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Imaging of Metastatic Disease to the Ovary/Adnexa. Magn Reson Imaging Clin N Am 2022; 31:93-107. [DOI: 10.1016/j.mric.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ovarian Masses in Patients With Breast Cancer. J Comput Assist Tomogr 2022; 46:716-721. [PMID: 35617667 DOI: 10.1097/rct.0000000000001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to investigate the characteristic findings of computed tomography (CT) or magnetic resonance imaging (MRI) to discriminate metastasis from primary ovarian tumors in patients with a history of breast cancer. METHODS This retrospective study enrolled consecutive 72 patients with a history of breast cancer who underwent surgical confirmation of an ovarian mass detected on CT or MRI (primary ovarian tumors, n = 66; metastases, n = 6). Two independent readers analyzed the grade of solid portions of the ovarian mass using a 5-point scale on CT or MRI. A predominantly cystic mass was defined as a solid grade of 1 to 2. Cancer antigen 125 (CA 125) and the initial stage of breast cancer were also investigated. RESULTS The proportions of predominantly cystic masses were significantly different between metastases (0% for both readers) and primary ovarian tumors (59% for reader 1 and 53% for reader 2, P < 0.05). For masses of solid portion grades 3 to 5, CA 125 was significantly higher for malignant epithelial tumors than for the other tumors (P < 0.001), and the initial stage of breast cancer was significantly higher for metastases than for the other tumors (P < 0.001), respectively. CONCLUSIONS In patients with a history of breast cancer, predominantly cystic masses detected on CT or MRI seem to be primary ovarian tumors. For the other masses, knowledge of CA 125 and initial breast cancer stage may help in the differential diagnosis.
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Diagnostic Accuracy of Whole-Body Computed Tomography for Incidental Ovarian Tumors in Patients with Prior Breast Cancer. Diagnostics (Basel) 2022; 12:diagnostics12020347. [PMID: 35204438 PMCID: PMC8870859 DOI: 10.3390/diagnostics12020347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 12/10/2022] Open
Abstract
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.
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Şahin Uysal N, Boyraz G, Usubütün A, Tuncer ZS. The evaluation of laparotomy results in breast cancer patients with gynecological pathologies. J Obstet Gynaecol Res 2020; 46:2126-2133. [PMID: 32779347 DOI: 10.1111/jog.14408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022]
Abstract
AIM The aim of the study was to evaluate the results of the laparotomies due to gynecological pathologies in breast cancer patients and to assess the distribution of gynecological pathologies and the clinical and laboratory findings contributing to the diagnosis. METHODS This study was conducted between years 2002 and 2011 at Hacettepe University Hospital. We obtained information about 86 consecutive breast cancer patients, including age, time of diagnosis and pathology of breast cancer, hormone receptor status, history of endocrine therapy, presenting symptoms, ultrasonography findings, CA 125 levels, endometrial biopsy results, type of gynecological surgery and pathology results. Data were analyzed with the use of SPSS software. RESULTS Twenty-one (24.4%) out of 86 patients had endometrial pathology, and 24 (27.9%) had adnexal pathology. Fourteen patients (16.2%) had malignant pathology, and of them, 11 had ovarian cancer 3 had endometrial cancer. There were five abnormal cytological findings: 2 ASCUS, 1 LSIL, 1 ASC-H and 1 adenocarcinoma. The patient with the cytology report of adenocarcinoma had the final diagnosis of endometrial cancer. Of the patients, 67 (77.9%) used tamoxifen, whereas 19 (22.1%) did not. Thirty-three patients (38.4%) with gynecological pathologies were detected incidentally during routine follow-up of breast cancer. CONCLUSION This study supports the increase of the gynecological pathology incidence in breast cancer patients and the recommendation of close gynecological follow-up in these patients. Asymptomatic patients might also develop genital cancer. The ultrasonographic appearance of the adnexal masses or endometrial thickness and any abnormal vaginal bleeding or high CA 125 levels are important parameters for evaluating breast cancer patients.
