Abstract
Introduction. A range of traumatic, vascular, inflammatory, infectious, and neoplastic processes can affect the orbit and its structures. In the area of otolaryngology, the rhino-orbital-cerebral involvement of invasive fungal rhinosinusitis can affect the orbit, which may look like initially a rhinosinusitis or even mimic malignancy. Case Presentation. Female patient, 32 years old, with headache and ocular proptosis. She was using prednisone in immunosuppressive doses for a year and had breast cancer treated three years earlier. The initial CT scan showed opacification of the sphenoid and ethmoid sinuses, left intraorbital involvement and contrast impregnation in the cavernous sinus. The biopsy resulted positive for invasive ductal carcinoma of the breast. Discussion. The initial CT scan of our patient showed both signs of early changes of invasive fungal rhinosinusitis (IFR) and possible metastatic involvement. The intracranial extension and ocular involvement are usually the most common signs of IFR (first hypothesis). Among metastases at the orbit and the eye, breast and lung carcinomas are the most frequent. Conclusion. Although several studies on the differential diagnosis of orbital lesions exist, especially when it concerns the involvement of the nasal cavity, the diagnosis by imaging is still a challenge.
Highlights
A range of traumatic, vascular, inflammatory, infectious, and neoplastic processes can affect the orbit and its structures
Breast carcinoma can metastasize to the nasal cavity and orbit and manifest with unspecific symptoms
This paper aims to report a case of orbital metastasis of breast cancer mimicking invasive fungal rhinosinusitis
Summary
Paranasal sinuses and orbit are potential sites for metastases. Distant metastases of skull base occur in 4% of patients with cancer and the most common primary sites are breast, prostate, and lung. Metastasis to the orbit is rare, it must be considered in the differential diagnosis of any patient with history of cancer, presenting with ophthalmic symptom [1]. Considering all types of orbital metastasis, in 19%, there is no history of cancer when the patient presents with ophthalmic symptoms and, in 10%, the primary site remains unclear, despite systemic evaluation. A careful history and physical examination, with special attention to the orbit and eye attachments, are necessary to identify subtle orbital anomalies that might otherwise be ignored or mistakenly contributed to a nonorbital process In this context, we can mention, in the area of otolaryngology, the rhino-orbital-cerebral involvement of invasive fungal rhinosinusitis, especially in immunocompromised patients [4]. This paper aims to report a case of orbital metastasis of breast cancer mimicking invasive fungal rhinosinusitis
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