A 39-year-old
Asian woman, with a known
history of
breast cancer, presented with a gradual onset of painless reduction in
vision in both
eyes. Examination revealed
visual acuity of counting
fingers in the right
eye and
light perception in the left. There were subretinal lesions in the posterior poles of both
eyes and
retinal detachment in the left
eye. Later she developed left
proptosis and restriction in left ocular
movement, most likely to be caused by metastatic extraocular spread. She subsequently died from disseminated metastatic
disease. Histopathological examination confirmed
tumor cells infiltrating the
choroids,
retina and
optic nerve in both
eyes. The
tumor cells were arranged in lobular fashion and stained positively with
Periodic Acid Schiff, suggesting the primary to be lobular
adenocarcinoma type. Choroidal metastatic
disease is common but bilateral
retinal and
optic nerve involvement with extraocular spread from
breast cancer is rare.