Breast cancer metastasis to the conjunctiva

Anica Nedeljko Bobić Radovanović; Dejan Rašić; Marko Buta; Radan Džodić

doi:10.2298/1707

Anica Nedeljko Bobić Radovanović Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Eye Disease, Clinical Center of Serbia, Belgrade, Serbia
Dejan Rašić Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Eye Disease, Clinical Center of Serbia, Belgrade, Serbia
Marko Buta Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
Radan Džodić Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Oncology and Radiology of Serbia, Belgrade, Serbia

DOI: https://doi.org/10.2298/1707

Keywords: conjunctiva, neoplasm metastasis, diagnosis, histological techniques, breast neoplasms,

Abstract

Introduction. Conjunctival metastasis is exceedingly rare, and it is, as a rule, a sign of advanced malignant disease with poor prognosis. We presented a female patient with breast cancer metastasis to the conjunctiva. Case report. A 45-year-old premenopausal female patient was presented with a solitary, yellowish, thin, demarcated lesion in the superior nasal quadrant of the bulbar conjunctiva of the left eye noted by chance a week earlier. There was no sign of irritation, and no pain, and no other functional or morphological problem in either eye or orbit. Five years before the appearance of conjunctival metastasis, breast carcinoma was diagnosed and the patient underwent chemotherapy, preoperative radiotherapy and radical mastectomy. Three years later, computed tomography scan showed metastasis in the left hepatic lobe with ascites and the patient underwent chemotherapy again. But, four months prior to the appearance of conjunctival lesion body scintigraphy showed multifocal sceletal lesions and nuclear magnetic resonance revealed diffuse hepatic metastases and bilateral ovarial tumors. Paliative radiotherapy and hormonal therapy (megestrol, 160 mg) were carried out. An excisional biopsy of the observed conjunctival lesion was performed under topical anesthesia and the material was subjected to histopathological (HP) examination. HP and immunohistochemical examinations established the presence of breast infiltrating lobular carcinoma metastatic to the conjunctiva. The patient showed rapid deterioration after intervention, and died after three weeks. Conclusion. A survival period less than one month after the appearance of conjunctival metastasis deserves attention because it is unexpected and has never been reported previously. It is not a rule that HP presentation of a metastatic lesion is so characteristic that it is possible to determine a primary tumor.

Author Biographies

Anica Nedeljko Bobić Radovanović, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Eye Disease, Clinical Center of Serbia, Belgrade, Serbia

Clinic for eye disease CCS,

Dejan Rašić, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Eye Disease, Clinical Center of Serbia, Belgrade, Serbia

Clinic for eye disease, CCS

Marko Buta, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia

Institute of oncology and radiology of Serbia

Radan Džodić, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Oncology and Radiology of Serbia, Belgrade, Serbia

Institute of oncology and radiology of Serbia

References

Albert DM, Zimmermann AW Jr, Zeidman I. Tumor metastasis to the eye. 3. The fate of circulating tumor cells to the eye. Am J Ophthalmol 1967; 63(4): 733−8.

Shields CL, Demirci H, Karatza E, Shields JA. Clinical survey of 1643 melanocytic and nonmelanocytic conjunctival tumors. Ophthalmology 2004; 111(9): 1747−54.

Ferry AP, Font RL. Carcinoma metastatic to the eye and orbit. I. A clinicopathologic study of 227 cases. Arch Ophthalmol. 1974; 92(4): 276−86.

Shields CL, Shields JA, Gross NE, Schwartz GP, Lally SE. Survey of 520 eyes with uveal metastases. Ophthalmology 1997; 104(8): 1265−76

Eliassi-Rad B, Albert DM, Green WR. Frequency of ocular metastases in patients dying of cancer in eye bank populations. Br J Ophthalmol 1996; 80(2): 125−8.

Bloch RS, Gartner S. The incidence of ocular metastatic carcinoma. Arch Ophthalmol. 1971; 85(6): 673−5.

Font RL, Ferry AP. Carcinoma metastatic to the eye and orbit III. A clinicopathologic study of 28 cases metastatic to the orbit. Cancer 1976; 38(3): 1326−35.

Albert DM, Rubenstein RA, Scheie HG. Tumor metastasis to the eye. I. Incidence in 213 adult patients with generalized malignancy. Am J Ophthalmol 1967; 63(4): 723−6.

Mewis L, Young SE. Breast carcinoma metastatic to the choroid. Analysis of 67 patients. Ophthalmology 1982; 89(2): 147−51.

Fenton S, Kemp EG, Harnett AN. Screening for ophthalmic involvement in asymptomatic patients with metastatic breast carcinoma. Eye (Lond) 2004; 18(1): 38−40.

Kiratli H, Shields CL, Shields JA, DePotter P. Metastatic tumours to the conjunctiva: report of 10 cases. Br J Ophthalmol 1996; 80(1): 5−8.

Skalicky SE, Hirst LW, Conway RM. Metastatic breast carcinoma presenting as a conjunctival lesion. Clin Experiment Ophthalmol 2007; 35(8): 767−9.

Benzimra J, Kherdaji F, McNaught A. Metastatic breast cancer to the conjunctiva and anterior chamber angle. J Clin Oncol 2007; 25(9): 1135−6.