What happened, in summary

A woman in her 70s experienced worsening blurred vision in her left eye and progressive narrowing of her right eye opening for 6 months. She also lost her sense of smell, had occasional frontal headaches, and lost weight and appetite. By the time she was assessed, there was no light perception in her left eye. Her right eye still had useful vision, although upward movement was restricted.

A breast examination found severe retraction of the left breast, tethered skin, an inverted nipple with a dry ulcer, and several enlarged lymph nodes in the left armpit. Further assessment showed that the cancer involved both the breast and a sinonasal mass. Biopsies from the breast and sinus confirmed invasive ductal carcinoma that was estrogen receptor-positive and progesterone receptor-positive.

The breast cancer had already spread to the ethmoid sinuses, with extension into the frontal sinuses and both eye sockets. Multiple skull bones were also involved, including the frontal, parietal and occipital bones, the sphenoid region, the jaw and the pterygoid bones. CT imaging did not show spread to the lungs, liver or gynecologic organs. This made the diagnosis stage IV breast cancer with an unusual sino-orbital presentation.

Treatment was palliative and focused on controlling the cancer, relieving local symptoms and preserving the vision that remained. She received 3 cycles of fluorouracil, epirubicin and cyclophosphamide, followed by 3 cycles of paclitaxel. She then received external radiotherapy, 40 Gy in 10 fractions.

At the latest follow-up 1 year later, her right-eye visual acuity remained good. She had tolerated chemoradiotherapy without complications, and neuroimaging showed no progression of the sino-orbital metastases.