BMJ Case Reports 2018; doi:10.1136/bcr-2017-223542
  • Unusual presentation of more common disease/injury

Orbital metastasis from an occult breast carcinoma (T0, N1, M1)

  1. Rui Proença2
  1. 1Department of Ophthalmology, Centro Hospitalar de Lisboa Central EPE, Lisboa, Portugal
  2. 2Centro de Referência de Oftalmo-Oncologia, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
  3. 3Ocular Pathology Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
  1. Correspondence to Dr Rita Pinto Proença, ritapintoproenca{at}, rita__proenca{at}
  • Accepted 6 April 2018
  • Published 11 April 2018


The authors report a case of an orbital metastasis from an occult breast carcinoma. A 66-year-old woman presented with a growing left orbital tumour. Orbital CT scan was consistent with lymphoma. However, ocular pathology revealed small neoplastic cells showing an ‘indian file pattern’ suggestive of metastatic carcinoma and immunohistochemistry was positive for CK7, CK CAM5.2 and oestrogen receptor. A systemic evaluation was then performed with mammogram, breast ultrasound and MRI considered normal. An exhaustive systemic evaluation revealed multiple bone lesions, a right axillary lymph node lesion, which presented the same pattern on pathology and immunohistochemistry, with no evidence of a primary tumour. A diagnosis of a metastatic lobular carcinoma of the breast (T0, N1, M1) was made and the patient was started on chemotherapy and adjuvant hormonal therapy.


  • Contributors RPP planned, conducted and wrote the manuscript. JF helped with data acquisition and analysis. MNB reviewed and edited the manuscript. RP helped with the writing and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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