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Natalie Homer, Frederick Jakobiec, Anna Stagner, Michael K Yoon; Volumetric analysis of metastatic scirrhous breast cancer of the orbit. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2421.
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© ARVO (1962-2015); The Authors (2016-present)
Metastatic scirrhous breast cancer is a rare but important cause of progressive enophthalmos. Although case reports exist, objective radiographic orbit volume changes in this disease have not yet been studied. We performed a retrospective study of the volumetric radiographic orbital changes in 4 patients (5 eyes) with metastatic scirrhous breast carcinoma.
A retrospective review of patients with biopsy-proven metastatic scirrhous breast carcinoma to the orbit seen in the Massachusetts Eye and Ear Ophthalmic Plastic Surgery Clinic between August 2011 and July 2015 was performed. Five orbits (4 patients) were identified. All patients underwent contrast-enhanced MRI of the orbits. The hospital’s radiology viewing software (Synapse, Fuji, Tokyo, Japan) was used to measure three-dimensional volumes by outlining relevant orbital structures on axial images and multiplying by slice thickness.
Of the total 4 patients identified, 3 had unilateral and 1 had bilateral involvement (Table 1). On MRI imaging, 4 of the 5 orbital lesions were limited to the intraconal space. All but one case showed decreased orbital soft tissue volume on the affected side. The majority of the volume loss was related to a decrease in orbital fat volume. When compared to the unaffected eye in unilateral cases, there was a correlation between tumor volume and total orbital volume loss, and between tumor volume and orbital fat volume loss. Total orbit volume loss was proportional to orbital fat volume change (Figure 1). Interestingly, there was no correlation between amount of clinically measured enophthalmos and radiographically determined tumor size, total radiographic orbit volume loss, or orbital fat volume loss.
This is the first quantitative study of orbital volume changes from scirrhous breast cancer metastases. We found that affected eyes have decreased total orbital volume, primarily attributable to decreased orbital fat volume. The lack of correlation between enophthalmos and tumor size gives further evidence that this tumor alters the surrounding orbital fat. Any patient with new onset enophthalmos and a history of breast cancer should be evaluated radiographically and with biopsy to evaluate for metastatic disease.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Table 1: Patient and disease characteristics
Figure 1: Tumor Burdon vs. Total Orbit Volume and Orbital Fat Volume Loss
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