Metastatic Breast Cancer Presenting as a Subconjunctival Mass
A 41-year-old woman visited our clinic complaining of conjunctival injection and a foreign body sensation in the left eye, with no other systemic symptoms. She was treated with antibiotics and steroid eye solutions at a local eye hospital, and was later referred to our clinic because of disease progression. She had a history of breast cancer and had been treated 2 years previously with modified radical mastectomy followed by adjuvant radiotherapy (50.4 Gy, 28 cycles; 1,411.2 Gy in total) and six cycles of chemotherapy (cyclolphosphamide, methotrexate, and 5-fluorouracil). Pathological examination revealed an invasive ductal carcinoma (stage T2N1M0) that was moderately differentiated, negative for estrogen receptor/progesterone receptor expression, cytokeratin 5/6, and c-erb-B2, and positive for p53 (positive reaction in more than 51% of tumor cells) and Ki-67 expression (labeling index of 31% in tumor cells). Axillary lymph node metastasis was found in 1 out of 18 resected nodes.\nThe best-corrected visual acuity was 20/20 in the right eye and 16/20 in the left eye, with an intraocular pressure of 9 mm Hg and 7 mm Hg in the right and left eyes, respectively. A slit lamp bi-microscopic examination showed a cystic mass under the temporal bulbar conjunctiva, associated with dilated overlying conjunctival vessels (). The anterior chamber, lens, and media were clear, no signs of choroid or retina involvement were observed, and extraocular muscle movement was not limited. Informed consent was obtained from the patient before the surgery. An excisional biopsy revealed a poorly differentiated adenocarcinoma positive for carcinoembryonic antigen and p53, and negative for gross cystic disease fluid protein 15, thyroid transcription factor-1, and estrogen receptor (). Positron emission tomography examination for systemic malignancy revealed multiple bony metastasis with bone marrow infiltration, multiple muscular and subcutaneous metastasis, multiple lung metastasis with metastatic subcarinal and left hilar lymph nodes, mesenteric metastasis, and pancreatic metastasis.