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Dundar B, Alrwashdeh A, Dahmoush L. Tumor to Tumor Metastasis: A Case Report of Metastatic Angiosarcoma to an Ovarian Brenner Tumor and Review of the Literature. Int J Gynecol Pathol 2023; 42:176-181. [PMID: 35283447 DOI: 10.1097/pgp.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While angiosarcoma metastatic to the ovary is rare, metastatic angiosarcoma to an ovarian tumor has never been reported in the literature, so far. We report a case of a 61-yr-old postmenopausal woman with history of breast cancer, presenting with metastatic angiosarcoma to an ovarian Brenner tumor. Initially at the frozen section examination, on limited sampling, and without knowledge of the patient's history, a diagnosis of at least proliferating Brenner tumor was rendered. Upon review of permanent sections, an intermixed angiosarcoma component was identified within Brenner tumor. Tumor to ovarian tumor metastasis is a rare phenomenon, with only 18 cases reported in the last 50 yr. It poses diagnostic challenges during sampling and histopathologic interpretation. Detailed clinical history, careful gross examination and sampling are important to recognize the separate tumor components.
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Affiliation(s)
- Bilge Dundar
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Ferrari F, Ficarelli S, Forte S, Valenti G, Ardighieri L, Sartori E, Odicino F. Extra-abdominal ovarian cancer presenting with breast metastases at diagnosis: Case report and literature review. Eur J Obstet Gynecol Reprod Biol 2020; 255:211-221. [PMID: 33152565 DOI: 10.1016/j.ejogrb.2020.10.004] [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: 04/24/2020] [Revised: 08/17/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Malignant ovarian tumours are diagnosed at an advanced stage in the majority of cases. However, only a small percentage present as extra-abdominal, non-lymph-node solid metastases, as in the breast, and they are usually cases of relapse. The discovery of mono- or bilateral breast lesions with peritoneal carcinosis and/or abdomino-pelvic lesions can be cumbersome in the differential diagnosis of primary tumours. This article aims to summarize current evidence on the detection of breast metastases at diagnosis of ovarian cancer. STUDY DESIGN A systematic review of the literature in Scopus, PubMed/MEDLINE, ScienceDirect and the Cochrane Library, including case reports and case series, was undertaken. Data regarding study features; population characteristics; clinical, radiological and histological assessment of the disease; treatment and follow-up were collected. In addition, a case report of a patient managed at the authors' centre is provided. RESULTS According to the search strategy, 16 articles (18 patients) were included in this review. Serous ovarian, fallopian tube or primary peritoneal cancer was detected in 61% of cases, while another type or a non-specified type of epithelial ovarian cancer was detected in 27.7% of cases; there was one case with granulosa cell tumour of the ovary and one case with mucinous ovarian tumour of low malignant potential. Breast metastases were mainly monolateral (66.6%), with other extra-abdominal sites of disease in the majority of the cases. A minority of patients (16.6%) received treatment for primary breast cancer with a subsequent diagnosis of ovarian cancer. Concomitant breast and abdominal surgery can be an option. PAX8, WT1 and CA125 immunohistochemical staining can aid in differential diagnosis. CONCLUSION Breast metastases of malignant ovarian tumours must be promptly recognized to ensure proper treatment. Specific immunohistochemical analysis can be a decisive assessment in uncertain cases.
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Affiliation(s)
- Federico Ferrari
- Department of Obstetrics and Gynaecology, ASST Spedali Civili Brescia, Brescia, Italy.
| | - Silvia Ficarelli
- Department of Obstetrics and Gynaecology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Sara Forte
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Gaetano Valenti
- Unit of Gynaecology and Obstetrics, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | | | - Enrico Sartori
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
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Tumor-to-tumor metastasis from appendiceal adenocarcinoma to an ovarian mature teratoma, mimicking malignant transformation of a teratoma: a case report. Diagn Pathol 2019; 14:88. [PMID: 31409389 PMCID: PMC6692929 DOI: 10.1186/s13000-019-0865-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Tumor-to-tumor metastasis (TTM) is a rare but well-documented phenomenon that is defined as metastasis in a histologically distinct tumor. Ovarian mature teratomas (OMTs) can coexist with various cancers by malignant transformation, which may make it difficult to distinguish these from TTM. Herein, we report a case of TTM from appendiceal adenocarcinoma to the OMT, mimicking the malignant transformation of OMT. Case presentation A 67-year-old Japanese woman underwent abdominal total hysterectomy and bilateral salpingo-oophorectomy for an ovarian tumor in another hospital. She was initially diagnosed with mucinous carcinoma/carcinoid arising in the OMT. One year after surgery, she was referred to our hospital after the presentation of increased appendiceal mass. Cecal biopsy targeting an appendiceal tumor revealed scattered mucinous cells with signet ring features, which were morphologically similar to the malignant components in the previously diagnosed right OMT. Both the appendiceal adenocarcinoma and malignant components of the OMT stained positive for CK7, CK20, CDX-2, and SATB2 but negative for estrogen receptor, progesterone receptor, and pax-8. Finally, we confirmed the diagnosis of appendiceal goblet cell carcinoid metastasizing to the right OMT. The patient had tumor-bearing survival due to systemic chemotherapy administered for 35 months after the initial surgery. Conclusions Awareness of the TTM phenomenon is important to avoid an incorrect diagnosis and to select the appropriate therapy when unusual malignancy is encountered in the OMTs.
