Abstract
BackgroundMetastatic breast tumors from other organs are very rare. We herein describe the case of a patient with a metastatic breast tumor due to ovarian cancer who was diagnosed by the succession of a p53 mutation.Case presentationThe patient was a 59-year-old woman with sigmoid colon stenosis. Diagnostic imaging revealed a pelvic mass, multiple liver tumors, ascites, and multiple swollen para-aortic lymph nodes, suggesting an advanced ovarian tumor. Transverse loop colostomy and partial resection of the greater omentum was performed followed by six cycles of paclitaxel with carboplatin chemotherapy (TC therapy). Her cancer almost disappeared, with the exception of a small tumor in her pelvis. Simple hysterectomy with bilateral salpingo-oophorectomy was performed. Two years and 5 months after the second surgery, a mass was detected in her right breast and simple mastectomy was performed. A histological examination of the tumors from the first surgery revealed infiltrating papillary adenocarcinoma and the solid nest proliferation of atypical cells with comedo necrosis and psammoma bodies. The findings of an immunohistochemical analysis were as follows: cancer antigen 125 (CA125 (+)), cytokeratin 7 (CK7 (+)), cytokeratin 20 (CK20 (−)), p53 (+) and CDX2 (−), estrogen receptor (ER (slightly +)), progesterone receptor (PR (slightly +)), and human epidermal growth factor receptor 2 (HER2 (1+)). The breast tumors presented similar morphological features (ER (−), PR (−), HER2 (−), CA125 (+), CK7 (+), CK20 (−), p53 (+), mammaglobin (−), and GCDFP15 (−)), which were not characteristic of breast cancer. A direct sequencing analysis of p53 revealed a p.V173M mutation in exon 5 in both the breast tumor and the ovarian cancer. It was not detected in normal tissue, suggesting that the breast tumors were metastatic serous adenocarcinomas from ovarian cancer.ConclusionsA direct sequencing mutation analysis of p53 was useful for distinguishing the primary tumor from the metastatic tumor. We should resect metastatic breast tumors to the extent that is possible because the prognosis of such patients is relatively good.
Highlights
Metastatic breast tumors from other organs are very rare
A direct sequencing mutation analysis of p53 was useful for distinguishing the primary tumor from the metastatic tumor
We should resect metastatic breast tumors to the extent that is possible because the prognosis of such patients is relatively good
Summary
The survival of patients with metastatic cancer has improved due to advances in its management [1]. Case presentation The patient was a 59-year-old female with a history of cholecystectomy due to gallstones, excision of fibroadenoma in the right breast, and a duodenal ulcer She suffered from stenosis of the sigmoid colon, and a local doctor referred her to the gynecology and gastroenterology division of our hospital. Colonoscopy revealed wall edema and stenosis approximately 30 cm from the anal verge (Fig. 1d) According to these findings, she was diagnosed with advanced ovarian cancer, and transverse loop colostomy and partial resection of the greater omentum were performed (Fig. 1e). Because no other metastatic mass was detected on PET/CT and the patient’s serum cancer antigen 125 (CA125) level was below the upper limit (Fig. 2e), simple mastectomy of the right breast was performed (Fig. 2f ). According to the findings of histological examinations, the tumors in the greater omentum that were resected in the first surgery demonstrated infiltrating papillary adenocarcinoma and the solid nest proliferation of a b c d e f g h
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