Morphological and phenotypical features of ovarian metastases in breast cancer patients

Diagnostic Accuracy of Whole-Body Computed Tomography for Incidental Ovarian Tumors in Patients with Prior Breast Cancer

Whole-body computed tomography (WBCT) serves as the first-line imaging modality for breast cancer follow-up. To investigate the imaging characteristics and diagnostic accuracy of WBCT for incidental ovarian tumors in patients with prior breast cancer, we retrospectively reviewed a consecutive cohort of 13,845 patients with breast cancer, of whom 149 had pathologically-proven ovarian lesions. We excluded patients with ovarian diagnosis before breast cancer, CT scan not including ovary, CT-pathology interval >30 days, and severe CT artifact. Among our 60 breast cancer patients (median age, 46 years) with pathologically proven ovarian lesions, 49 patients had benign diseases, seven had primary ovarian cancer and four had ovarian metastasis from breast cancer. The histologic types of breast cancer with ovarian metastases included invasive ductal carcinoma, lobular carcinoma and angiosarcoma. Cystic ovarian lesions identified on WBCT during the breast cancer follow-up are more likely to be benign, while solid-cystic lesions are likely to be primary ovarian cancers, and solid lesions may indicate ovarian metastasis. The diagnostic accuracy, sensitivity, specificity, and areas under the receiver operating characteristic curve of WBCT were 98.3%, 100.0%, 98.0%, and 0.99 (malignant vs. benign); 90.0%, 100.0%, 85.7%, and 0.93 (metastasis vs. primary ovarian cancer), respectively. The only false positive solid lesion was a Sertoli–Leydig tumor. In conclusion, WBCT may help diagnose incidental ovarian tumors in patients with prior breast cancers and guide disease management.

Heterogeneity of CEACAM5 in breast cancer

CEACAM5 is overexpressed in many primary breast carcinomas. However, the exact role of CEACAM5 in breast cancer tumorigenesis remains unresolved. Here, we examined a repository of 110 cryopreserved primary breast carcinomas by immunohistochemistry to assess the distribution of CEACAM5 in tumor subtypes. The majority of estrogen receptor-positive and HER2-overexpressing tumors were CEACAM5-positive, whereas most of Triple-negative tumors were negative. Assessing sample sets of paired primary breast cancers and corresponding lymph node lesions from a total of 59 patients revealed a high correlation between primary tumor and lymph node with regard to CEACAM5-status. However, a notable subset of sample sets demonstrated intratumoral heterogeneity in the primary tumor, the metastatic lesion or both, suggesting that both CEACAM5-positive and –negative cells can play a role in tumor dissemination. When examining the consequence of expression of CEACAM5 in breast cancer cell lines in culture assays we found that CEACAM5-expressing cells were less invasive. In survival analysis, using cohort studies of breast cancer, expression of CEACAM5 predicted different clinical outcomes depending on molecular subtypes. Altogether, our analysis suggests that CEACAM5 plays a context-dependent role in breast cancer that warrants further investigation.

Ovarian metastasis from breast cancer in three Chinese females: Three case reports

RATIONALE

The biological behavior and clinical features of ovarian metastasis from breast cancer remain unclear; diagnosis and treatment of this condition are challenging.

PATIENT CONCERNS

We reported three cases of ovarian metastasis from breast cancer in Chinese women aged 44, 46, and 30 years. The prognosis was different in all three patients; however, no symptoms of ovarian metastasis were observed.

DIAGNOSIS

All three premenopausal patients were diagnosed with hormone receptor-positive breast cancer and two of them had axillary lymph node metastasis. All three women had multiple extra-ovarian metastases when ovarian metastasis was detected.

INTERVENTIONS

All patients received systemic antitumor therapy and underwent bilateral ovariectomy.

OUTCOMES

Patient 1 had stable bone metastasis; patient 2 had stable lung metastasis and died of heart disease, and patient 3 had multiple brain metastases, which suggested poor outcomes.

LESSONS

It is important to screen for ovarian metastasis from breast cancer when evaluating suspicious ovarian masses detected via transvaginal ultrasound in patients with a breast cancer history. Therefore, we recommend simple laparoscopic bilateral oophorectomy not only for pathological diagnosis but also for metastatic tumor removal and therapeutic castration. In such cases, systemic therapy is essential because ovarian metastasis is often a component of systemic metastatic disease.