Abstract
Purpose :
Breast cancer is the most common primary source of orbital metastases but is rare overall. This study aims to provide a large institutional retrospective study to assess clinical and radiographic features, histopathologic findings, treatment, and outcomes of patients with orbital metastasis of breast cancer.
Methods :
A retrospective review of the Florida Lions Ocular Pathology database at Bascom Palmer Eye Institute from 1997-2022 identified patients with breast cancer metastasis to the orbit and ocular adnexa. Medical records were reviewed for patient demographics, clinical, imaging, and histopathological findings, management, and outcomes.
Results :
Thirty-seven patients were identified with clinical details available for 23 (Table 1). The mean age at orbital presentation was 61±13 years. All patients were female (39% Caucasian, 35% black). 19 (82%) patients had a prior diagnosis of breast cancer (mean 4.6 years between primary and orbital diagnosis) while 4 (17%) presented with orbital lesions as first manifestation of systemic disease. 22 patients had unilateral lesions and 1 had bilateral. 43% had an orbital lesion ipsilateral to the prior breast lesion. 19 occurred in the orbit, while 1 occurred in the extraocular muscle (EOM), 2 in the eyelid, and 1 in the conjunctiva. Patients had ptosis (57%), decreased vision (30%), diplopia (35%), proptosis (22%), and enophthalmos (22%). On imaging, 39% were extraconal, 39% were both intra- and extraconal, 35% involved the lacrimal gland, and 52% involved EOM. All patients underwent diagnostic biopsy without further orbital surgery. 76% were invasive lobular and 24% were invasive ductal carcinoma. Of the total cases (n=37), 21 (57%) were ER+/PR+, 12 (32%) were ER+/PR-, only one was HER2+ (ER+/PR-), and 4 cases (11%) were triple negative. Of patients with specified treatment (n=16), the majority received chemotherapy (94%) and orbital radiation (69%). At follow-up (mean 39 months), 13 (57%) were alive with disease, 2 (9%) were alive disease-free, and 4 (17%) were deceased.
Conclusions :
This large institutional study highlights clinical and immunohistochemical features of periorbital and orbital metastatic breast carcinoma. It may have variable clinical presentation, represent the first manifestation of systemic disease, and is more often invasive lobular with ER+/PR+ on histopathology. Treatment includes chemotherapy and radiation; however, the overall rate of disease-free survival remains low.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.