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Diffuse ocular metastasis of ductal breast carcinoma following vitreoretinal surgery
  1. Martina C Herwig1,2,
  2. Hans-Peter Fischer3,
  3. Frank G Holz1,
  4. Karin U Loeffler1,2
  1. 1Department of Ophthalmology, University of Bonn, Bonn, Germany
  2. 2Division of Ophthalmic Pathology, Department of Ophthalmology, University of Bonn, Bonn, Germany
  3. 3Department of Pathology, University of Bonn, Bonn, Germany
  1. Correspondence to Dr Martina C Herwig, Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127 Bonn, Germany; martina.herwig{at}ukb.uni-bonn.de

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Case report

A 65-year-old female presented to our hospital for enucleation of her painful and blind left eye. During the last 2 years, she had been operated on several times for recurrent retinal detachment of unknown aetiology and proliferative vitreoretinopathy including repeat vitrectomy with instillation and removal of silicone oil. On examination, she presented with an inflamed left eye without any light perception and complained of an intermittent left-sided headache. The cornea was cloudy with neovascularisation and band keratopathy which obscured any further details of the intraocular structures (figure 1A). Ultrasound OS revealed a non-specific thickening of the choroid and hyper-reflective membranes near the posterior pole consistent with a persistent retinal detachment (figure 1B). The medical history was remarkable for metastatic breast carcinoma diagnosed 23 years previously in 1986. Subsequently, the patient underwent radiotherapy and breast-saving therapy. In 1994, the patient developed a metastasis to the pleura and received chemotherapy with tamoxifen for 5 years. This metastasis was thought to develop from the original cancer. The patient also received radiotherapy and surgery (complete excision of the infiltrated part of the pleura and reduction of the infiltrated breast) in the mean time. In 2004, the patient had a new metastasis in the pleura and again underwent excisional surgery of the metastasis and pleurodesis as well as radiotherapy for bone metastases.

Figure 1

(A) Clinical appearance of the phthisical eye with band keratopathy and corneal neovascularisation. (B) Sonography of the left globe showing an old bullous retinal detachment as well as hyper-reflectivity of the slightly thickened choroid.

Enucleation was performed subsequently. The procedure was unexpectedly difficult due to strong adhesions between the conjunctiva, the sclera and the posterior periocular tissues.

The tissue was fixed in formalin and submitted for ophthalmopathological evaluation. Macroscopic examination showed a small part (10×20 mm) and the remaining main part of the globe (23×17×14 mm). In order …

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