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Erschienen in: Journal of Medical Case Reports 1/2021

Open Access 01.12.2021 | Case report

Metastatic ovarian cancer spreading into mammary ducts mimicking an in situ component of primary breast cancer: a case report

verfasst von: Yurina Maeshima, Tomo Osako, Hidetomo Morizono, Mayu Yunokawa, Yumi Miyagi, Mari Kikuchi, Takayuki Ueno, Shinji Ohno, Futoshi Akiyama

Erschienen in: Journal of Medical Case Reports | Ausgabe 1/2021

Abstract

Background

Accurate diagnosis of metastatic tumors in the breast is crucial because the therapeutic approach is essentially different from primary tumors. A key morphological feature of metastatic tumors is their lack of an in situ carcinoma component. Here, we present a unique case of metastatic ovarian carcinoma spreading into mammary ducts and mimicked an in situ component of primary carcinoma. To our knowledge, this is the second case (and the first adult case) confirming the in situ-mimicking growth pattern of a metastatic tumor using immunohistochemistry.

Case presentation

A 69-year-old Japanese woman was found to have a breast mass with microcalcifications. She had a known history of ovarian mixed serous and endocervical-type mucinous (seromucinous) carcinoma. Needle biopsy specimen of the breast tumor revealed adenocarcinoma displaying an in situ-looking tubular architecture in addition to invasive micropapillary and papillary architectures with psammoma bodies. From these morphological features, metastatic serous carcinoma and invasive micropapillary carcinoma of breast origin were both suspected. In immunohistochemistry, the cancer cells were immunoreactive for WT1, PAX8, and CA125, and negative for GATA3, mammaglobin, and gross cystic disease fluid protein-15. Therefore, the breast tumor was diagnosed to be metastatic ovarian serous carcinoma. The in situ-looking architecture showed the same immunophenotype, but was surrounded by myoepithelium confirmed by immunohistochemistry (e.g. p63, cytokeratin 14, CD10). Thus, the histogenesis of the in situ-like tubular foci was could be explained by the spread of metastatic ovarian cancer cells into existing mammary ducts.

Conclusion

Metastatic tumors may spread into mammary duct units and mimic an in situ carcinoma component of primary breast cancer. This in situ-mimicking growth pattern can be a potential pitfall in establishing a correct diagnosis of metastasis to the breast. A panel of breast-related and extramammary organ/tumor-specific immunohistochemical markers may be helpful in distinguishing metastatic tumors from primary tumors.
Hinweise

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Abkürzungen
GCDFP15
Gross cystic disease fluid protein-15

Introduction

Breast cancer is the most common malignancy in women worldwide. However, metastases to the breast from extramammary solid tumors are rare and account for only 0.2–0.9% of all breast malignancies [13]. The most common primary tumors metastasizing to the breast vary depending on the specific patient population studied [4], but malignant melanoma, lung carcinoma, ovarian carcinoma, gastrointestinal carcinoma, and sarcoma are repeatedly reported [47].
Accurate diagnosis of metastatic tumors in the breast is crucial because their staging, treatment and prognosis are essentially different from primary breast tumors [6]. One of the key morphological features for the diagnosis of metastatic tumors is their lack of an in situ (intraductal and/or intralobular) carcinoma component [3, 5, 7]. The presence of an in situ component strongly supports the diagnosis of primary carcinoma. However, in this case report, we present a unique case of metastatic ovarian carcinoma spreading into mammary ducts, which mimicked an in situ component of primary breast carcinoma.

