Ovary tumor
Metastases to ovary
Breast carcinoma

Author: Nalini Gupta, M.D. (see Reviewers page)
Editorial Board review: Carlos Parra-Herra, M.D.

Revised: 27 May 2016, last major update February 2015

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Breast carcinoma [title] metastatic to ovary

Cite this page: Breast carcinoma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/ovarytumormetatstaticbreastcarc.html. Accessed April 28th, 2017.
Definition / general
  • Usually incidental finding associated with (a) staging, (b) oophorectomy for patient with BRCA mutation or strong family history of breast cancer, or (c) therapeutic oophorectomy (induced hormone suppression for hormone receptor+ breast carcinoma)
  • Ovarian involvement is seen in ~30% of therapeutic oophorectomies for advanced breast cancer, and at autopsy in ~10% of breast cancer cases (Am J Surg Pathol 2006;30:277)
  • Involvement by lobular carcinoma (36%, including signet-ring cell type) is more frequent than ductal carcinoma (2.6%) (Br J Cancer 1984;50:23, Adv Anat Pathol 2007;14:149)
  • Metastatic disease frequently arises up to 5 years post diagnosis, median 11.5 months, and is related to breast cancer stage (Br J Cancer 1984;50:23)
Pathophysiology
  • High rates of hormone receptor+ breast cancer and premenopausal status suggest that hormone regulation is important in metastases to ovary
Clinical features
Radiology description
  • USG: mostly bilateral ovarian involvement by solid tumors 10 cm in size or less
Case reports
Treatment
  • Diagnosis of metastatic carcinoma to the ovary is usually done on salpingo-oophorectomy specimens:
  • Subsequent treatment is commonly not necessary
  • More extensive surgery (contralateral salpingo-oophorectomy, hysterectomy, lymph node dissection) may be considered if obvious or suspected residual tumor and no other sites of metastatic involvement on imaging
  • Minimal (e.g., palliative debulking) can also be considered
  • Surgery is defined as "optimal" when largest residual tumor mass is <2 cm (J Korean Med Sci 2009;24:114)
Clinical images

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Bilateral, large, hypoechoic, solid adnexal masses

Gross description
  • 80% are bilateral
  • Multiple solid tumor nodules with soft consistency
  • Involvement of ovarian surface and superficial cortex is common
Microscopic (histologic) description
  • Morphology mirrors the architecture and cytomorphology of the breast primary (including histologic grade)
  • Lobular carcinoma: small cords and clusters of tumor cells in ovarian cortex, single cells in between normal cortical stroma; histiocytoid or signet ring cell morphology can be seen
  • Ductal carcinoma: tubules / glands or solid nests of tumor cells in a variable fibrous stroma
Microscopic (histologic) images

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Diffuse infilitration by
lobular type epithelial cells

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Ductal

Cytology description
  • Cell clusters have high nuclear-cytoplasmic ratio, moderate cytoplasm, vesicular nuclei, conspicuous nucleoli
Cytology images

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Malignant cells in
cluster, Giemsa

Positive stains
Negative stains
  • PAX8: usually positive in most ovarian carcinomas subtypes (Am J Surg Pathol 2008;32:1566)
  • WT1: positive in only 2% of breast metastases versus 63% of ovarian tumors, but also negative in ovarian clear cell, mucinous and endometroid subtypes
  • CA125: weak / negative in breast carcinomas, 90% of ovarian carcinomas are CA125+ (Am J Surg Pathol 2005;29:1482)
Differential diagnosis
  • Primary ovarian adenocarcinoma: PAX8+, CA125+
  • Metastatic carcinoma from other sites (GI tract): history of known primary and IHC for primary site (CK20, CDX2, TTF1, Napsin A)