Ovary and Uterus, Rare Sites of Metastases from Breast Cancer: A Case Series

Abstract

Bones, lungs, and liver are frequent sites of metastases of breast cancer. However, female genital tract (ovaries, uterus, etc.) metastases of breast cancer often present a challenge for diagnosis. The distinction between primary and metastasis may be difficult. Immunostaining has a pivotal role in determining the distinction of breast cancer metastases to ovaries and uterus and primary ovarian and uterine cancer. We herein report rare cases of ovarian and uterine metastases in women who have prior carcinoma of the breast and the role of immunohistochemistry in diagnosing these cases. Case 1 highlights a 42-year-old with breast cancer, stage IV who presented with a breast mass and nipple retraction and an enlarging abdominal mass, probably an ovarian new growth, probably malignant by transvaginal sonography. Exploratory laparotomy, peritoneal fluid cytology, total abdominal hysterectomy with bilateral salpingo-oophorectomy, random peritoneal biopsy, bilateral lymph node dissection were done revealing metastatic ovarian cancer probably invasive lobular carcinoma of breast origin. Case 2 reports 42 years old diagnosed with hormone receptor-positive breast cancer stage IV, received 4 cycles of systemic chemotherapy and 20 cycles of radiation therapy of mediastinal mass. On Tamoxifen as a maintenance drug hence ovarian ablation was recommended. Total abdominal hysterectomy with bilateral salpingo-oophorectomy, intraabdominal omentectomy were done with the histopathologic result of metastatic carcinoma with mixed lobular and ductal features probably breast in origin on bilateral ovaries. Case 3 is a 38 y/o with 8 month-history of breast mass with associated pain, diagnosed with invasive ductal carcinoma, right stage IIIB (T4N0M0) after modified radical mastectomy of the right breast. On follow-up, abdominopelvic CT scan done showed multiple intraabdominal and retroperitoneal and pelvic lymphadenopathies probably metastasis. Exploratory laparotomy, drainage of ascitic fluid, infrasonic omentectomy, bilateral salpingo-oophorectomy, peritoneal biopsy were done with histopathologic findings of metastatic poorly differentiated carcinoma, probably ductal carcinoma, bilateral ovaries.