Case presentation

Clinical summary

A 69-year-old Japanese woman was found to have a right breast mass with calcifications and pleural nodules on computed tomography for post-treatment surveillance of ovarian cancer (Fig. 1a). This patient had undergone debulking surgery and chemotherapy (carboplatin plus paclitaxel) for stage IIIc ovarian cancer 9 years before, and she had received additional chemotherapy (carboplatin plus paclitaxel) for bilateral axillary lymph node metastasis 4 years before. Then, she had been followed up every 3 months.
On physical examination, a 33 × 30-mm induration was palpable in the upper-outer quadrant of the patient’s right breast. Mammography showed segmental distribution of the amorphous microcalcifications associated with a focal asymmetric density in the upper-outer area of the breast (Fig. 1b–d). Ultrasonography showed a 33 × 33 × 16-mm irregular hypoechoic area with high echo spots and indistinct margins (Fig. 1e). From these images, ductal carcinoma in situ or invasive ductal carcinoma with a predominant intraductal component was primarily suspected, but metastatic ovarian cancer could not be excluded considering her clinical history. The patient underwent vacuum-assisted needle biopsy for the breast lesion. After the biopsy, she was treated with chemotherapy (carboplatin plus gemcitabine followed by carboplatin plus doxorubicin) for 2 years. At the time of this report (2 and half years after the biopsy), she receives best supportive care for metastatic ovarian cancer and myelodysplastic syndrome.

Pathological findings of previous ovarian tumor

Macroscopic examination of the surgical specimens revealed a 65 × 55 × 45-mm, lobulated, whitish-yellow, solid mass in the right ovary; an 8-mm mass on the surface of the left ovary; and multiple disseminated tumors, up to 16 mm in size, in the greater omentum.
Microscopically, the right ovarian tumor displayed a complex branching papillary architecture (Fig. 2a). The epithelium lining the papillae was stratified and was composed of endocervical-type mucinous epithelium (Fig. 2b) and serous epithelium (Fig. 2c). There were multiple invasive cancer foci in the stroma composed of endocervical-type mucinous epithelium displaying tubular architecture (Fig. 2d) and serous epithelium displaying micropapillary architecture with psammoma bodies (Fig. 2e). Thus, the tumor was diagnosed to be seromucinous carcinoma (mixed endocervical-type mucinous and low-grade serous carcinoma) associated with seromucinous borderline tumor. The immunohistochemical analysis supported the diagnosis (Table 1).
Table 1.
Antibodies for immunostaining and results for the present case.
Antibody
Clone
Source
Dilution
Immunoreactivity
Ovarian carcinoma
Breast tumor
Mucinous, endocervical type (seromucinous)
Serous, low grade
WT1
WT49
Leica
1/30
(+)
(+++)
(+++)
PAX8
BC12
Nichirei
RTU
(+)
(+++)
(+++)
CA125
M11
Dako
1/50
(+++)
(+++)
(+++)
p53
DO-7
Dako
1/2000
wild type
wild type
wild type
ER
SP1
Ventana
RTU
(+++)
(+++)
(+++)
PgR
1E2
Ventana
RTU
(++)
(+)
(−)
GATA3
HG3-31
Santa Cruz
1/50
(−)
(−)
(−)
Mammaglobin
304-1A5
Dako
1/500
(−)
(−)
(−)
GCDFP15
D6
BioLegend
1/500
(−)
(−)
(−)
HER2
4B5
Ventana
RTU
(−)
(−)
(−)
Ki67
MIB1
Dako
1/50
15%
15%
15%
ER estrogen receptor, PgR progesterone receptor, GCDFP15 gross cystic disease fluid protein-15, HER2 human epidermal growth factor-2, RTU ready to use, (+) focal and weak staining, (++) intermediate staining, (+++) diffuse and strong staining
The left ovary was also diagnosed with seromucinous carcinoma with seromucinous borderline tumor. In the omentum, there were multiple disseminations of serous carcinoma accompanied with psammoma bodies and desmoplastic stroma (Fig. 2f).

