Surgery Relieved Eye Symptoms From Metastatic Breast Cancer

What happened, in summary

A 45-year-old woman sought care after two months of progressive protrusion of her right eye, double vision, and eye pain. Examination also found a firm 7 × 4 × 3 cm right breast mass with palpable axillary and supraclavicular lymph nodes. MRI showed a large sphenoorbital tumour displacing the optic nerve and eye muscles and invading the sphenoid wing and orbital wall. Further imaging identified bilateral pulmonary nodules and lytic lesions in the right scapula and proximal humerus. Biopsy of the breast mass showed invasive carcinoma with mucinous features. She underwent a right pterional craniotomy with excision of the sphenoorbital tumour and orbital decompression. Pathology confirmed mucinous carcinoma that was mammaglobin-positive and GATA3-positive, consistent with breast origin. Surgery produced immediate resolution of the eye protrusion, and her double vision improved without new neurological deficits. Whole-brain radiation, anthracycline- followed by platinum-based chemotherapy, monthly zoledronic acid, and later hormone therapy were planned for the metastatic disease. The patient declined all further treatment. At six-month follow-up, she had no new symptoms and retained the symptomatic improvement achieved through surgery. She continued to live with metastatic breast cancer involving the orbit, lungs, and bone while choosing not to pursue additional systemic or radiation treatment.