Ovarian cancer presenting as an axillary mass: Case series and literature review

Left Axilla Adenocarcinoma of Unknown Origin

A 76-year-old woman presents with a palpable left axillary mass, yet no breast lesions are found. What is your diagnosis?

The Application of Fine Needle Aspiration Biopsy in the Diagnosis of Axillary Masses

INTRODUCTION

We intend to determine the diagnostic power of fine needle aspiration biopsy (FNAB) for differentiation between malignant and benign lesions on axillary masses and draw the physicians' attention to the benefits of FNAB cytology in the diagnosis of axillary masses.

METHODS

In this study, 1,328 patients with an axillary mass diagnosed by FNAB were retrospectively reviewed. These cases were registered at the affiliated hospital of Southwest Medical University (China), July 2014 to June 2017. Cytological results were verified either by histopathology following surgical resection or clinical follow-up.

RESULTS

Of the 1,328 patients affected by axillary masses, 987 (74.3%) cases were female, and 341 (25.7%) cases were male. The highest incidence of patients was in the age group of 41-50 years (375, 28.2%). There were 1,129 (85.0%) patients with benign lesions and 199 (15.0%) with malignant lesions. Of the 199 malignant lesions cases, 21 cases were lymphomas, 2 cases were accessory breast cancers, and 176 cases were lymph node metastatic tumors. Under lymph node metastases, the most frequent primary tumors were breast cancer (141, 80.1%), followed by lung cancer (21, 11.9%). According to the study, the characters of 1,328 cases showed statistically significant difference (χ2 = 4.534, p = 0.033), and the incidence of females with axillary mass was significantly higher than that of males. There was a statistically significant difference in the distribution of benign and malignant cases in the patient age groups (χ2 = 1.129, p = 0.000), and the incidence of patients of 41-50 years of age was significantly higher than that of other patients. The diagnostic accuracy of FNAB in axillary masses was analyzed with the results of 95.98% of sensitivity, 99.56% of specificity, 97.45% of positive predictive value, and 99.29% of negative predictive value.

CONCLUSION

Our results confirm that FNAB is a valuable initial screening method regarding pathologic diagnosis of axillary mass, in particular with respect to malignancy in 41- to 50-year-old female patients.

Metastatic serous borderline tumor with micro-invasive ovarian carcinoma presenting as a breast lump: A case report

RATIONALE

Breast metastasis from serous borderline tumor with micro-invasive carcinoma of ovary is a very rare condition. The breast lump as the only clinical presentation is rarely seen in ovarian carcinoma, which may lead to be misdiagnosed, and the mechanism of breast metastasis from ovarian tumors in early stage still needs to be explored. Differentiation from primary breast cancer and extramammary malignancy is crucial because the treatment and prognosis are significantly different.

PATIENT CONCERNS

A 33-year-old female presented with a painless, movable, 1.0 × 1.0 cm lump in the upper outer quadrant of the right breast for a month.

DIAGNOSES

Breast metastasis of serous borderline tumor with micro-invasive ovarian carcinoma confirmed by pathology and immunohistochemistry.

INTERVENTIONS

The patient underwent lumpectomy, bilateral ovarian tumor stripping operation and prophylactic chemotherapy.

OUTCOMES

No signs of recurrence have been detected in 1.5 years of follow-up.

LESSONS

Distant metastasis may occur in early stage of ovarian carcinoma. It is important to determine the origin of the primary tumor and develop an effective treatment strategy for patients. Imaging findings and pathological diagnostic criteria are important to accurately differentiate between metastasis and primary breast lesions, which may improve the patient's outcomes.

Axillary nodal metastasis in ovarian cancer: a report of three cases and review of literature

BACKGROUND

Ovarian cancer represents a major global health burden that is rarely associated with distant metastasis. Axillary lymph node metastasis from ovarian cancer is rare and is reported only in few case reports in literature.

CASE PRESENTATION

We report three cases of ovarian carcinoma associated with axillary lymph node metastasis as well as a brief literature review. The pathologic subtype in one case was malignant mixed Mullerian tumor, while the other two cases were high-grade serous ovarian carcinoma. Axillary nodal metastasis was reported as a synchronous event in one case, while it was reported as recurrence events in the other two cases.

CONCLUSION

Physicians should be aware of this uncommon mode of metastasis in ovarian cancer cases. Multi-disciplinary discussion is crucial in the management of these cases to offer them the best suitable treatment.

MiR-19a negatively regulated the expression of PTEN and promoted the growth of ovarian cancer cells

Ovarian cancer is the most lethal malignancy of the women genital tract. Exploring novel factors involved in the development of ovarian cancer and characterizing the molecular mechanisms by which regulate the tumorigenesis of ovarian cancer are quite necessary. Here, we found that miR-19a was highly expressed in ovarian cancer tissues and cell lines. Overexpression of miR-19a promoted the viability of ovarian cancer cells, while down-regulation of miR-19a inhibited the growth of ovarian cancer cells. To further understand the underlying molecular mechanism of miR-19a in regulating ovarian cancer cell growth, the downstream targets of miR-19a were predicted. The bioinformatics analysis showed that the tumor suppressor PTEN was found as one of the targeting candidates of miR-19a. MiR-19a bound the 3'-UTR of PTEN and highly expressed miR-19a decreased both the mRNA and protein levels of PTEN in ovarian cancer cells. Overexpression of PTEN suppressed the promoting effect of miR-19a on regulating the growth of ovarian cancer cells. Notably, the expression of miR-19a and PTEN was inversely correlated in ovarian cancer tissues. These results demonstrated the potential oncogenic role of miR-19a in ovarian cancer, which suggested that miR-19a might be a promising target in the diagnosis and treatment of ovarian cancer.