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Affiliation(s)
- Nihal Şahin Uysal
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gökhan Boyraz
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alp Usubütün
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zafer S Tuncer
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Novel classification of ovarian metastases originating from colorectal cancer by radiological imaging and macroscopic appearance. Int J Clin Oncol 2020; 25:1663-1671. [PMID: 32494980 DOI: 10.1007/s10147-020-01717-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/26/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Diagnosis of secondary ovarian tumors originating from colorectal cancer has previously been based upon history of malignancy and radiological findings of bilateral masses with a "stained glass appearance." The purpose of this study was to perform a detailed investigation of the radiological and macroscopic features of ovarian metastases originating from colorectal cancer, which remain to be fully characterized. METHODS Study participants were 48 consecutive patients with ovarian metastases from colorectal cancer who underwent resection of ovarian tumors at the National Cancer Center Hospital between August 1998 and January 2019. Ovarian tumors were classified into subgroups using computed tomography (CT), magnetic resonance imaging (MRI), and macroscopic appearance. RESULTS CT/MRI findings and macroscopic appearance were classified into the following four types: type 1 (oval, homogeneous-solid) (n = 5); type 2 (heterogeneous-solid, small in size with multinodular surface) (n = 3); type 3 (solid-cystic, predominantly solid) (n = 18); and type 4 (cystic-solid, multilocular with solid components) (n = 22). Type 1 mimics Krukenberg tumors, type 2 mimics ovarian metastases from breast cancer, type 3 mimics primary ovarian endometrioid cancer, and type 4 mimics primary ovarian mucinous cancer, with a "stained glass appearance". Twenty-eight (58%) patients had bilateral metastases. Eleven patients (23%) underwent hysterectomy and/or pelvic lymph node dissection in addition to ovarian resection. CONCLUSION We introduced a novel classification system for ovarian metastases originating from colorectal cancer, which may be beneficial for assessing ovarian metastases from colorectal cancer and avoiding unnecessary surgery due to misdiagnosis of primary ovarian tumors.
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Armas I, Brandão M, Guerreiro I, Guerreiro I, Lobo J, Freitas C, Pinto-de-Sousa J, de Sousa JA. Incidental diagnosis of breast cancer in the pursuit of the treatment of intestinal obstruction. AUTOPSY AND CASE REPORTS 2019; 9:e2018071. [PMID: 30863737 PMCID: PMC6394361 DOI: 10.4322/acr.2018.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/24/2018] [Indexed: 11/23/2022] Open
Abstract
Intestinal lipomatosis is rare and often asymptomatic but can present with intestinal obstruction. Occasionally, metastatic breast cancer is identified in the ovary before a breast primary is discovered. We report the case of a 50-year-old woman diagnosed with synchronous intestinal obstruction due to lipomatosis, and incidental ovarian metastases from breast cancer. The patient presented with a 12-day history of nausea, diffuse abdominal pain, and constipation. An abdominal x-ray showed air-fluid levels, and computed tomography documented small bowel distention. An explorative laparotomy was performed, which revealed small bowel distention, an obstructive lesion of the ileocecal valve, three terminal ileum lesions, ascites, and heterogeneous ovaries. Right ileocolic resection and left oophorectomy were performed. The pathological diagnosis revealed lipomatous submucosal lesion of the ileocecal valve and ileum, and 17 lymph nodes, which were all negative for malignant cells. The oophorectomy revealed ovarian metastasis from breast carcinoma. Ascitic fluid was positive for malignant cells. Mammography and breast/axillary ultrasonography showed a solid nodule of the left breast, ductal carcinoma, and multiple enlarged left axillary lymph nodes, which were positive for neoplastic cells. Immunohistochemical evaluation showed hormonal receptor positivity and C-erb2 negativity. Breast magnetic resonance imaging showed a 14 mm left nodule and a positron emission tomography scan revealed 18F-FDG uptake in the left breast, left axillary lymph nodes, right ovary, and peritoneum. The tumor was staged as stage IV ductal breast carcinoma, cT1N1M1, Grade 2, Luminal B-like. The multidisciplinary oncological meeting proposed chemotherapy, and a re-staging breast MRI after chemotherapy, which showed a complete response. The patient started treatment with letrozole and remains disease-free 22 months after finishing chemotherapy.