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Tan W, Tao L, Zhou Z, Yin W, Chen Y. Tumor-to-tumor metastasis: a rare case of breast carcinoma metastasizing to a pheochromocytoma, and a literature review. Diagn Pathol 2019; 14:46. [PMID: 31109373 PMCID: PMC6528332 DOI: 10.1186/s13000-019-0816-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/18/2019] [Indexed: 12/18/2022] Open
Abstract
Background Tumor-to-tumor metastasis is a well-recognized but uncommon entity. Breast carcinoma is one of the most common metastatic donors. Breast carcinoma metastasizes commonly to adrenal glands. However, the co-existence of a metastatic lesion with an existing adrenal tumor is a rare finding. Case presentation A 35-year-old woman was diagnosed with pheochromocytoma using computed tomography and ultrasound examinations. The tumor was surgically removed. Histological and immunohistochemical staining suggested that there were two components in the tumor: pheochromocytoma and metastatic cancer. Conclusion This is the second published case of pheochromocytoma with tumor-to-tumor metastasis from an invasive ductal carcinoma of the breast. Furthermore, we highlight the importance of awareness of tumor-to-tumor metastasis in pathological diagnosis.
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Affiliation(s)
- Weiwei Tan
- Department of Pathology, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Lili Tao
- Department of Pathology, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China.
| | - Zhuping Zhou
- Department of Imaging, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Weihua Yin
- Department of Pathology, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
| | - Yaoli Chen
- Department of Pathology, Peking University Shenzhen Hospital, Shenzhen, Guangdong Province, People's Republic of China
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Kang M, Lee KB, Park YH, Cho HY. First reported case of intrahepatic cholangiocarcinoma metastasis to thecoma. J OBSTET GYNAECOL 2018; 39:429-431. [PMID: 30428729 DOI: 10.1080/01443615.2018.1504901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Myunghee Kang
- a Departments of Pathology , Gachon University Gil Medical Center , Incheon , South Korea
| | - Kwang-Beom Lee
- b Department of Obstetrics and Gynecology , Gachon University Gil Medical Center , Incheon , South Korea
| | - Yeon Ho Park
- c Department of Surgery , Gachon University Gil Medical Center , Incheon , South Korea
| | - Hyun Yee Cho
- a Departments of Pathology , Gachon University Gil Medical Center , Incheon , South Korea
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Meisel JL, Hyman DM, Jotwani A, Zhou Q, Abu-Rustum NR, Iasonos A, Pike MC, Aghajanian C. The role of systemic chemotherapy in the management of granulosa cell tumors. Gynecol Oncol 2014; 136:505-11. [PMID: 25546114 DOI: 10.1016/j.ygyno.2014.12.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Granulosa cell tumors (GCTs) are rare, and the role of chemotherapy in their management is not clearly defined. METHODS We performed a retrospective cohort study of GCT patients diagnosed from January 1996 through June 2013 at the Memorial Sloan Kettering Cancer Center, comparing those who received adjuvant chemotherapy to those who did not. Differences between groups were assessed using the log-rank test. Statistical significance was set at p<0.05. RESULTS Of 118 patients, 10 (8%) received adjuvant chemotherapy (1 [1%] of 103 stage I and 9 [60%] of 15 stage II-IV patients). Thirty-two patients (27%) experienced disease recurrence. Four patients had residual disease after initial surgery, and all received adjuvant chemotherapy; each recurred within 24.3 months (median PFS, 8.2 months). The time to first recurrence was longer in patients who did not receive adjuvant chemotherapy. For patients with recurrent disease, receiving chemotherapy after surgery for first recurrence did not seem to improve time to second recurrence versus surgery alone (HR 0.98; p=0.965). Additionally, 12 patients (10%) had a previous diagnosis of breast cancer-an incidence rate 3.22 times higher than Surveillance, Epidemiology, and End Results (SEER) data predicts (p<0.001). CONCLUSIONS Although the numbers were small, in this analysis chemotherapy was not found to improve the recurrence-free interval of patients with GCTs, a finding that requires prospective validation. Residual disease after surgery was associated with poor prognosis. Finally, there was a significantly higher than expected incidence of antecedent breast cancer in this population, an association that deserves further exploration.
