Unusual Clinical Presentation of Breast Carcinoma: Metastatic Eyelid. (Clinical Case)

INTRODUCTION: Breast cancer is the neoplasm frequently associated with cutaneous dissemination, these metastases occur in cases of known primary tumor (sometimes diagnosed and treated many years earlier) and associated involvement of other organs, may occasionally be the presenting sign. Breast cancer starts as a local disease, but 10 and 15% of patients will develop aggressive disease or distant lymph node metastasis in a period less than 3 years from the time of diagnosis, including metastatic disease may occur at after 10 years. Cutaneous metastases from breast cancer occur more frequently in the chest, back and scalp, with a majority of infiltrating ductal carcinomas and, less frequently, other histologic types. The metastatic breast carcinoma of the eyelid is manifested as a painless nodule at the eyelid with histiocytoid histology or a more typical pattern. Most breast metastases are rare undifferentiated pattern showing well-formed ducts, but ductal and lobular forms can remember the primary. Cutaneous metastases confer a poor prognosis, with mortality exceeding 70% in the first year of diagnosis. CASE REPORT: Female 64 years old, she complained of right lower eyelid nodule. Lesion biopsy is performed, pathology reports: poorly differentiated carcinoma infiltrating fibro tissue and skeletal muscle, consistent with lobular carcinoma of probable breast primary origin, the result of each breast. Areolar retraction is observed and induration retro areolar right breast and upper quadrants union, right axillary adenopathy. Mammogram is performed and observed image spiculated at the junction of the upper quadrants, several nodular images axilar. Trucut level of injury: Infiltrating lobular carcinoma, poorly differentiated foci of perineural invasion. Estrogen receptors: Positive and Progesterone: Negative, HER2/neu: No amplification. Estrogen receptors eyelid: 80% positive, Progesterone: 60% positive, HER2/neu: No amplification. General Analytical is done, bone scans, normal double contrast Tomographic Scanning. Get 4 sessions of Neo adjuvant. Go to a modified radical mastectomy more axillary lymph node dissection. Pathology: lobular carcinoma conventional irregular, commits all quadrants breast, metastatic to 14 of 15 lymph nodes). Make 6 sessions of chemotherapy and 25 adjuvant radiotherapy. Patient in good condition diagnosed a year. DISCUSSION: In general the most common primary tumors in the population are the most frequently metatastizan skin, breast carcinoma being the most common primary tumor associated with cutaneous dissemination. Although the majority of skin metastases of breast cancer are presented as intradermal or subcutaneous nodules single or multiple, have been described other clinicopathological cutaneous metastases of breast cancer, metastatic breast carcinoma eyelid. The dermal invasion occurs most often by direct extension or lymphatic spread, the less common hematogenous. In terms of location, cutaneous metastases of breast cancer usually affect the skin overlying or near the primary tumor, rarely appear on the buttocks, legs, perianal region and eyelids. Generally, cutaneous metastases are usually associated with advanced dise ase with metastases to multiple organs usually with poor prognosis. Therefore, the diagnosis of cutaneous metastases should always be followed for conducting the necessary studies to rule out involvement of other organs.