Pathological findings of breast tumor

Microscopic examination of the needle biopsy specimen revealed invasive adenocarcinoma displaying micropapillary and papillary architectures in the breast stroma (Fig. 3a, b). The cancer cells displayed intermediate nuclear atypia and low mitotic activity. Psammoma bodies were frequently observed. In addition, a small number of cancer nests showed a tubular architecture surrounded by myoepithelium, which appeared to be an in situ carcinoma (Fig. 3a, 3c, 3e). On the hematoxylin-and-eosin-stained slides, metastatic serous carcinoma was primarily suspected due to the morphological similarities to the previous ovarian carcinoma, but invasive micropapillary carcinoma of the breast origin could not be ruled out considering the in situ-like foci.
In immunohistochemistry, the cancer cells were immunoreactive for WT1 (Fig. 3d), PAX8, and CA125, and negative for GATA3, mammaglobin, and gross cystic disease fluid protein-15 (GCDFP15) (Table 1). Therefore, the breast tumor was diagnosed to be metastatic ovarian serous carcinoma.
Regarding the in situ-like tubular foci, the cancer cells lining the tubule and papillae showed the aforementioned immunophenotype (e.g. positive WT1, Fig. 3f), but the tubular foci were surrounded by myoepithelium which was immunoreactive for myoepithelial markers [p63 (Fig. 3g), cytokeratin 14 (Fig. 3h), CD10 and calponin], and negative for endothelial markers (podoplanin and CD31). Thus, the histogenesis of the in situ-like tubular foci may be explained by the spread of metastatic ovarian cancer cells into existing mammary ducts.

Discussion

We present a unique case of ovarian carcinoma metastasizing to the breast and spreading into mammary ducts, which mimicked an in situ component of primary breast carcinoma. One case report of metastatic pancreatic tumor in a child firstly confirmed this in situ-mimicking growth pattern by immunohistochemistry [8]. Two other reports briefly mentioned this growth pattern of metastatic tumors, but appropriate immunohistochemical stains to prove intraductal growth were not performed [2, 9]. Thus, to our knowledge, this is the second case (and the first adult case) confirming the growth pattern by immunohistochemistry. This in situ-mimicking growth pattern can be a potential pitfall for establishing a correct diagnosis of metastasis. The same growth pattern, aside from the metastatic tumor, was recently reported in a soft tissue tumor arising in the breast [10].
Histologically correct and type-specific diagnosis of tumors metastasizing to the breast is vital to ensure appropriate management. However, because of their rarity, it is sometimes difficult for pathologists to make the accurate diagnosis. The following four points can be given as diagnostic clues for metastatic tumors [25, 7, 11, 12]: (1) clinical history of extramammary malignancy, (2) unusual morphology for primary breast cancer, (3) absence of an in situ component, and (4) lack of breast-related immunophenotype.
Clinical history of extramammary cancer is essential in making a diagnosis of metastasis to the breast [3, 5, 11]. Almost all breast cancer cases that pathologists diagnose in daily practice are primary cancers. Thus, suspicion of metastatic tumors may sometimes be raised only after clinical history is provided. Comparison of mammary and extramammary tumors is important in this situation.
The diagnosis of metastatic tumors is easier when the tumor has an unusual appearance for a breast primary lesion or a typical morphology of its primary site of origin [12]. Two-thirds of metastases to the breast have distinctive histological features, raising the possibility of the diagnosis [3]. In remaining cases, however, the histological appearance is similar to a primary mammary tumor, and the clinical history and other information are important to establish the correct diagnosis for these cases.
The presence of an in situ carcinoma component is pathognomonic of primary breast carcinoma. On the contrary, the absence of an in situ component supports the diagnosis of a metastatic tumor to the breast [3, 5, 7]. However, in situ-like atypical ductal proliferations are reported in metastatic tumors in the breast, and pathologists should be careful not to regard this in situ-like structure as true in situ carcinoma and exclude the possibility of metastatic tumor. The in situ-mimicking lesions in metastatic tumors can be classified into three types based on histogenesis: (a) lymphovascular emboli from metastatic tumors [2, 11], (b) metastatic tumors spreading into existing mammary duct units [2, 8, 9], and (c) true in situ carcinoma or atypical ductal/lobular hyperplasia of breast origin coexisting with metastatic tumors [9, 12]. The immunohistochemical panel mentioned below can be useful for the differential diagnosis (Table 2).
Table 2.
Immunohistochemical markers for the differential diagnosis of in situ-mimicking architectures in metastasis to the breast
 
