Ovarian tumour in postmenopausal woman 16 years after the treatment of breast cancer accompanied with increased serum level of CA-125 and CA 15-3

The literature reveals that most of the patients with ovarian metastases of breast carcinoma are premenopausal and have bilateral involvement. Manifestations of ovarian metastases usually occur within 5 years after diagnosis of primary breast cancer and are accompanied by metastases of other localization in half the cases. We report a case of a 61-year-old woman with a history of breast cancer. 16 years after breast cancer traetment bilateral ovarian tumour were disclosed. We also found an increased serum concentrations of tumor markers CA-125 and CA 15-3. After surgical exploration which confirmed neoplasmatic character of the tumour, bilateral salpingooophorectomy and omentectomy were done. Histological examinations showed the carcinoma cells of epithelial origin in both ovaries and omentum. We did not find primary tumour in any other site, including left breast, stomach, colon and uterus. To discriminate between primary ovarian carcinoma and metastases of breast carcinoma to the ovaries we performed immunohistochemical staining using antibodies against cytokeratin (CK), epithelial membrane antigen (EMA), estrogen receptor (ER), progesteron recpetor (PR), human milk fat globule (HMFG) and lactoalbumin alpha. Carcinoma cells were always positive for CK and EMA (100%) and to a lesser extent for ER (90%) and for PR (30%). We aslo found a high intensity staining reaction of carcinoma cells with antibodies against HMFG and lactoalbumin alpha. Based on histological and immunohistochemical examinations we diagnosed the metastases of lobular breast carcinoma to the ovaries and omentum. After six cours of paclitaxel (Taxol) there were no signs of residual diseases in pelvis. Serum concentration of CA-125 significantly decreased and CA 15-3 normalized. After six months of subsequent hormonal therapy multiple metastases in bones occured, accompanied with serum elevation of CA-125 and CA 15-3. There were still no signs of disease in pelvis and any other sites. She was treated with pamidronate (Aredia), radiotherapy and 89SrCl2. Patient died 14 months after bone dissemination and 29 months after the initial diagnosis of ovarian metastases.