title: Orbital metastases as first sign of metastatic spread in breast cancer: case report and review of the literature.
abstract: BACKGROUND
  Intraorbital metastases of breast cancer is rare with only 3-10% of all ocular metastases. We report a case of orbital metastases as first sign of systemic metastatic spread in a female patient with breast cancer.
  
  
  METHODS
  The patient had been diagnosed with breast cancer 3 years before. Her present complain was local pain, diplopia and periorbital swelling. A CT scan revealed extensive bony destruction of the orbital roof/anterior skull base. Bone scintigraphy demonstrated additional uptake at the level of the skull base, cervical spine, ilium and ribs suggesting metastatic spread to the skeleton. A navigation-assisted intraorbital biopsy from the orbital roof revealed a metastasis of breast cancer. With the confirmed diagnosis of metastatic breast cancer the patient was refered to the oncologist for further tumor staging. As further treatment she received systemic palliative chemotherapy in addition to intravenous treatment with bisphosphonates.
  
  
  CONCLUSIONS
  In patients with a previous history of breast cancer who complain even of mild ophthalmologic symptoms such as local pain, periorbital edema, it is important to consider ocular or orbital metastatic disease. Adequate 3D-Imaging followed by a biopsy will usually confirm the diagnosis.
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. eckardt.andre@mh-hannover.de
authors.forename: André M
authors.initials: AM
authors.lastname: Eckardt
authors.forename: Majeed
authors.initials: M
authors.lastname: Rana
authors.forename: Harald
authors.initials: H
authors.lastname: Essig
authors.forename: Nils-Claudius
authors.initials: NC
authors.lastname: Gellrich
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis; D009918:Orbital Neoplasms / Q000175:diagnosis / Q000556:secondary*; D014057:Tomography, X-Ray Computed