A Cutaneous Clue: Metastatic Breast Cancer Mimicking Periorbital Cellulitis

A 73-year-old woman presented with 2 months of painless left periorbital erythema and swelling, previously treated as “orbital cellulitis” with multiple antibiotic courses without response. Examination showed firm, erythematous nodularity of the left upper and lower eyelids with broad extension around the orbital rim and slightly of the right upper lid (panel A,B) with radiographic postseptal orbital involvement without clinical orbital symptoms (panel C,D). Initial biopsy reported “probable chalazion,” but repeat biopsy revealed estrogen receptor–positive, progesterone receptor–positive, human epidermal growth factor receptor 2-negative high-grade invasive histiocytoid lobular carcinoma. Histologically, eyelid involvement of breast cancer metastasis tends to be lobular in subtype, similar to that seen in orbital metastatic cases; however, as the histiocytoid subtype of lobular breast carcinoma may be prone to histopathologic misidentification, recognition of this cutaneous metastatic presentation is critical to enable timely oncologic management. Patient permission was obtained for the use of the photograph.FIG.: