Orbital metastasis is a rare event, and metastatic disease affecting the extraocular muscles is an even less frequent complication of solid tumors. Herein, we report an unusual case of ptosis as the initial presentation of an invasive breast cancer. A 68-year-old woman presented with III and VI partial nerve paresis, secondary to a compressive retrobulbar mass. Magnetic resonance imaging revealed an infiltrative lesion involving the extraocular muscles. Tissue biopsy yielded a result compatible with metastasis to the orbit, with immunohistochemistry analysis suggesting breast as the primary organ. Mammography identified an area of architectural distortion; stereotactic wire-guided biopsy confirmed the result of the previous orbital biopsy. A positron emission tomography scan demonstrated disseminated disease. Palliative chemotherapy with bone-modulating agents and subsequent hormonal therapy was proposed. Unfortunately, the patient did not respond to therapy and died 38 months after diagnosis.
Aged ; Biopsy ; Breast Neoplasms* ; Breast* ; Diagnosis ; Drug Therapy ; Female ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Mammography ; Muscles* ; Neoplasm Metastasis ; Oculomotor Muscles ; Orbit ; Orbital Neoplasms ; Paresis ; Positron-Emission Tomography

Background: Pregnancy is associated with both new-onset and exacerbation of pre-existing arrhythmias, particularly supraventricular tachycardia, with increased maternal and fetal risks and with added concerns on the safety of the available drug therapy and catheter ablation techniques. These are often withheld, with worse outcomes, and lead to challenging decisions in the approach to pregnant women with refractory supraventricular arrhythmias.Case presentation: We present a case of a 28-year-old 37-weeks pregnant woman with symptomatic, almost incessant, atrial tachycardia causing tachycardia-induced cardiomyopathy, refractory to medical therapy, that evolved in acute cardiac failure and needed emergency cesarian delivery. The patient was afterward submitted to catheter ablation therapy, with an electrical isolation of the ectopic foci on the lower left pulmonary vein with radiofrequency and total suppression of the arrhythmia. The patient and infant were discharged clinically well and during follow-up the patient was asymptomatic, without recurrence of tachycardia and with complete recovery of left ventricle function. Conclusions This case highlights the challenges in the treatment of this special population with a stepwise medical approach that proved ineffective and clinical deterioration requiring termination of pregnancy and catheter ablation in the postpartum period, with a successful maternal and fetal outcome.