Metastasis of serous ovarian carcinoma to the breast: a case report and review of the literature

Abstract

Background: Breast metastasis from primary ovarian cancer is rare, with an estimated frequency of 0.07%. More than 110 cases are reported in the literature of metastatic spread of ovarian cancer to the breast and axilla. This entity usually represents aggressive late disease characterized by multi-drug chemoresistance and a poor prognosis with a median survival time of 16 months. Currently no standardized treatment protocol exists for this condition.

Case presentation: We present a case of a 59-year-old Caucasian female with recurrent high-grade serous ovarian cancer who was diagnosed with symptomatic unilateral breast metastasis while on fourth line chemotherapy with weekly paclitaxel. She was treated with local radiation with 2300 cGy to the right breast with a complete response. She then had a subsequent recurrence in the ipsilateral breast 8 months after completion of post treatment imaging. She remains alive to date approximately 2 years after her initial diagnosis of breast metastasis on seventh line treatment.

Conclusions: Breast metastasis from primary ovarian cancer is rare and represents advanced disease characterized by multi-drug chemoresistance and a poor prognosis. This case describes radiation therapy as a safe, effective treatment option to improve local control and quality of life in these patients, but with limited durability of response.

Keywords: Breast metastasis; Ovarian adenoarcinoma; Ovarian cancer.

Fig. 1

Axial CT chest with intravenous contrast. Pre-treatment CT chest (a, b) demonstrates a heterogenous enhancing mass (red arrows) in the right upper outer breast. Biopsy clip is noted. Post-treatment CT chest (c, d) demonstrates no enhancement and decreased size of the right upper outer breast mass, particularly the more inferior portion (d)

Fig. 2

Histopathological sections and immunochemistry demonstrating metastatic ovarian high-grade serous carcinoma. A Histologic sections of the left ovary with infiltrative tumor cells in the ovarian stroma (arrowhead, H&E stain at 5x). B On higher magnification, the tumor cells are large with hyperchromatic nuclei (arrowhead, H&E stain at 20x). C The tumor cells are immunoreactive for PAX-8 (immunohistochemical stain with a brown chromogen, 20x). D Histologic sections of the right breast with infiltrative tumor cells (arrowhead, H&E stain at 5x). E On higher magnification, the tumor cells are morphologically similar to the patient’s ovarian tumor (arrowhead, H&E stain at 20x). F PAX-8 immunohistochemical stain with brown chromogen highlights the tumor cells, confirming the diagnosis of metastatic ovarian high-grade serous carcinoma (20x)