Ovarian Cancer Metastasis to the Breast: A Case Report and Review of the Literature

Abstract

Although ovarian cancer often presents as a widespread disease, metastases to the breast and/or axillary lymph nodes are a very rare event, accounting for only 0.03–0.6% of all breast cancers. Its early recognition and accurate distinction from primary breast cancer are of crucial importance to choose an adequate systemic therapy over unnecessary surgeries. We presented the case of a 53-year-old woman who was diagnosed with breast metastases 2 years after the diagnosis of advanced primary serous ovarian cancer. The patient underwent primary cytoreductive surgery and platinum-based chemotherapy in combination with bevacizumab, followed by bevacizumab maintenance for 18 months. After 2 years of negative follow-ups, the disease unexpectedly spread to the left breast and axillary lymph nodes. No axillary lymph node dissection or breast surgery was performed. The patient received axillary radiotherapy and multiple chemotherapy lines: gemcitabine/cisplatin, liposomal doxorubicin, topotecan, olaparib/cediranib, paclitaxel, and cisplatin. Unfortunately, none of these treatments improved her prognosis and she died 3 years after the disease recurrence. Ovarian cancer metastasis to the breast reveals a disseminated disease with a poor prognosis. Currently, no valid treatment options are available as the disease shows multidrug chemoresistance. In the era of precision medicine, the characterization of genetic and molecular markers may play a role in offering new promising targeted therapies.

Ovarian Cancer With Breast Metastasis and Two Pathogenic Variants of BRCA1 Gene

“…The most common sites of distant metastasis in ovarian cancers are the liver, followed by distant lymph nodes, lung, bone, and brain, respectively [ 17 ]. Ovarian cancers rarely metastasize to the breast [ 5 ]. Metastasis to the breast consists of only 2% of all breast malignancies, with ovarian cancer accounting for only 0.03 to 0.6% [ 18 ].…”

“…Caruso et al reported 120 cases of ovarian cancer with breast metastasis between 1999 to 2019. Serous carcinoma of the ovaries is the most common histologic type of ovarian cancer metastases to the breast [ 5 ]. It was reported that there was a preference for metastasis to the left breast [ 5 , 22 ].…”

“…Serous carcinoma of the ovaries is the most common histologic type of ovarian cancer metastases to the breast [ 5 ]. It was reported that there was a preference for metastasis to the left breast [ 5 , 22 ]. The ascites are drained through the lymph nodes into the thoracic duct that eventually drains into the left subclavian vein and blood circulation; thus, the role of the hematogenous route is more prominent.…”

“…It is estimated that 75% of patients present with advanced stage, with either widely metastatic disease within the peritoneal cavity or distant metastasis [ 4 ]. Ovarian cancers rarely metastasize to the breast and axillary lymph nodes [ 5 , 6 ]. The differentiation between the primary breast neoplasm from metastasis is required for a proper approach to treatment since the treatment and prognosis are quite different.…”

Role of Circulating Biomarkers in Platinum-Resistant Ovarian Cancer

“…Actually, in OC the role of immunotherapy is still uncertain, and results from immunotherapeutic agents administered alone are not as positive as expected, and nowadays, the use of immunotherapeutic drugs in OC is limited to clinical trials. Since few and ineffective chemotherapeutic agents are currently available for PtR OC, immunotherapeutic drugs, especially in combination with other agents [202][203][204][205][206][207], could represent a future successful strategy and change the prognosis of affected women. Consequently, the main challenge regarding the identification of populations that could benefit more from this approach and biomarkers that predict the response to this treatment deserves a separate discussion.…”