Commentary

Fox and colleagues present a 46-year-old woman with stable metastatic breast carcinoma who developed progressive unilateral vision loss. MRI suggested an optic nerve sheath meningioma. After surgical resection through a supraorbital approach, however, pathological analysis identified metastatic breast carcinoma. The case demonstrates that breast carcinoma can, on rare occasion, metastasize to the optic nerve and mimic an optic nerve sheath meningioma. Ten other cases reported in the literature are summarized. This diagnosis should be remembered in patients with breast cancer in their medical history, even when mastectomy was remote, as in this case, and when the patient is thought to be in remission. The poor prognosis associated with metastatic breast carcinoma to the optic nerve indicates a conservative surgical approach.