Extramammary organ/tumor-specific
Breast-related
Myoepithelial
Lymphatic endothelial
Lymphovascular tumor emboli
(+)
(−)
(−)
(+)
Intraductal spread by metastatic tumorsa
(+)
(−)
(+)
(−)
Coexistence of true in situ carcinoma
(−)
(+)
(+)
(−)
aThe present case
Immunohistochemistry plays a major role in the accurate diagnosis of metastatic tumor in the breast. A panel of breast-related markers (e.g., GATA3, mammaglobin, GCDFP15, and SOX10) is helpful to rule out a metastasis [5]. In addition, a panel of extramammary organ/tumor-specific markers can be used to delineate the likely primary site of metastasis [5]. In addition, myoepithelial markers (e.g. p63, cytokeratin 14, and calponin) and endothelial markers (e.g., podoplanin and CD31) may be useful for the differential diagnosis of in situ-like architecture in the metastatic tumors [4, 5, 11].
Serous carcinoma is the most common type of ovarian tumor metastasizing to the breast [13]. Metastatic serous carcinoma can resemble invasive micropapillary carcinoma of the breast, and psammomatous calcifications can be seen in both [3, 14, 15]. One study reported that approximately 24% of metastatic serous carcinomas in the breast were initially interpreted as primary carcinomas [14]. In fact, invasive micropapillary carcinoma was originally designated “pseudopapillary (serous-like) carcinoma” because of its resemblance to serous carcinoma of Müllerian origin [15]. A key morphological finding for the differential diagnosis may be the presence or absence of a fibrovascular core in the papillary/micropapillary structure. Invasive micropapillary carcinoma mainly shows micropapillary (pseudopapillary) architecture without fibrovascular cores [15], while serous carcinoma often displays (macro-)papillary structure with fibrovascular cores in addition to their micropapillary architecture [16]. A panel of breast-related and Müllerian duct/serous tumor-specific immunohistochemical markers (e.g. WT1 and PAX8) can be helpful in differentiating tumors of ovarian from breast origin. However, estrogen and progesterone receptors are not helpful because both tumors can be positive for these [13].
In the present case, immunohistochemistry played a critical role in establishing an accurate diagnosis of the metastatic tumor and in elucidating the histogenesis of its in situ-mimicking architecture. Although the breast tumor was histologically similar to the previous ovarian carcinoma, invasive micropapillary carcinoma of breast origin could not be ruled out because the in situ-like component surrounded by myoepithelium was present. Based on the positive Müllerian/serous markers and negative breast-related markers, the breast tumor and the in situ-like component was diagnosed as metastatic serous carcinoma. The histogenesis of the in situ-like architecture could be due to spread of the metastatic tumor into existing mammary ducts, since myoepithelium around the in situ-like component was confirmed by myoepithelial immunomarkers.

Conclusions

We present a unique case of metastatic ovarian carcinoma spreading into mammary ducts, which mimicked an in situ component of primary breast carcinoma. This in situ-mimicking growth pattern of metastatic tumors can be a potential pitfall in establishing a correct diagnosis of metastasis to the breast. A panel of breast-related and extramammary organ/tumor-specific immunohistochemical markers may be helpful in distinguishing metastatic tumors from primary tumors.

Acknowledgements

We thank Dr. Akiko Tonooka and Dr. Tomohiro Chiba (Division of Pathology, Cancer Institute of Japanese Foundation for Cancer Research) for their comments on the pathological diagnosis of the ovarian tumor.
This study was conducted in accordance with the basic principles of the Declaration of Helsinki.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent form is available for review by the Editor-in-Chief of this journal.

