Zusammenfassung
Während die Metastasierung des Mammakarzinoms in Strukturen des Auges aus gynäkologischer Sicht eine Rarität darstellt, sind Malignome der Brust bei Nachweis von okulären Metastasen der häufigste Primarius. Besonders die Tatsache, dass in 3 % der Fälle die okuläre Metastase als Erstmanifestation eines bis dahin okkulten Mammakarzinoms imponiert [[1]], bedarf einer dahingehenden Sensibilisierung der Fachdisziplinen.
Der vorliegende Fall beschreibt den Krankheitsverlauf einer Patientin mit Erstmanifestation eines bis dahin unbekannten Mammakarzinoms in Form einer retrobulbären Metastase. Bezeichnend ist die lange zeitliche Latenz bis zur endgültigen Diagnose des Mammakarzinoms, die letztlich erst nach bioptischer Sicherung des retrobulbären Tumors histologisch erfolgte.
Abstract
From the gynecologic point of view ocular metastases are uncommon and mostly unknown, while malignancies of the breast are the most common primary tumor when metastases are found in the eye. Even more unknown is the fact that in 3 % of breast cancer cases the first clinical manifestation is a tumor in the eye [[1]]. We describe the case of a 64-year-old woman who has been treated by her ophthalmologists for increasing motility disorders of the eye. The woman had a known endocrinologic orbitopathy. The worsening of her symptoms was at first associated with the endocrinologic orbitopathy. But the initiated corticoid treatment did not improve the symptoms: they even worsened. Subsequently further diagnostic tests were done in the course of which a retrobulbar tumor was diagnosed. The histology suggested the primary tumor was breast cancer. The described procedures took one year, after which the woman was referred to the gynaecological department, where a mammography led to the final diagnosis of breast cancer.
Due to the high incidence of breast cancer the total number of women who first see an ophthalmologist for vision problems caused by a tumor in the eye is not negligible.
This shows that both sides - the gynecologists and ophthalmologists - should be sensitised to the fact that the primary of any tumor of the eye can be breast cancer, in order to direct treatment more quickly to the cause of the cancer, thus leading to a better curative success.
Schlüsselwörter
Retrobulbäre Metastase - choroidale Metastase - Mammakarzinom - okkultes Mammakarzinom
Key words
Breast cancer - retrobulbar metastasis - ocular metastasis
Literatur
-
1 Demicri H, Shields C L, Chao A-N, Shields J A. Uveal Metastasis from Breast Cancer in 264 Patients. Annual Meeting of American Academy of Ophthalmology. Orlando, FL, October. 2002
-
2
Kamby C, Ejlertsen B, Andersen J, Birker N E, Rytter L, Zedeler K, Rose C.
The pattern of metastases in human breast cancer - Influence of systemic adjuvant therapy and impact on survival.
Acta Oncology.
1988;
27
715-719
-
3
Nelson C C, Hertzberg B S, Klinworth G K.
A histopathologic study of 716 unselected eyes in patients with cancer at the time of death.
Am J Ophthalmol.
1983;
95
788-793
-
4
Bloch R S, Gartner S.
The incidence of ocular metastatic carcinoma.
Arch Ophthalmol.
1971;
85
673-675
-
5
Mewis L, Young S E.
Breast carcinoma metastatic to the eye. Analysis of 67 patients.
Ophthalmology.
1982;
89
147-151
-
6
Wiegel T, Kreusel K M, Bornfeld N, Bottke D, Stange M, Foerster M H, Hinkelbein W.
Frequency of asymptomatic choroidal metastasis in patients with disseminated breast cancer: results of a prospective screening programme.
Br J Ophthahalmol.
1998;
82
1159-1161
-
7
Merrill C F, Kaufmann D I, Dimitrov N V.
Breast cancer metastatic to the eye is a common entity.
Cancer.
1991;
68
623-627
Dr. med. Barmak Adhami
Frauenklinik für Gynäkologie und Geburtshilfe der Universitätsklinik Aachen
Pauwelsstraße 30
52074 Aachen
Email: badhami@ukaachen.de
