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Presented by Pedram Argani, M.D. and prepared by Marc Halushka M.D., Ph.D.
Case 5: 77 year-old female with an upper outer quadrant breast mass, status post-TAH/BSO two years ago.
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1. Question
Week 181: Case 5
77 year-old female with an upper outer quadrant breast mass, status post-TAH/BSO two years ago.images/Halushka/conf51804/case5image1.jpg
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images/Halushka/conf51804/case5image5.jpgCorrect
Answer: Metastatic ovarian carcinoma
Histology: The tumor is associated with the lymphoid stroma, and likely is present within an axillary lymph node. The tumor has a papillary architecture, and high grade cytology. Review of the patient’s prior ovarian tumor revealed similar cytology. By immunohistochemistry, the tumor was strongly immunoreactive for WT-1 in a nuclear fashion, and labeled for CA-125. GCDFP but did not show definitive labeling of the tumor.
Discussion: In situ papillary carcinoma would be associated with myoepithelial cells, which were not present in the current lesion. Lymphoid stroma would be most unusual for this lesion. This tumor has a circumscribed border, which would make infiltrating ductal carcinoma unlikely. The staining for the markers WT-1 and CA-125 support ovarian origin over breast. Melanoma is suggested by the prominent nucleoli, but is excluded by the immunohistochemical labeling pattern.
Ovarian carcinoma is one of the more common tumors that metastasizes to the breast, along with melanoma, lung carcinoma, gastric carcinoma, and renal cell carcinoma. Features that favor a metastasis over primary breast carcinoma includes an absence of in situ component, a lack of sclerosis or elastosis, a pushing border, and multiple satellite foci or lymphatic emboli.
Incorrect
Answer: Metastatic ovarian carcinoma
Histology: The tumor is associated with the lymphoid stroma, and likely is present within an axillary lymph node. The tumor has a papillary architecture, and high grade cytology. Review of the patient’s prior ovarian tumor revealed similar cytology. By immunohistochemistry, the tumor was strongly immunoreactive for WT-1 in a nuclear fashion, and labeled for CA-125. GCDFP but did not show definitive labeling of the tumor.
Discussion: In situ papillary carcinoma would be associated with myoepithelial cells, which were not present in the current lesion. Lymphoid stroma would be most unusual for this lesion. This tumor has a circumscribed border, which would make infiltrating ductal carcinoma unlikely. The staining for the markers WT-1 and CA-125 support ovarian origin over breast. Melanoma is suggested by the prominent nucleoli, but is excluded by the immunohistochemical labeling pattern.
Ovarian carcinoma is one of the more common tumors that metastasizes to the breast, along with melanoma, lung carcinoma, gastric carcinoma, and renal cell carcinoma. Features that favor a metastasis over primary breast carcinoma includes an absence of in situ component, a lack of sclerosis or elastosis, a pushing border, and multiple satellite foci or lymphatic emboli.
