast cancer with leptomeningeal dissemination. This report highlights a rare presentation of secondary intracranial hypertension due to concurrent orbital and meningeal metastasis from breast cancer. The case underscores the diagnostic value of MRI and CSF cytology, as well as the limited therapeutic options available in such advanced settings. Recognition of this presentation is important, as it is associated with high mortality and primarily requires a palliative approach.