Metastases to the breast mimmicking an inflammatory breast carcinoma: A Case Report
Metastasis to the breast from an ovarian carcinoma presenting as an inflammatory breast cancer.
Respected JRCR editors, I hereby apply for an invitation to submit the case to the Journal of Radiology Case Reports. History: A 45-year-old woman was diagnosed with FIGO stage IIIB (pT3b pn0) mixed epithelial ovarian carcinoma in April 2019. She underwent a suboptimal cytoreductive surgery and received 6 cycles of adjuvant chemotherapy (Carboplatin AUC 5- Paclitaxel). In February 2020 the patient was diagnosed with peritoneal progression and in April she showed signs and symptoms compatible with inflammatory breast cancer. Imaging Findings: In the diagnostic abdominal Contrast-Enhanced Computed Tomography (CECT) a cystic and solid left ovarian mass with a greater solid component, compatible with ovarian primary neoplasm was found. It also showed associated ascitic fluid (Fig. 1,2). In a control CECT in February, more ascitic fluid was noticeable (Fig.3) and it had positive cytology but no measurable implants. In April 2020 a later control CECT showed asymmetric enhancement of the left breast parenchyma and left axillary lymphadenopathies (Fig.4,5) Left breast enlargement with diffuse swelling and erythema was found on the physical examination (Fig 6) Digital Breast Tomosynthesis (DBT), ultrasonography (USG), and breast Magnetic Resonance Imaging (MRI) were performed for specific breast and axillary evaluation. DBT confirmed the presence of left breast diffuse skin thickening without delimiting clear focal parenchymal lesions. (Fig 7). Axillary ultrasonography showed suspicious lymphadenopathies in the left axilla (Fig 8). The breast MRI exhibited left breast enlargement with thickened skin and non-mass diffuse and heterogeneous enhancement. (Fig 9,10) Also left axillary lymphadenopathies were noticeable (Fig. 11). The patient underwent an ultrasound-guided core biopsy of the axillary lymphadenopathies and a skin punch biopsy and the pathology report revealed metastatic disease from a known ovarian neoplasm (Fig 12). After the diagnosis of metastatic disease, she started receiving palliative Carboplatin and Doxorubicin-based chemotherapy but unfortunately, that did not improve her prognosis and the patient passed away just eight months later. Take home message: When ovarian cancer spreads to the breast the prognosis is very poor and currently, there are no valid treatment options. This entity should be differentiated from primary breast cancer as the management and prognosis are significantly different and also to avoid unnecessary tests and surgeries in these patients.