Answer to the last #DiagnosticDilemma
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Answer to the last D/D (A 60-year-old woman presented to the emergency department with a 2-month history of blurry vision in her left eye. Her medical history was notable for breast cancer treated 3 years earlier with lumpectomy, axillary-node dissection, radiation, and hormonal therapy. Magnetic resonance imaging of the head revealed a mass, measuring 19 mm by 15 mm by 17 mm, involving the inferior rectus muscle of the left eye. The final diagnosis of Orbital metastasis was made.)

A 60-year-old woman presented to the emergency department with a 2-month history of blurry vision in her left eye. Three years earlier, she had received a diagnosis of estrogen receptor– and progesterone receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative invasive ductal carcinoma of the right breast. She had undergone lumpectomy, axillary-node dissection, and adjuvant radiation therapy, followed by therapy with tamoxifen at a dose of 20 mg daily. At the time of the current presentation, examination revealed proptosis and an inability to look up with the left eye. There was no axillary lymphadenopathy, and no masses were noted on breast examination. Magnetic resonance imaging of the head revealed a mass, measuring 19 mm by 15 mm by 17 mm, involving the inferior rectus muscle of the left eye.

Biopsy revealed metastasis of hormone receptor–positive, HER2-negative breast cancer. The patient began treatment with fulvestrant and palbociclib, followed by radiation therapy. At follow-up 6 months after the initiation of treatment, she had resolution of the proptosis and blurry vision; imaging showed that the mass was no longer present and there were no new sites of metastatic disease.

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Source: NEJM
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