Breast Metastases from Ovarian Carcinoma: A Review

Background: Breast metastasis from ovarian carcinoma is a rare manifestation of extramammary malignancy and a recognized diagnostic pitfall as it may mimic primary breast cancer. This review summarizes current evidence regarding the pathogenesis, clinicopathologic features, imaging findings, differential diagnosis, and diagnostic approach to breast metastasis from ovarian carcinoma.

Materials and Results: The pathogenesis of breast involvement is multifactorial and likely includes hematogenous and lymphatic spread with aggressive metastatic biology. Radiological features are suggestive but nonspecific, usually as a circumscribed mass without suspicious calcifications or distortion or less commonly as multifocal, bilateral or similar to inflammatory breast cancer on mammogram, and hypoechoic solid masses with circumscribed or mildly irregular margins and posterior acoustic enhancement on ultrasound. Mammography and ultrasound are typically used for initial breast assessment, whereas breast MRI improves lesion characterization and local extent evaluation. FDG PET/CT is particularly valuable for systemic staging and detection of additional metastatic disease. Definitive diagnosis depends on histopathologic examination and immunohistochemistry, especially the demonstration of Müllerian markers with the absence of typical breast markers.

Conclusions: Breast metastasis from ovarian cancer is a rare manifestation of an advanced malignancy with poor prognosis. Most commonly seen in high-grade serous ovarian carcinoma. Imaging plays a central role in lesion detection and staging, though none of the modalities can accurately distinguish metastatic ovarian disease from primary breast lesion. Definitive diagnosis relies on core biopsy and immunohistochemistry. Early and accurate recognition is critical to avoid diagnostic error, ensure appropriate systemic management and to avoid unnecessary mastectomy