乳腺癌是一个重要的全球健康问题,导致妇女的大量发病率和死亡率。激素受体阳性(HR+)/HER2阴性(HER2-)乳腺癌占相当大比例的病例。在管理方面取得了重大进展。CDK4/6抑制剂(CDK4/6is)是一种新的靶向治疗,已证明其在辅助治疗中的疗效。高级和转移性设置。富含雌激素的小叶乳腺癌的倾向,比如眼周组织和眼眶脂肪,可以解释他们的眼眶转移倾向。目前这些病例的治疗策略主要是姑息治疗,预后仍然很差。本文介绍了一例51岁女性进行性右眶周水肿的独特病例,疼痛,和有限的眼运动。影像学检查显示双侧眶内和眶外浸润,这是活检的。组织病理学分析显示轻度慢性炎症浸润,纤维组织增厚,小叶癌细胞中分化,GATA3和CK7标记阳性,100%的肿瘤细胞核表达雌激素受体(ER+)。系统评估显示,两个乳房均有多中心结节形成。进一步的诊断评估揭示了HR/HER2-双侧小叶乳腺癌伴同步双侧眼眶转移。全身治疗开始于每天两次的abemaciclib150mg和每天一次的来曲唑2.5mg。然而,该方案因毒性而中断.两周后,与来曲唑一起使用减少的abemaciclib剂量(100mg,每天两次)恢复治疗,合理的宽容。初步诊断为无法手术的转移性癌症近两年后,患者仍采用相同的全身治疗方案,无侵袭性疾病的征象.该病例报告是首例双侧小叶乳腺癌双侧眼眶转移患者。显示对联合使用abemaciclib和来曲唑的一线治疗方案的令人印象深刻和持续的反应。还介绍了有关乳腺癌双侧眼眶转移的文献综述。
Breast cancer is a significant global health concern, contributing to substantial morbidity and mortality among women. Hormone receptor-positive (HR+)/HER2-negative (HER2-) breast cancer constitutes a considerable proportion of cases, and significant advancements have been made in its management. CDK4/6 inhibitors (CDK4/6is) are a new targeted therapy that has demonstrated efficacy in adjuvant, advanced and metastatic settings. The propensity of lobular breast carcinomas for estrogen-rich sites, such as periocular tissues and orbital fat, may explain their tendency for orbital
metastases. Current treatment strategies for these cases are predominantly palliative, and the prognosis remains poor. This article presents a unique case of a 51-year-old female with progressive right periorbital edema, pain, and limited ocular motility. An imaging work-up showed bilateral intra and extraconal orbital infiltration, which was biopsied. The histopathologic analysis disclosed mild chronic inflammatory infiltrate with thickened fibrous tissue and moderately differentiated lobular carcinoma cells, positive for GATA3 and CK7 markers, with 100% of tumor nuclei expressing estrogen receptors (ER+). A systemic evaluation showed a multicentric nodular formation in both breasts. Further diagnostic assessments unveiled an HR+/HER2- bilateral lobular breast carcinoma with synchronous bilateral orbital
metastases. Systemic treatment was initiated with abemaciclib 150mg twice daily and letrozole 2.5mg once a day. However, this regimen was interrupted due to toxicity. After two weeks, treatment was resumed with a reduced abemaciclib dose (100mg twice daily) alongside letrozole, with a reasonable tolerance. Nearly two years after the initial diagnosis of inoperable metastatic cancer, the patient remains on the same systemic treatment regimen with no signs of invasive disease. This case report is the first of a patient presenting with bilateral orbital
metastases from bilateral lobular breast cancer, showing an impressive and sustained response to a first-line treatment regimen combining abemaciclib and letrozole. A literature
review on bilateral orbital
metastases from breast cancer is also presented.