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Affiliation(s)
- Jane L Meisel
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David M Hyman
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Developmental Therapeutics, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Anjali Jotwani
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qin Zhou
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
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Raap M, Antonopoulos W, Dämmrich M, Christgen H, Steinmann D, Länger F, Lehmann U, Kreipe H, Christgen M. High frequency of lobular breast cancer in distant metastases to the orbit. Cancer Med 2014; 4:104-11. [PMID: 25355547 PMCID: PMC4312124 DOI: 10.1002/cam4.331] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/04/2014] [Accepted: 08/10/2014] [Indexed: 12/03/2022] Open
Abstract
Metastasis to the periocular soft tissue of the orbit is a rare manifestation of metastatic cancer. Infiltrating lobular breast cancer (ILBC) is a special breast cancer subtype, which accounts for 10–15% of all mammary carcinomas and for ∼1% of all malignancies. Here, we report on a high frequency of lobular breast cancer in patients with orbital metastases identified in an original series of metastatic tumor specimens and by a systematic literature review. A series of 14 orbital metastases was compiled from formalin-fixed paraffin-embedded archival tissues. All cases were subjected to histological re-review and detailed immunophenotypical characterization. In addition, we performed a meta-analysis of 68 previously published case reports describing orbital metastases, with special reference to breast cancer subtypes. Based on clinical history, histomorphology, immunophenotype, and/or comparison with matched primary tumors, orbital metastases were derived from breast cancer in 8/14 cases, seven of which were classified as metastatic lobular breast cancer. Other entities included non-small cell lung cancer (4/14), infiltrating ductal breast cancer (1/14), prostate cancer (1/14) and adenocarcinoma of the esophagus (1/14). In line with this original series of orbital metastases, lobular breast cancer was the most common malignancy in 72 patients with orbital metastases described in 68 independent case reports. In conclusion, lobular breast cancer represents the cancer subtype with the highest prevalence among orbital metastases. The high frequency of ILBC in orbital metastases illustrates the special metastatic behavior of this tumor entity and may have implications for the understanding of the organotropism of metastatic lobular breast cancer.
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Affiliation(s)
- Mieke Raap
- Institute of Pathology, Hannover Medical School, Hannover, Germany
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Tanaka T, Kato T, Ohmichi M. Granulosa cell tumor of the ovary after long-term use of tamoxifen and toremifene. J Obstet Gynaecol Res 2012; 38:1379-84. [PMID: 22612286 DOI: 10.1111/j.1447-0756.2012.01878.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The relation between the use of tamoxifen and gynecologic tumors has been documented. In this case, a 58-year-old postmenopausal woman had been treated with tamoxifen for 5 years followed by toremifene for 1.5 years due to the presence of stage II estrogen receptor-positive breast cancer. The patient was found to have a stage Ic granulosa cell tumor of the ovary despite undergoing annual gynecologic examinations. This report presents a case of granulosa cell tumor of the ovary after the long-term use of tamoxifen and toremifene.
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Affiliation(s)
- Tomohito Tanaka
- Department of Obstetrics and Gynecology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Osaka, Japan.
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Abahssain H, Kairouani M, Gherman R, M'rabti H, Errihani H. Granulosa cell tumor of the ovary and antecedent of adjuvant tamoxifen use for breast cancer. World J Surg Oncol 2010; 8:67. [PMID: 20704728 PMCID: PMC2928230 DOI: 10.1186/1477-7819-8-67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 08/12/2010] [Indexed: 11/26/2022] Open
Abstract
Background Adult granulosa cell tumor associated with antecedent use of tamoxifen as adjuvant hormonotherapy for breast cancer is rare. The pathogenesis of this occurrence remains difficult to explain. The estrogenic effect of tamoxifen can be one such explanation. Case presentation A 47 year-old women was treated with surgery, chemotherapy, radiotherapy and tamoxifen for stage III estrogen receptor positive breast carcinoma. Ten months after stopping tamoxifen, we diagnosed a stage Ic granulosa cell tumor of the ovary. Conclusions Use of tamoxifen has been found to be associated with gynecological tumors like endometrial carcinoma. Its association with granulosa cell tumor of the ovary is uncommon. Only two previous cases have been reported in literature.
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Yasuhara Y, Mikami Y, Ishiguro S. Metastatic breast carcinoma identified in a uterine leiomyosarcoma. Pathol Int 2008; 58:317-21. [DOI: 10.1111/j.1440-1827.2008.02230.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Scopa CD, Aletra C, Lifschitz-Mercer B, Czernobilsky B. Metastases of breast carcinoma to the uterus. Report of two cases, one harboring a primary endometrioid carcinoma, with review of the literature. Gynecol Oncol 2005; 96:543-7. [PMID: 15661249 DOI: 10.1016/j.ygyno.2004.09.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND Metastases to the uterus are rare, accounting for less than 10% of all cases of metastases to the female genital tract from extragenital cancers. The endometrium is even less frequently affected by metastases. Lobular carcinoma is the most common type of breast cancer that metastasizes to the uterus. CASES Two cases of infiltrating lobular carcinoma of the breast metastatic to endometrium and myometrium, one of them harboring an endometrioid adenocarcinoma, are reported. Both patients were on tamoxifen therapy and presented with uterine bleeding. CONCLUSION To the best of our knowledge, uterine carcinoma serving as recipient of metastatic carcinoma from the breast has not been previously documented. This possibility should be considered when an unusual bimorphic pattern appears in a tumor until proven otherwise.
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Affiliation(s)
- Chrisoula D Scopa
- Department of Pathology, Regional University Hospital, University of Patras, Medical School, Patras, Greece.
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