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Affiliation(s)
- Isabel Armas
- Unidade Local de Saúde do Nordeste, General Surgery. Bragança, Portugal
| | - Mariana Brandão
- Instituto Português de Oncologia do Porto, Medical Oncology. Porto, Portugal
| | - Inês Guerreiro
- Instituto Português de Oncologia do Porto, Medical Oncology. Porto, Portugal
| | - Inês Guerreiro
- Instituto Português de Oncologia do Porto, Medical Oncology. Porto, Portugal
| | - João Lobo
- Instituto Português de Oncologia do Porto, Patology Department. Porto, Portugal
| | - Carla Freitas
- Centro Hospitalar Tâmega e Sousa, General Surgery. Penafiel, Porto, Portugal
| | - João Pinto-de-Sousa
- Centro Hospitalar Tâmega e Sousa, General Surgery. Penafiel, Porto, Portugal
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Tian W, Zhou Y, Wu M, Yao Y, Deng Y. Ovarian metastasis from breast cancer: a comprehensive review. Clin Transl Oncol 2018; 21:819-827. [DOI: 10.1007/s12094-018-02007-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022]
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Reinert T, Nogueira-Rodrigues A, Kestelman FP, Ashton-Prolla P, Graudenz MS, Bines J. The Challenge of Evaluating Adnexal Masses in Patients With Breast Cancer. Clin Breast Cancer 2018; 18:e587-e594. [PMID: 29680194 DOI: 10.1016/j.clbc.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
This narrative literature review addresses the problem of an adnexal mass discovered during the course of breast cancer (BC) care, which may represent a benign condition, a metastatic process, or a primary ovarian cancer (OC), clinical scenarios associated with distinct physiopathology and prognosis. Furthermore, the coexistence of BC and OC in the same patient may be owing to a hereditary disorder, deserving specific management strategies and counseling. The initial detection and evaluation of an adnexal mass in a patient with BC requires a high index of suspicion, and the initial workup should include a thorough medical history and physical examination, measurement of tumor markers, complete blood count, and imaging tests. Transvaginal ultrasonography remains the standard tool, and findings suggestive of malignancy include bilateral tumors, thick septations, predominance of a solid component, Doppler flow to the solid component, and ascites. From the pathology point of view, features that are suggestive of metastatic disease include bilaterality, mild ovarian enlargement, vascular emboli, no omental deposits, and the absence of transition from benign to malignant epithelium. Although there is a considerable overlap in OC and BC immunohistochemical profiles, BC usually stain positive for GCDFP-15 and negative for vimentine, PAX8, and WT1, and OC often stain positive for CK7, PAX8, WT1, and to mesothelin. Genetic counselling should always be indicated in this clinical scenario. In conclusion, diagnostic spectrum of an ovarian mass in a patient with BC is broad, and a systematic multi-professional strategy is necessary to conduct these challenging cases.
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Affiliation(s)
- Tomás Reinert
- Hospital do Câncer Mãe de Deus, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Angélica Nogueira-Rodrigues
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil; Brazilian Group of Gynecologic Oncology (EVA), Belo Horizonte, Brazil; DOM Oncologia, Minas Gerais, Brazil
| | | | - Patricia Ashton-Prolla
- Departamento de Genética e Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Márcia Silveira Graudenz
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Departamento de Patologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Instituto de Patologia, Porto Alegre, Brazil
| | - José Bines
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil.
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