眼症状で発見された乳癌副鼻腔転移例

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  • A Case of Breast Cancer Metastasis to the Paranasal Sinuses Presenting with Ocular Symptoms
  • ガン ショウジョウ デ ハッケン サレタ ニュウガン フクビコウ テンイレイ

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<p>Distant metastases from breast cancer are not uncommon, however, spread to the paranasal sinuses is fairly rare. Herein, we report a case of ethmoid sinus metastasis from breast cancer. A 74-year-old woman presented with diplopia 10 months after a right mastectomy for breast cancer. Subsequently, the symptoms of visual impairment, vomiting, headache and generalized fatigue appeared rapidly. She was referred to our department a month after the onset. CT examination revealed lesions in the right ethmoid sinus and orbital apex, with osteolysis of the medial orbital wall and skull base. MRI examination revealed a right ethmoid lesion which was visualized as a high intensity of T2-weighted images and as a low intensity on T1-weighted images. The findings were suggestive of malignant tumor of the right ethmoid sinus, and we performed endoscopic sinus surgery under general anesthesia. The right ethmoid sinus was filled with fragile tissue and the lamina papyracea was partially destroyed. The histological diagnosis made from a biopsy specimen was triple-negative invasive ductal carcinoma. Whole-body CT examination revealed metastases to the axillary lymph nodes, mediastinal lymph nodes, pleura, and both lungs. Her general condition deteriorated, she refused further therapy, and she died 4 months after the onset.</p><p>According to previous case reports of breast cancer metastasis to the paranasal sinuses, diplopia, proptosis, and visual impairment are the most frequent symptoms. These symptoms resemble those of invasive fungal rhinosinusitis, and for differential diagnosis, MRI and histological examination are useful. Otolaryngologists need to consider paranasal sinuses and the orbit as potential sites of metastasis from breast cancer.</p>

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