Competing interests

None declared.
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Literatur
1.
Zurück zum Zitat Georgiannos SN, Chin J, Goode AW, Sheaff M. Secondary neoplasms of the breast: a survey of the 20th century. Cancer. 2001;92(9):2259–66.CrossRef Georgiannos SN, Chin J, Goode AW, Sheaff M. Secondary neoplasms of the breast: a survey of the 20th century. Cancer. 2001;92(9):2259–66.CrossRef
2.
Zurück zum Zitat Hajdu SI, Urban JA. Cancers metastatic to the breast. Cancer. 1972;29(6):1691–6.CrossRef Hajdu SI, Urban JA. Cancers metastatic to the breast. Cancer. 1972;29(6):1691–6.CrossRef
3.
Zurück zum Zitat Lee AH. The histological diagnosis of metastases to the breast from extramammary malignancies. J Clin Pathol. 2007;60(12):1333–41.CrossRef Lee AH. The histological diagnosis of metastases to the breast from extramammary malignancies. J Clin Pathol. 2007;60(12):1333–41.CrossRef
4.
Zurück zum Zitat Patel S, Silverman JF, Saad RS, Dabbs DJ. Metastatic tumors in the breast. In: Dabbs DJ, editor. Breast pathology. 2nd ed. Elsevier; 2016. Patel S, Silverman JF, Saad RS, Dabbs DJ. Metastatic tumors in the breast. In: Dabbs DJ, editor. Breast pathology. 2nd ed. Elsevier; 2016.
5.
Zurück zum Zitat Kulka J, Varga Z. Metastases to the breast. In: Board WCoTE, editor. WHO classification of breast tumours. 5th ed. Lyon: IARC Press; 2019. Kulka J, Varga Z. Metastases to the breast. In: Board WCoTE, editor. WHO classification of breast tumours. 5th ed. Lyon: IARC Press; 2019.
6.
Zurück zum Zitat Williams SA, Ehlers RA 2nd, Hunt KK, Yi M, Kuerer HM, Singletary SE, et al. Metastases to the breast from nonbreast solid neoplasms: presentation and determinants of survival. Cancer. 2007;110(4):731–7.CrossRef Williams SA, Ehlers RA 2nd, Hunt KK, Yi M, Kuerer HM, Singletary SE, et al. Metastases to the breast from nonbreast solid neoplasms: presentation and determinants of survival. Cancer. 2007;110(4):731–7.CrossRef
7.
Zurück zum Zitat DeLair DF, Corben AD, Catalano JP, Vallejo CE, Brogi E, Tan LK. Non-mammary metastases to the breast and axilla: a study of 85 cases. Mod Pathol. 2013;26(3):343–9.CrossRef DeLair DF, Corben AD, Catalano JP, Vallejo CE, Brogi E, Tan LK. Non-mammary metastases to the breast and axilla: a study of 85 cases. Mod Pathol. 2013;26(3):343–9.CrossRef
8.
Zurück zum Zitat Judson K, Argani P. Intraductal spread by metastatic islet cell tumor (well-differentiated pancreatic endocrine neoplasm) involving the breast of a child, mimicking a primary mammary carcinoma. Am J Surg Pathol. 2006;30(7):912–8.CrossRef Judson K, Argani P. Intraductal spread by metastatic islet cell tumor (well-differentiated pancreatic endocrine neoplasm) involving the breast of a child, mimicking a primary mammary carcinoma. Am J Surg Pathol. 2006;30(7):912–8.CrossRef
9.
Zurück zum Zitat Bacchi CE, Wludarski SC, Ambaye AB, Lamovec J, Salviato T, Falconieri G. Metastatic melanoma presenting as an isolated breast tumor: a study of 20 cases with emphasis on several primary mimickers. Arch Pathol Lab Med. 2013;137(1):41–9.CrossRef Bacchi CE, Wludarski SC, Ambaye AB, Lamovec J, Salviato T, Falconieri G. Metastatic melanoma presenting as an isolated breast tumor: a study of 20 cases with emphasis on several primary mimickers. Arch Pathol Lab Med. 2013;137(1):41–9.CrossRef
10.
