case_images: PMC9149480_01
case_images: a Ptosis of the right eye at presentation. b Sagittal T1WI image shows diffuse bulky enlargement of the superior rectus and levator palpebrae superioris muscle complex ("asterisk"). It shows involvement of its tendinous insertion ("yellow arrow"); coronal T2WI (c) and coronal FLAIR (d) images show similar yet smaller involvement of the lateral rectus muscle ("asterisks").
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case_images: PMC9149480_01_cro-0015-0423-g01.jpg
case_images: F1
case_images: Magnetic resonance imaging without contrast of the brain and orbit revealed no brain abnormalities, but there was a marked enlargement of the superior rectus and levator palpebrae superioris muscle complex; also lateral rectus muscle was affected with mild proptosis (Fig. 1).
case_images: a Histopathologic examination of the right orbital biopsy shows invasion of striated muscle fibers by neoplastic cells (H&E stain, x100). The tumor cells are immunostained with antibodies directed against CK AE1\AE3, GATA3, ER, PR, and HER2/neu, thus confirming their breast origin. b Neoplastic cells expressing cytokeratin AE1\AE3 (IHC for CK AE1\AE3, x200). c Neoplastic cells expressing GATA3 (IHC for GATA3, x200). d Diffuse positivity for ERs (IHC for ER, x200). e Diffuse weak positivity for PRs (IHC for PR, x200). f Negativity for HER-2 receptors (IHC for HER-2/neux200). IHC, immunohistochemistry.
case_images: cro-0015-0423-g02.jpg
case_images: PMC9149480_01_cro-0015-0423-g02.jpg
case_images: F2
case_images: For diagnostic confirmation, an open biopsy from superior rectus muscle was taken and showed invasion of striated muscle fibers by neoplastic cells (Fig. 2). ER and PR were positive, but human epidermal growth factor receptor-2 (HER-2/neu) was negative (Fig. 2).
case_images: a Ophthalmological examination during follow-up reveals mild upper lid ptosis of the right eye with regression of local redness. Improvement of ocular movements in dextroversion (b), dextroelevation (c), and elevation has been noticed (d).
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case_images: PMC9149480_01_cro-0015-0423-g03.jpg
case_images: F3
case_images: Follow-up was done over a period of 28 months, from the initial diagnosis of metastases to the time of this report, and found out that ptosis has partially disappeared and elevation of the right eye has totally recovered (Fig. 3).