Nodular Scleritis Revealing Metastasis of Breast Cancer: Diagnosis Not to Be Neglected

Abstract

We report the case of ocular metastasis in a 48-year-old woman presenting left eye redness and pain. The patient was followed in another health institution for nodular scleritis and received systemic corticosteroids with moderate improvement. Medical history revealed that she was diagnosed three years ago with invasive ductal carcinoma of the left breast treated by tumorectomy with ganglion dissection. An ophthalmological examination found a hard scleral nodule with vascular architectural disorganization. A biopsy was performed, and the histopathological study revealed the presence of secondary tumor proliferation of poorly differentiated carcinoma of mammary cancer. This case report shows the fact that any unusual ocular presentation, even one simulating anterior scleritis, in a patient with a history of breast cancer should raise suspicion of metastasis.

Surgically-induced necrotising scleritis complicated byNocardiainfection following routine cataract surgery

“…Similarly, Taban et al describe a patient with anterior scleritis as a presenting feature of metastatic adenocarcinoma of the lung, again resistant to treatment 23. The condition has also been reported accompanying breast carcinoma 24. Abnormal immune function in patients with malignancy may contribute to the development of inflammatory conditions such as scleritis, in addition to tumour cell infiltration.…”

Ocular Tumor in a Woman With Breast and Kidney Carcinomas

“…Metastasis to the uvea commonly arises within the choroid (90% of cases) because of its rich vascularity, but metastasis to the sclera is exceptionally rare. [1][2][3] Confirmatory testing with fine-needle aspiration biopsy (choice A) is not required since there is no suspicion for choroidal malignancy. Treatment with plaque radiotherapy (choice B) is not appropriate since this is not a malignant tumor posing risk of growth or metastasis.…”

“…However, in this case, the OCT showed the lesion completely confined to the sclera, with no choroidal component and causing elevation and thinning of the overlying choroid. Metastasis to the uvea commonly arises within the choroid (90% of cases) because of its rich vascularity, but metastasis to the sclera is exceptionally rare . Confirmatory testing with fine-needle aspiration biopsy (choice A) is not required since there is no suspicion for choroidal malignancy.…”

A case of nodular episcleritis mimicking a solitary giant episcleral mass

“…2,3 In our case, the patient was only presented by an enormous size of deep red episcleral nodule absence of any evident discomfort, more interestingly, no evidence from the laboratory test was found to attribute it to any systemic disease; Multiple imaging systems including UBM, MRI, OCT had been then used in this case, which revealed an episcleral nodule with mild tissue edema in the UBM images and a space-occupying lesion in the superior sclera through MRI. However, some scleral tumor including fibrous histiocytomas, 4 episcleral neurofibroma 5 and ocular metastasis 6,7 may possess the similar symptom and imaging manifestation as nodular anterior episcleritis, increasing the risk of misdiagnosis. Considering this, it is essential to establish a histological diagnosis which will define the next stage in the management plan.…”