Zurück zum Zitat Luangxay T, Osako T, Yonekura R, Sugiura Y, Kikuchi M, Gomi N, et al. Giant cell tumor of soft tissue of the breast: case report with H3F3A mutation analysis and review of the literature. Pathol Res Pract. 2020;216(2):152750.CrossRef Luangxay T, Osako T, Yonekura R, Sugiura Y, Kikuchi M, Gomi N, et al. Giant cell tumor of soft tissue of the breast: case report with H3F3A mutation analysis and review of the literature. Pathol Res Pract. 2020;216(2):152750.CrossRef
11.
Zurück zum Zitat Gupta D, Merino MI, Farhood A, Middleton LP. Metastases to breast simulating ductal carcinoma in situ: report of two cases and review of the literature. Ann Diagn Pathol. 2001;5(1):15–20.CrossRef Gupta D, Merino MI, Farhood A, Middleton LP. Metastases to breast simulating ductal carcinoma in situ: report of two cases and review of the literature. Ann Diagn Pathol. 2001;5(1):15–20.CrossRef
12.
Zurück zum Zitat Badve S. Other malignant lesions of the breast. In: O'Malley FP, Pinder SE, editors. Breast pathology. Foundation in diagnostic pathology. Elsevier; 2006. Badve S. Other malignant lesions of the breast. In: O'Malley FP, Pinder SE, editors. Breast pathology. Foundation in diagnostic pathology. Elsevier; 2006.
13.
Zurück zum Zitat Yamasaki H, Saw D, Zdanowitz J, Faltz LL. Ovarian carcinoma metastasis to the breast case report and review of the literature. Am J Surg Pathol. 1993;17(2):193–7.CrossRef Yamasaki H, Saw D, Zdanowitz J, Faltz LL. Ovarian carcinoma metastasis to the breast case report and review of the literature. Am J Surg Pathol. 1993;17(2):193–7.CrossRef
14.
Zurück zum Zitat Recine MA, Deavers MT, Middleton LP, Silva EG, Malpica A. Serous carcinoma of the ovary and peritoneum with metastases to the breast and axillary lymph nodes: a potential pitfall. Am J Surg Pathol. 2004;28(12):1646–51.CrossRef Recine MA, Deavers MT, Middleton LP, Silva EG, Malpica A. Serous carcinoma of the ovary and peritoneum with metastases to the breast and axillary lymph nodes: a potential pitfall. Am J Surg Pathol. 2004;28(12):1646–51.CrossRef
15.
Zurück zum Zitat Pettinato G, Manivel CJ, Panico L, Sparano L, Petrella G. Invasive micropapillary carcinoma of the breast: clinicopathologic study of 62 cases of a poorly recognized variant with highly aggressive behavior. Am J Clin Pathol. 2004;121(6):857–66.CrossRef Pettinato G, Manivel CJ, Panico L, Sparano L, Petrella G. Invasive micropapillary carcinoma of the breast: clinicopathologic study of 62 cases of a poorly recognized variant with highly aggressive behavior. Am J Clin Pathol. 2004;121(6):857–66.CrossRef
16.
Zurück zum Zitat Serous tumours. In: Kurman RJ, Carcangiu ML, Herrington CS, Young RH, editors. WHO classification of tumours of female reproductive organs. 4th ed. Lyon: IARC Press; 2014. Serous tumours. In: Kurman RJ, Carcangiu ML, Herrington CS, Young RH, editors. WHO classification of tumours of female reproductive organs. 4th ed. Lyon: IARC Press; 2014.
Metadaten
Titel
Metastatic ovarian cancer spreading into mammary ducts mimicking an in situ component of primary breast cancer: a case report
verfasst von
Yurina Maeshima
Tomo Osako
Hidetomo Morizono
Mayu Yunokawa
Yumi Miyagi
Mari Kikuchi
Takayuki Ueno
Shinji Ohno
Futoshi Akiyama
Publikationsdatum
01.12.2021
Verlag
BioMed Central
Erschienen in
Journal of Medical Case Reports / Ausgabe 1/2021
Elektronische ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-020-02653-w

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