Case 1
A 42-year old female presented with a left upper eyelid lesion causing unilateral ptosis.
CT and MRI demonstrated an ill-defined extraconal mass in the left orbital roof with no associated bone erosion (Fig.
1).
Excisional biopsy favoured metastatic breast cancer.
Subsequent breast examination found bilateral breast masses and an enlarged left axillary lymph node.
Ultrasound and contrast-enhanced mammography showed bilateral breast masses suspicious for malignancy (Fig.
2).
Breast biopsies diagnosed invasive lobular carcinoma.
Staging CT,
bone scintigraphy and MRI revealed multiple osseous metastases throughout the thoracic spine.
Case 2
A 49-year old female presented with left-sided retro-orbital headache associated with diplopia,
periorbital swelling and restricted eye movement.
CT and MRI demonstrated soft tissue stranding in the intraconal fat of the left orbit and thickening of the left medial rectus muscle (Fig.
3 and Fig.
4).
This was initially treated as optic neuritis.
Seven months later,
repeat CT and MRI found no change.
Orbital biopsy found signet ring adenocarcinoma following which a breast examination was performed revealing left breast skin distortion and nipple discharge.
Ultrasound and mammography (Fig.
5) identified a stellate mass in the left breast extending to the chest wall as well as an abnormal axillary lymph node with an irregular cortex.
Breast biopsies diagnosed invasive lobular carcinoma.
Staging CT neck and thorax,
abdomen and pelvis (TAP) found no evidence of metastatic disease elsewhere.
Case 3
A 66-year old female presented with atraumatic hip pain and difficulty weight-bearing.
A radiograph and CT identified a non-displaced comminuted fracture of the right femoral neck which was treated with dynamic hip screw fixation.
One month later,
she complained of generalised headache and diplopia.
Examination found a right oculomotor nerve palsy.
A CT brain (Fig.
6) revealed a lytic lesion in the right skull base,
soft tissue involvement of the right optic foramen and a small enhancing metastasis in the right frontal lobe.
Bone scintigraphy found abnormal radiotracer uptake in the right femur,
skull and at several other sites,
suspicious for osseous metastases (Fig.
7).
A breast examination and CT TAP were performed with the aim of localizing the underlying primary cancer.
Both uncovered a large left breast mass (Fig.
8).
The CT also demonstrated extensive metastatic spread with additional metastases in the lungs,
liver and bones.
Breast ultrasound and mammography confirmed the presence of a large breast mass extending towards the nipple (Fig.
9).
Breast biopsies diagnosed left invasive ductal carcinoma.