QUIZ: No. 3, 25/01/2026

QUIZ No. 3

Diagnosis – Left intraconal metastasis with disseminated skeletal metastases – likely from carcinoma breast

Findings - Chest X-ray - Absent left breast shadow, consistent with post-mastectomy status. No focal lung mass. CT Brain - Multiple lytic calvarial lesions, largest in the left frontal bone, with destruction of the inner table and minimal soft tissue component consistent with skull metastases. CE-MRI brain with orbits shows a well-circumscribed left intraconal orbital lesion causing compression of the optic nerve, with normal extraocular muscles. The lesion demonstrates heterogeneous post-contrast enhancement without gross orbital wall destruction. Additionally, multiple enhancing calvarial marrow lesions are noted along with a hyperintense lesion in the C2 vertebral body, findings suggestive of disseminated skeletal metastases.

Discussion

Carcinoma breast is the most common primary malignancy to metastasise to the orbit, particularly in elderly females. Breast cancer accounts for approximately 30-50% of orbital metastases.

Orbital metastases from breast carcinoma may appear as well-defined or infiltrative lesions, often showing heterogeneous enhancement due to variable tumor cellularity, necrosis, or fibrosis.

The predilection of breast carcinoma to metastasize to the orbit is thought to be related to the hormone sensitivity of these tumours, with estrogen produced by periorbital adipose tissue creating a favourable microenvironment for metastatic seeding.

Systemic therapy with hormonal agents or chemotherapy, supplemented by palliative radiotherapy for symptomatic orbital and skeletal metastases.                               

Teaching Pearl:

Ø  Orbital metastases from breast carcinoma may present as well-defined, heterogeneously enhancing lesions.

Ø  Orbital metastases from breast carcinoma frequently arise from hormone receptor–positive tumours, and some authors suggest that local estrogen receptor expression.