Primary and metastatic ovarian cancer in patients with prior breast carcinoma. Pre-operative markers and treatment results.

BACKGROUND: The pre-operative diagnosis of primary and metastatic malignant ovarian tumors in patients treated for breast cancer is difficult. The objective of this study was to analyze and compare the characteristics and outcome of women with a history of breast cancer in order to identify pre-operative markers useful in differential diagnosis and the role of surgery in their management. MATERIALS AND METHODS: The medical records of 36 patients with a history of breast cancer, who had been operated on either for primary or metastatic cancer between 1987 and 2003, were reviewed retrospectively. RESULTS: Twenty-seven patients had been diagnosed with primary epithelial ovarian cancer (POC) and nine had metastatic disease (MOC), resulting in a 3:1 ratio. The median age of breast and ovarian cancer diagnosis was 45 and 56 years, respectively, and the median interval was 8 years. The serum CA 125 level was elevated in the majority of cases, in 70% of the POC group and 56% of the MOC, but the median level was higher, though not statistically significant, in the former. Serum CA 15-3 levels were elevated >100 U/ml in 89% of patients with MOC (p = 0.0002). BrCA mutation risk, as calculated with the BRCAPRO software program, was 41.8% and 9% in primary and metastatic tumors, respectively (p=0.0477). Ovarian spread was not the only site of metastatic breast cancer in 55.5% of the MOC group, compared to 11% of the POC patients Disease was disseminated in the abdominal cavity at the time of diagnosis in both groups, however, 78% of patients had unilateral tumors in the POC group and bilateral disease in the MOC (p=0.0133). Cytoreduction to less than 2 cm tumor diameter was feasible in 67% of primary and 44% of metastatic neoplasms. In the follow-up period (12-204 months), the median survival was 10 months for patients with metastatic disease, compared to 33 months for those with primary tumors (p<0.05). CONCLUSION: Small bilateral ovarian enlargements and minor serum elevation of CA 125 titers in patients with initial Stage IV breast cancer, suffering from multiple metastatic disease, are likely to illustrate MOC. Unilateral ovarian mass and high serum levels of CA 125 in apparently disease-free patients with a positive family history and high prevelance of BRCA mutations are suggestive of primary tumors. Optimal cytoreduction was feasible in both groups, but survival was longer in patients with primary tumors (p<0.05).

Solitary parenchymal splenic recurrence of ovarian adenocarcinoma: a case report and review of the literature.

We report a rare case of solitary parenchymal splenic recurrence of epithelial ovarian cancer which developed 27 months after the initial treatment. The patient, a 53-year-old woman, with a history of breast cancer, underwent total abdominal hysterectomy bilateral salpingo-ophorectomy (TAH & BSO), omentectomy and pelvic lymph node sampling for a serous carcinoma of the ovaries (stage IIIB). She subsequently received 6 cycles of cisplatinum chemotherapy. During follow-up, rising CA 125 serum levels heralded the 6 x 6 cm parenchymal splenic lesion which was documented by CT scan. She underwent splenectomy after pneumococcal vaccination, sandostatin and chemoprophylaxis. Histopathological evaluation revealed metastatic parenchymal disease consistent with recurrent ovarian cancer. She remains alive and disease-free for 20 months since the last operation. Isolated parenchymal splenic lesions are very rare and may occur as a late recurrence in epithelial ovarian cancer. Splenectomy can be performed with acceptable morbidity and confers a substantial survival benefit to patients.