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Metastasis and Carcinoma Case Studies / Ovarian Cancer Diagnosis and Treatment / Breast Lesions and Carcinomas · Journal article
BMC Women S Health · August 15, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a single case of ovarian cancer metastatic to breast in a BRCA1-mutated patient who achieved 27 months of progression-free survival on olaparib maintenance, followed by HER2 conversion at recurrence. The case illustrates diagnostic challenges, raises a hypothesis about transdiaphragmatic lymphatic spread, and documents sequential targeted therapy, but provides no comparative evidence and cannot be generalized.
Case report. One 44-year-old woman with synchronous high-grade serous ovarian carcinoma and breast metastasis, carrying a germline BRCA1 pathogenic mutation. Intervention: Neoadjuvant chemotherapy, cytoreductive surgery, olaparib maintenance therapy, and enrollment in a clinical trial of anti-HER2 antibody–drug conjugate.
Patient with synchronous BRCA1-mutated (c.964del) high-grade serous ovarian carcinoma with breast metastasis achieved 27 months of progression-free survival on olaparib maintenance therapy Breast lesion showed HER2 conversion from 0 (at diagnosis) to IHC 2+ with FISH amplification at platinum-resistant recurrence PAX8/WT1/GATA3 immunohistochemical panel critical for distinguishing ovarian metastasis from primary breast carcinoma
No information on toxicity, dose adjustments, or reasons for olaparib discontinuation at 27 months
This case underscores the importance of immunohistochemical panels to distinguish metastatic ovarian disease from primary breast cancer, and documents sustained benefit from PARP inhibition in a BRCA1-mutated setting. However, as a single case, it cannot inform routine clinical practice decisions; the HER2 conversion observation requires validation in larger cohorts before changing management algorithms.
Single case report documenting an unusual metastatic pattern and therapeutic response; raises mechanistic questions about lymphatic spread and HER2 conversion but lacks comparative data or generalizable evidence.
As stated by the source record.
Quoted from the source exactly as published.
This case underscores the importance of immunohistochemical panels to distinguish metastatic ovarian disease from primary breast cancer, and documents sustained benefit from PARP inhibition in a BRCA1-mutated setting. However, as a single case, it cannot inform routine clinical practice decisions; the HER2 conversion observation requires validation in larger cohorts before changing management algorithms.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Background Breast metastasis from extramammary malignancies is rare, with ovarian cancer being an exceptionally uncommon primary source. These metastases frequently mimic primary breast carcinoma, posing substantial diagnostic and therapeutic challenges. Case presentation A 44-year-old woman presented with a breast mass initially suspected to be a primary breast carcinoma based on estrogen receptor (ER) (+, 80%), progesterone receptor (PR) (+, 5%), and Human Epidermal Growth Factor Receptor 2 (HER2) (0) staining. However, subsequent workup revealed a synchronous ovarian high-grade serous carcinoma (PAX8+/WT1+), raising the question of dual primary versus metastatic disease and prompting re-review of the breast biopsy, which ultimately confirmed the metastatic ovarian origin of the breast lesion. A pathogenic germline BRCA1 mutation c.964del (p.Ala322Leufs*19) was identified. After neoadjuvant chemotherapy and cytoreductive surgery, the patient received olaparib maintenance therapy, achieving 27 months of progression-free survival before platinum-resistant recurrence. Repeat HER2 testing of the breast lesion at recurrence showed conversion to IHC 2 + with FISH amplification, prompting enrollment in a clinical trial evaluating an anti-HER2 antibody–drug conjugate (ADC). Conclusions This case highlights three key points. First, the PAX8/WT1/GATA3 immunohistochemical panel is critical for distinguishing ovarian metastasis from primary breast carcinoma. Second, the route of spread from the ovary to the breast, possibly transdiaphragmatic via the cardiophrenic and internal mammary nodes, requires further investigation. Third, PARP inhibitor maintenance in the context of a germline BRCA1 mutation provided sustained disease control, and HER2 status conversion at recurrence opened a therapeutic window for sequential antibody–drug conjugate (ADC) therapy.
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