Bilateral extraocular muscle metastasis from primary breast cancer

Abstract

Abstract-Background:In retrospective studies, estimates of hastened dying among seriously ill patients range from Ͻ2% in one national survey to as much as 20% in end-stage disease cohorts. Objective: To examine, in prospective studies, dying patients in the months before death, in order to understand the wish to die. Methods: Patients with advanced ALS with a high likelihood of death or need for tracheostomy within 6 months were identified. Patients were assessed monthly with an extensive psychosocial interview, including a diagnostic interview for depression. Family caregivers were interviewed on the same schedule and also after patient deaths. Results: Eighty patients with ALS were enrolled, 63% of eligible patients; 53 died over follow-up. Ten (18.9%) of the 53 expressed the wish to die, and 3 (5.7%) hastened dying. Patients expressing the wish to die did not differ in sociodemographic features, ALS severity, or perceived burden of family caregivers. They were more likely to meet criteria for depression, but differences were smaller when suicidality was excluded from the depression interview. Patients who expressed the wish to die reported less optimism, less comfort in religion, and greater hopelessness. Compared with patients unable to act on the wish to die, patients who hastened dying reported reduction in suffering and increased perception of control over the disease in the final weeks of life. Conclusion: These findings suggest caution in concluding that the desire to hasten dying in end-stage disease is simply a feature of depression.

Bilateral Metastases to Extraocular Muscles from Lobular Breast Carcinoma

“…This complies with the general view that skeletal muscle is considered an uncommon site of secondary growth of solid tumors, while they are rather frequent in malignant lymphomas and leukemias [3]. Metastastic carcinoma to the extraocular muscles is extremely rare [1,7], accounting for 9% of all metastases to the orbit [11]. Only 4 cases of bilateral orbital metastases affecting all the extraocular muscles, as in our patient, have been reported [5][6][7]11].…”

“…Metastastic carcinoma to the extraocular muscles is extremely rare [1,7], accounting for 9% of all metastases to the orbit [11]. Only 4 cases of bilateral orbital metastases affecting all the extraocular muscles, as in our patient, have been reported [5][6][7]11]. The first case report was that of Bedford et al [7] (table 1).…”

“…The other three cases [5,6,11], diagnosed by an MRI or a CT scan, showed infiltration of the extraocular muscles, and the diagnosis was confirmed by a biopsy. In two cases, the metastases originated from a poorly differentiated carcinoma [6,11], in one case from a lobular carcinoma [5], while in the case reported by Spitzer et al the patient had manifestations of extraocular metastasis 2 months before the diagnosis of breast cancer [6]. The most common complaints are: orbital pain [3,5], decreased vision [5] and binocular diplopia [3][4][5]12].…”

“…Although in that case the patient presented with ophthalmoplegia and exophthalmia [7], the metastases were confirmed from the autopsy and it was due to scirrhous carcinoma [7]. The other three cases [5,6,11], diagnosed by an MRI or a CT scan, showed infiltration of the extraocular muscles, and the diagnosis was confirmed by a biopsy. In two cases, the metastases originated from a poorly differentiated carcinoma [6,11], in one case from a lobular carcinoma [5], while in the case reported by Spitzer et al the patient had manifestations of extraocular metastasis 2 months before the diagnosis of breast cancer [6].…”

“…The most common complaints are: orbital pain [3,5], decreased vision [5] and binocular diplopia [3][4][5]12]. The differential diagnosis between metastases and other diseases is of crucial importance because non-specific complaints with regard to the eye, which consist of extraocular motility problems and irritation, are initially all believed to be due to an inflammatory etiology [9] or to thyroid disease manifestation [11]. Metastases to the extraocular muscles can be detected by ultrasonography [4], magnetic resonance imaging (MRI) and CT scan.…”