case_images: PMC10845133_01
case_images: Patient timeline.
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case_images: A 51-year-old female presented with a seven-month history of painful progressive periorbital edema and limitation of extraocular movements of the right eye ( Figure 1 ).
case_images: Clinical presentation and orbital findings at the initial appointment. (Clinical pictures) Right inferior dystopia with restriction in extraocular elevation and adduction of the right eye. (Orbit Imaging) Orbit axial and coronal T1 MRI showing post-gadolinium enhancing lesions (intra and extra-conal), with mass effect and inflammatory changes of orbital fat.
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case_images: f2
case_images: Physical examination revealed inferior dystopia of the right eye with limited horizontal movements on the right eye, without diplopia ( Figure 2 ). Similar discrete signal alterations were identified within the left orbit, mainly between the optic nerve and the medial and inferior rectus muscles ( Figure 2 ).
case_images: Orbital biopsy. (Supero-left) Orbital biopsy comprised soft tissue and lacrimal gland fragments with infiltration by lobular breast carcinoma. (Supero-right) Lacrimal gland showing discohesive cells with nuclear atypia, many resembling signet-ring cells and containing intracellular mucin. (Infero-left) Thickened fibrous tissue where isolated cells and cell rows of similar histologic characteristics are identified. (Infero-right) Infiltrating cells exhibiting immunoreactivity for estrogen receptors, suggesting breast origin.
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case_images: Histopathologic examination revealed moderately differentiated lobular carcinoma cells ( Figure 3 ). Immunohistochemical analysis revealed positivity for GATA3 and CK7 markers, with 100% of tumor nuclei expressing estrogen receptors (ER+) ( Figure 3 ).
case_images: Orbital findings after sixteen months of systemic treatment and clinical presentation in 08/2023. (Orbit Imaging) Orbit axial and coronal T1 MRI showing imaging improvement in the orbital region, marked by permeabilization of bilateral intraorbital fat. (Clinical pictures) Significant clinical improvement in ocular movement restrictions, with only partial limitation remaining on right adduction.
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case_images: f4
case_images: In May 2023, after sixteen months of systemic therapy, the patient achieved a complete response in both breasts and a significant improvement on orbital imaging, with practically complete permeabilization of bilateral intraorbital fat with only a minor residual metabolic fixation detected in the left orbit ( Figure 4 ). OI, with visual field recovery, and extraocular motility improved with only a mild limitation of right eye adduction ( Figure 4 ). OCT revealed an improvement in retinal ganglion cell layer thickness and normalization of the optic disc in the right eye.