No abstract

and photophobia. CT scan of the orbits showed a soft tissue lesion at the apex of the right maxillary sinus associated with bony erosion extending into the orbit and the greater wing of the sphenoid (Fig. 1). A biopsy of the mass was obtained endoscopically. Pathologic analysis showed metastatic ductal mammary carcinoma (Fig. 2). Immunohistochemistry was positive for estrogen receptor (ER), progesterone receptor (PR), mammaglobin, CK 7, E-cadherin, and GCDFP-15, and negative for Her-2, CK 20, P63, TTF1, androgen receptor, PAX 8, cdx-2, and WT1. A PET/CT scan showed a right breast of 1.3 cm and multiple blastic and lytic lesions throughout the skele-ton. She subsequently developed liver and skin metastases. Her treatment consisted of radiation therapy and hormone therapies due to a performance status 2. The patient is currently alive and her visual symptoms have improved.It is unusual for breast cancer to metastasize to the paranasal sinuses. Whether the metastasis started in the sinus and eroded to the bone or vice versa is difficult to know, although from the imaging studies the former seems more likely. Regardless, her clinical presentation is extremely rare and it is interesting that this lead to the diagnosis of metastatic breast cancer with no other symptoms at initial presentation.A 42-year-old African female patient was sent to our department for a routine mammographic evaluation. She had a previous mammogram showing a well-defined low-density nodule in the upper quad-rant of her left breast, as well as two clusters of amorphous, pleomorphic microcalcifications in the inferior quadrants of this breast; a small well-defined nodule in the upper-outer quadrant of her right breast suggestive of an intramammary node was also seen. Ten years ago, while still living in Angola, patient reported a history of pruriginous lesions in her legs. She complained of chronic diarrhea as well.Mammographic and ultrasound evaluation of the left breast revealed well-defined hypoechoic nodule in the (a) (b) (c) Figure 2. Photomicrographs of the biopsy specimen showing metastatic ductal mammary carcinoma. Tumor cells were positive for estrogen receptor, progesterone receptor, and mammaglobin. (a) Hematoxylin and eosin stain, (b) immunostaining for progesterone receptor and (c) mammaglobin.