Bilateral metastasis to the retina, choroids and optic nerve from breast cancer: A clinicopathological case

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