Ovarian Neoplasm in a Patient with Prior Breast Carcinoma - Challenges and Pitfalls in Diagnostic Process

Introduction: Metastatic lesions account for approximately 8% of all ovarian neoplasms. About 12% of clinically apparent metastases from non-gynecological primary site originate from breast carcinomas with a variable period of manifestation and detection. Report of Case: We present a case of 58-year-old woman who underwent bilateral adnexectomy with small bowel resection during urgent operation for an incarcerated umbilical hernia. There was a slight enlargement in both ovaries and presence of cystic formation with some papillary structures in the right one. Histologically, bilateral infiltration of tumor cells with moderate cytological and nuclear atypia and tubular, nested and cystic growth pattern was observed. The patient had a long list of co-morbidities: liver cirrhosis, ascites, isolated cytology with presence of tumor cells, elevated level of CA125 and quadrantectomy of the right breast, performed 15 years ago. Diagnostic examination continued in differing primary ovarian carcinoma from metastatic process using immunohistochemical markers – Gross cystic disease fluid protein-15 (GCDFP-15), Mammaglobin, Wilms tumor protein (WT1), p53, Ki67 and hormone receptors for estrogen (ER), progesterone (PR) and human epidermal growth factor (HER2). Considering the clinical data and the results from the pathological examination we concluded that the patient had bilateral ovarian metastases from breast carcinoma. We share our stepwise approach to the diagnosis discussing some of the difficulties emerged in the process and some of the pitfalls reaching the final conclusion.