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Kurt et al. J Cancer Metastasis Treat 2019;5:8 I http://dx.doi.org/10.20517/2394-4722.2018.80 Page 5 of 6

important markers. Still, it is difficult to tell the same for metastatic tumors [13,14] . Except elevated CA 15-3
levels, other tumor markers (CA 125, CA 19-9, carcino-embryonic antigen, alpha-fetoprotein) were in
normal range in our case.

As patient history, laboratory findings and physical examination, radiological examination is also an
important means while detecting the primary focus of the tumor. In addition to ultrasonography,
mammography, magnetic resonance imaging and CT; PET-CT is also very helpful. Especially during
the postmenopausal period, when the ovaries are non-functional, the diagnostic power of PET-CT is
[11]
higher . Mammography manifested the findings for breast cancer rather clearly. The expectation for
broad involvement of lymph nodes and presence of distant metastases was low at the stage of microinvasive
breast cancer, therefore the possibility of the right ovarian mass being a second primary malignancy was
considered. Although the imaging methods were very revealing regarding the extensiveness of the lesion,
they were inadequate for the distinction between primary and metastatic tumor. Consequently, final
[15]
diagnosis was established with laparotomy . Presence of an adnexal mass, while there is a diagnosis or
possibility of breast cancer, should be evaluated carefully regarding increased risk of malignancy.

Distant organ metastasis is beyond expectation at the moment of diagnosis for microinvasive breast cancers.
Nevertheless, ovarian metastasis should be kept in mind provided there is involvement of regional lymph
nodes and the tumor is histologically lobular type [8,9,16] . Despite the fact that it was not tested at our case, if
the immunohistochemistry of the breast tumor is negative for hormone receptors and shows findings like
increased expression of Ki-67 and HER2, it should be alarming for increased metastatic potential [4,10,16] .

Microinvasive breast cancers constitute a rare subgroup of invasive breast cancers. Since their histological
features are better acknowledged and imaging technologies are more enhanced, more patients are
diagnosed with the disease in recent years. While it presents a fair survival expectation, systemic spread
and metastases may occur in very early phases of microinvasive breast cancers, when it is accompanied with
regional lymph node involvement and poor prognostic immunohistochemical factors. Hence, testing for
immunohistochemical and molecular markers may provide more information regarding the biology and
[10]
behavior of this tumor . Metastases from non-genital organs to the ovary are associated with poor survival.
Due to the expediting effect on the process of diagnosis and treatment, laparotomy and laparoscopy should
be performed promptly as definitive methods. Multidisciplinary approach is the most important principle
for the diagnosis and treatment of a malignancy that presents itself with metastases, also for the investigation
of the primary focus.

DECLARATIONS
Authors’ contributions
Wrote the manuscript: Kurt S, Timur HT
Provided data regarding the patient’s treatment in the department of Obstetrics and Gynecology: Kurt S,
Timur HT, Saatli HB
Provided information about the patient’s treatment in the department of General Surgery: Sevinc AI
Provided the pathological findings and other information from the department of Pathology: Ulukus EÇ

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.