Orbital Metastases from Breast Cancer: Retrospective Analysis at an Academic Cancer Center.

Orbital metastases from breast cancer (BC) are rare, but often debilitating. BC accounts for nearly half of metastases to the orbit. Orbital metastases may be discovered years after the initial diagnosis of BC, and are rare at initial presentation. A search of the institutional data base at an academic cancer center identified BC patients who developed or presented with orbital metastases from 2000 to 2013. Baseline characteristics, treatment modalities, survival and treatment responses were collected from the electronic medical record. There were 20 patients identified with orbital metastases (0.7% of all BC cases). The median age at diagnosis of BC was 49 years; 80% had estrogen positive disease. The interval between the initial diagnosis of BC and the presentation of orbital metastases was 8.5 years (0-19 years). Orbital disease was the initial presentation of BC in two cases. Three patients developed bilateral orbital metastases and seven had accompanying brain metastases. The most common presentation was decreased vision (55%), followed by diplopia (25%). The median survival after orbital metastases was 24 months. Thirteen patients (65%) received local radiation therapy. Of those radiated, 90% reported improvement of orbital symptoms. Other treatments included intraocular bevacizumab, surgery, and systemic therapy. Orbital metastases tend to occur in estrogen receptor positive disease and are often found years after BC onset. Orbital metastases may be associated with the development of brain metastases. Radiotherapy is the preferred local therapy and had high symptom control in this cohort. Oncologists should be aware of the signs of orbital metastases and the treatment options.

Primary cutaneous cryptococcosis treated with debridement and fluconazole monotherapy in an immunosuppressed patient: a case report and review of the literature.

Cryptococcus neoformans is an opportunistic yeast present in the environment. Practitioners are familiar with the presentation and management of the most common manifestation of cryptococcal infection, meningoencephalitis, in patients with AIDS or other conditions of immunocompromise. There is less awareness, however, of uncommon presentations where experience rather than evidence guides therapy. We report a case of primary cutaneous cryptococcosis (PCC) in a patient who had been immunosuppressed by chronic high-dose corticosteroid for the treatment of severe asthma. This case highlights the importance of early recognition of aggressive cellulitis that fails standard empiric antibiotic treatment in an immunocompromised patient. It also demonstrates successful treatment of PCC with a multispecialty approach including local debridement and fluconazole monotherapy.

What is the role of positron emission tomography in osteonecrosis of the jaws?

PURPOSE: Bisphosphonate-related osteonecrosis of the jaw (BP-ONJ) has become an associated side effect of BP therapy and several imaging modalities have been studied to show an ability to detect clinical disease. Because most patients at the authors' university hospital who develop BP-ONJ also undergo concurrent positron emission tomographic (PET) scanning, the authors investigated the utility of PET scans for diagnosis of BP-ONJ. PATIENTS AND METHODS: A retrospective chart review was performed of patients whose PET scans were acquired within 1 year of their BP-ONJ diagnosis (1998 through 2006). BP-ONJ was defined as intraoral exposure of the maxilla or mandible in patients on BPs and not given radiation to that area. This was performed at a university hospital with oncologic patients treated with BPs. All PET scans in this study were secondarily reviewed by a single expert reader for internal consistency (T.B.B.). A detailed timeline of the course of BP-ONJ was constructed by the review of medical records for each patient and the relation of each patient's PET scan results to that patient's BP-ONJ disease was evaluated. Data analysis was a descriptive analysis of PET scan findings in this patient population. RESULTS: Of the 25 patients studied, 5 were excluded for insufficient clinical or radiologic data. Of the 20 remaining patients (16 male, 4 female), 46 PET scans were performed and showed 53 areas of enhancement. Many patients had multiple PET scans performed while experiencing exposed bone, and 5 of these patients had alternating positive and negative scans with exposed bone, resulting in 13 patients with positive enhancement on a scan with exposed bone and 9 patients with no enhancement on a scan with exposed bone. Of the 13 patients with PET enhancement, 4 had signs of clinical infection documented at the time of examination. Sensitivity, specificity, and accuracy of PET scanning for BP-ONJ were 43%, 19%, and 62%, respectively. There were 7 patients with PET scans performed after clinical resolution of their exposed bone and 6 of those had no enhancement. CONCLUSION: The purpose of this study was to report findings on PET scanning for patients with BP-ONJ. Although PET scans are useful in oncology, the present findings do not support their routine use for exclusively diagnosing or following cases of BP-ONJ.