Orbital metastasis or idiopathic orbital pseudotumor? - A case report from a patient previously diagnosed with primary breast cancer

Sep 21, 2026

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Cancer metastatic to the orbit can be difficult to distinguish from idiopathic orbital pseudotumor during clinical and radiological evaluation. This case report presents diagnostic clinical findings, imaging features, differential diagnosis, and treatment considerations for orbital neoplasms of unknown origin. A 63-year-old woman with orbital swelling, ocular pain, globe displacement, chemosis, and progressive vision loss initially received an idiopathic diagnosis; steroids were ineffective. History of double primary breast cancer prompted orbital biopsy, supporting orbital metastasis as the most likely cause when symptoms and imaging were assessed together.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Introduction

Presentation of case

Discussion

Conclusion

International Journal of Surgery Case Reports 120 (2024) 109845 Contents lists available at ScienceDirect International Journal of Surgery Case Reports journal [homepage:](homepage: www.elsevier.com/locate/ijscr)[ www.elsevier.com/locate/ijscr](homepage: www.elsevier.com/locate/ijscr) | Case report
Orbital metastasis or idiopathic orbital pseudotumor? A case report from a
patient previously diagnosed with primary breast cancer Giorgio Barbera a , Vittorio Faverob , Guido Lobbiac, * , Riccardo Nocinia
a Head and Neck Department, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani, 1, 37126 Verona, VR, Italy b University of Padua – Section of Maxillofacial Surgery, Department of Neuroscience, Italy
c Resident in Maxillofacial Surgery, University of Verona, Head and Neck Department, Piazzale Ludovico Antonio Scuro 10, 37134 Verona, VR, Italy | | | | --- | --- | --- | | A R T I C L E I N F O | | A B S T R A C T | | Keywords:
Orbital metastasis Breast cancer Metastatic pattern Case report | | Introduction: Cancer metastatic to the orbit may be difficult to distinguish from idiopathic orbital pseudotumor at clinical and radiological examination. This case report describes clinical, radiological features, differential diagnosis, and treatment options for orbital neoplasms of unknown origin.
Presentation of case: A 63-year-old woman presented to our Unit because of orbital swelling, ocular pain, globe displacement, conjunctival chemosis, and progressive vision loss. The patient had been seen by an ophthalmologist at another hospital. The initial diagnosis was idiopathic orbital pseudotumor. Steroid therapy did not resolve clinical symptoms. Her medical history held decisive clues: ten years before this presentation she had been diagnosed with double primary breast cancer, invasive lobular breast carcinoma, and invasive ductal breast carcinoma. Orbital biopsy was performed for differential diagnosis.
Discussion: Considering the rapid onset and severity of symptoms, the radiological features of the orbit, and the patient's medical history of breast cancer, orbital metastasis should have been the most likely diagnosis. Orbital biopsy was performed because of the history of multiple primary cancers and because metastatic origin had to be determined to define the best treatment strategy.
Conclusion: Biopsy is necessary under specific circumstances in the diagnosis of orbital metastasis, especially when presentation is ambiguous and when differential diagnosis is challenging. A patient's medical history may hold vital clues to correct diagnosis. | 1. Introduction Orbital metastases (OM) account for 4 to 8 % of orbital neoplasms. In almost 40 % of cases, orbital metastases derive from breast carcinoma [1,2], making breast cancer the most common malignancy to spread to the orbit [2]. It has been vastly observed that breast cancer is a rather heterogenous disease: cancers can differ in biology, responsiveness to therapy, survival rate, and metastatic behavior. The two breast cancer subtypes most often diagnosed are invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). ILC accounts for 10 to 15 % of all breast cancers, while IDC accounts for 50 to 70 %. ILC is known to be less respondent to neoadjuvant therapy than IDC [3]. The risk of death at 10 years is 50 % higher for ILC patients than for those affected by IDC [4]. Finally, the two types of breast cancer metastasize differently to the orbit: a metanalysis of 72 case reports by Raap et al. found that 15 % of orbital metastases were due to ILC whereas only 3 % were related to IDC [5]. In addition, ILC has a five times greater propensity to metastasize to the orbit than IDC [2,5]. Regarding unusual metastatic sites, the orbit accounts for 25 %, followed by the stomach (23 %), and the rectum (8 %), demonstrating the peculiar organotropism that ILC has for orbital tissues [5]. While clinical history and imagin

FAQs

Why is orbital metastasis difficult to distinguish from idiopathic orbital pseudotumor?

Orbital metastases may resemble idiopathic orbital pseudotumor on both clinical assessment and radiological examination, creating diagnostic ambiguity.

What symptoms and initial diagnosis did the patient present with?

A 63-year-old woman presented with orbital swelling, ocular pain, globe displacement, conjunctival chemosis, and progressive vision loss. The initial diagnosis at another hospital was idiopathic orbital pseudotumor, and steroid therapy did not resolve symptoms.

When is biopsy necessary for diagnosing orbital metastasis?

Biopsy is necessary in specific circumstances, especially when the presentation is ambiguous and differential diagnosis remains challenging. The patient’s medical history was identified as a key clue, supporting the metastatic origin and guiding the best treatment strategy.

Sep 21, 2026

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