breast and ovary sydrome case

1. •45 years old female sohaira mashood, no
comorbids, mother had CA breast diagnosed at the
age of 55 years.
•Presented in Sep 2020 with complaints of
abdominal pain and menorrhagia for 3 months and
lump in left breast for 1 month.
•BL MAMMOGRAM AND US BREAST: 2x1cm mass at
3 O'clock position of left breast. Right breast and BL
axilla are normal.
•TRUCUT BIOPSY OF BREAST LUMP: Infiltrating
lobular carcinoma.ER 7/8,PR 6/8 and Her 2 Neu
Negative.

2. • US ABDOMEN AND PELVIS: Fibroid mass measuring
10x41x45mm. There is irregular shaped echogenic area of
4.2x2.9cm in right iliac fossa within terminal ileum near
ileocecal junction it could be nodal/inflammatory/intestinal
content.
• LAPAROTOMY WAS DONE ON 7/9/20: IOFs were: Pelvic
cavity studded with multiple tubercles in cecum, terminal
ilium and ascending colon. Omentum is thickened, friable and
bleed to touch. Mild to moderate ascetic fluid. Biopsy
specimens were taken from pouch of Douglas and omentum.

3. • BIOPSY TAKEN FROM POUCH OF DOUGLAS AND A PIECE MEASURING
5X4CM FROM OMENTUM shows metastatic high grade serous carcinoma
IHC statins favoring origin from female genital tract. (WT-1, Cytokeratin 7
and p53 positive)
• ASCITIC FLUID CYTOLOGY Shows Highly atypical cells favoring metastatic
carcinoma.
• CA 125 = 896
• It was diagnosed as breast ovarian syndrome. Double malignancy with Ca
left breast (T1N0MO) and high grade serous carcinoma of female GU tract
origin.
• PET-CT was advised for staging:

4. STAGING PET-CT ON OCTOBER,02,2020
•Mild FDG avidity is noted in the left breast, without
corresponding CT findings.
•Metabolically inactive left adnexal Multi-lobulated
cystic mass consistent with primary pathology.
•Metabolically active abdominal nodes with FDG
avid and non avid peritoneal deposits-metastatic.

5. • Case was discussed in Tumor Board (INMOL Hospital) on 3/10/2020 and
decided to give 4 cycles of Paclitaxel and Carboplatin Followed by response
evaluation with CT Scan.
• After 4 cycles of Chemotherapy CT CHEST, ABDOMEN AND PELVIS was
done on 31/12/20:
1) No residual or recurrent lesion in left breast.
2) A benign looking left axillary lymph node measuring 11mm with preserved fatty
hilum.
3) Minimal BL pleural effusion, more marked on right side.
4) Multiple cystic lesion in uterus and parametrial location.
5) A small focus of 9mm noted in liver could be metastatic deposit.
6) Few subcentimetric aortocaval nodes largest at the level of renal hilum is of 9.5mm.
7) No evidence of omentoperitoneal disease.

6. • Case discussed with Senior Consultants and decided to give 02 more
cycles of Paclitaxel and Carboplatin Followed by PET-CT.
• RECENT PET-CT: dated 18/2/21 (after 6 cycles of chemo)
• Metabolically inactive left adnexal cystic mass- partial regression since PET-CT
images of October 2020.
• No Metabolically active finding noted in the body with reference to known
malignancy.
•FURTHER MANAGEMENT PLAN????