|Year : 1979 | Volume
| Issue : 1 | Page : 23-24
Metastatic carcinoma breast in lateral rectus muscle
Anna Thomas1, Molly Mathew Oommen1, Doss Sudarsanam2, AD Singh3
1 Department of Ophthalmology, Christian Medical College, Vellore, India
2 Department of Pathology, Christian Medical College, Vellore, India
3 Department of Radiotherapy, Christian Medical College, Vellore, India
Department of Ophthalmology, Christian Medical College, Vellore
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Thomas A, Oommen MM, Sudarsanam D, Singh A D. Metastatic carcinoma breast in lateral rectus muscle. Indian J Ophthalmol 1979;27:23-4
|How to cite this URL:|
Thomas A, Oommen MM, Sudarsanam D, Singh A D. Metastatic carcinoma breast in lateral rectus muscle. Indian J Ophthalmol [serial online] 1979 [cited 2020 Aug 3];27:23-4. Available from: http://www.ijo.in/text.asp?1979/27/1/23/31540
According to Duke-Elder metastasis of tumours to orbit are less frequently encountered than intraocular metastasis. The ratio given by Ferry is 1:8 and Brihaye 1:5. Metastasis occurs only on rare occasions as the first indication of the systemic disease.
Two cases of carcinoma breast were reported by Wintersteiner and by Bedford and Daniel. Ashton and Morgan reported 2 further cases. Since metastasis in extraocular muscles is of such rare incidence we thought of reporting this case which was referred to us from our radiotherapy department for "a fleshy mass in the left sclera."
| Case Report|| |
Miss G, a 40 year old female was referred to us in July 1977 by the Radiotherapy Department for a fleshy mass in the left sclera of a month's duration. She had been diagnosed to have carcinoma of the right breast in June 1975 for which a radical mastectomy and bilateral oopherectomy were done in June 1975. In 1976 she was diagnosed to have secondaries in the pleura for which she was put on Endoxan and Sustanon.
On examination her vision was 6/6 and J 1 in each eye with glasses. In the left eye there was a linear fleshy mass of 5 mm breadth on the temporal side. It extended 7 mm from the limbus to the orbit. The posterior margin was not visible. The mass was not painful or tender.
Fundus and slit lamp examination did not reveal any abnormalities. Regional lymph glands were not palpable. A biopsy excision was planned but on incising the conjunctiva and tenons capsule the lateral rectus was found to be infiltrated with tumour mass giving the muscle a greyish white beaded appearance. A small bit about 3 mm in length was excised and sent for histopathology.
Histopathology: Section showed hyaline connective tissue infiltrated extensively by clumps of rounded epithelial cells with much pleomorphism and mitotic activity. [Figure - 1][Figure - 2]
Impression: Poorly differentiated carcinoma-lateral rectus region of left eye-consistent with secondary from breast.
She was given external radiation therapy to the left eye and put on Fndoxan 100 mg daily. After completing external radiation and chemotherapy we saw her again in December 1977 when vision in the right eye was 6/6 and J I with glasses and that in the left eye 6/36 not improving with glasses. The growth on the lateral aspect had completely regressed and the conjunctiva over the lateral rectus was not raised and there was no restriction of movement of the eye ball. The cornea was dry and lustreless and sensation diminished.
| Discussion|| |
Carcinomatous metastasis to extraocular muscles are extremely rare and that from cancer breast, is still more so. Ashton and Morgan attributes the rare incidence of secondary tumours in voluntary muscles to the constant movement of the muscles which prevents the lodgement of neoplastic cells. Another probable factor put forth by them is an unsuitable chemical environment for their continued growth after the tumour cells are lodged in the extraocular muscles.
In the case reported here the site of the primary tumour was known, so a provisional diagnosis of secondary from carcinoma breast was made. But the involvement of the whole length of the lateral rectus was not suspected.
In intraocular tumours the more common involvement of left eye is attributed to the more direct pathway by the left carotid artery, Parson. In view of this it is interesting to note that though the right breast was the one involved, the metastatic deposit was found in the left lateral rectus, the blood supply of which come from the lacrimal artery which is a branch of the ophthalmic artery.
In conclusion, it is important to rule out secondary deposits in the eye and orbit in cases of primary carcinoma elsewhere in the body.
| References|| |
Ashtota, N., and Morgan. G., 1974, Brit. J. Ophthal., 58, 112.
Bedford, P.D., and Daniel, P.M., 1960, Amer. J. Ophthal., 49,
Brihaye, 1968, Neuro•Chirurgic, 14,
410 cited by Duke-Elder.
Duke-Elder, S., 1974, System of Ophthalmology,
Vol. X111, P 1144.
Ferry, 1967, Int. Ophthc,l Clin., 7,
615 cited by Duke-Elder.
Parsons, 1905, cited by Duke-Elder.
Wintersteiner, H., 1899, Klin. Mbl. Augenheilk, 37,
331 cited by Ashton and Morgan.
[Figure - 1], [Figure - 2]