Ovarian masses are common findings in general gynecological practice. Approximately 5%–10% of ovarian malignancies are diagnosed as metastatic tumors. Primary angiosarcoma can arise anywhere in the body and when it arises in the breast, it usually affects women in their 3rd and 4th decades and accounts for one in 1700–2300 cases of primary breast cancer. Although unusual, breast angiosarcomas tend to metastasize hematogenously rather than lymphogenously, have high rates of local recurrence, that often develop metastases soon after treatment, and have a dismal prognosis. We present a case of a solitary ovarian metastasis from angiosarcoma of the breast.
The patient is a 41-year-old woman, who noticed a right breast mass in December 2004. A mammogram and ultrasound at that time were suggestive of a cyst. Repeat mammogram and ultrasound in October 2005 showed the lesion to have grown. The patient underwent needle localization and excisional biopsy, revealing a 4.9 cm intermediate grade angiosarcoma. The patient subsequently underwent chemotherapy with a total of 6 cycles of liposomal doxorubicin.
Restaging CT scans of the chest, abdomen, and pelvis (Figure
CT scan of the abdomen and pelvis (10/13/2007). Axial (a) and (b) and Coronal (c) images obtained through the pelvis demonstrate a complex solid and cystic mass in the left adnexa (whie arrow) measuring
MRI of the pelvis (10/29/2007). Coronal T2-weighted images (a) and (b) demonstrate a left adnexal mixed solid and cystic mass (white arrow). The hyperintense T2 area represents the cystic component, and the isointense T2 area is the soft tissue component of the mass. Sagittal T2-weighted image (c)demonstrates the cystic component of the mass (white arrow). On coronal T1 Fat-Sat postcontrast image (d), the solid component of the mass enhanceshomogeneously after gadolinium administration; however, the cystic component is hypointense (white arrow.)
CT scan of the abdomen and pelvis (1/12/208). Axial (a) and (b) and coronal (c) images of the pelvis demonstrate a large, predominantly hypodense, left adnexal soft tissue mass (white arrow). Note that the cystic component of the mass has resolved and the soft tissue portion has significantly increased.
Ovaries are common sites for metastatic disease; however, metastases to the ovaries account for only 10% of ovarian cancers. Colon cancer is the most frequent primary malignancy of nongenital origin giving rise to ovarian metastases [
The differential diagnosis for adnexal masses seen in patients with primary nonovarian malignancy consists of metastases, primary ovarian malignancy, or incidental benign pathology. Metastases to the ovary are typically bilateral, solid, and strongly enhance after contrast administration. Cystic and necrotic areas are common and tumors may be predominantly cystic, thus resembling primary ovarian cancer. The overlap of radiologic appearances between primary ovarian cancer and metastases to the ovaries is substantial, and imaging distinction between the two may be impossible [
Megibow et al. [
There is relatively little published information concerning the spread and frequency of metastatic sarcoma to the ovary. In a series from 1990, Young and Scully described 21 cases of metastatic sarcoma to the ovaries [
To our knowledge, there are no case reports in the literature describing a solitary ovarian metastasis of breast angiosarcoma shown on CT and MRI. The MRI of the pelvis performed in our patient demonstrated a predominantly solid, hyperintense T2, and hypointense T1 lesion that enhanced after gadolinium administration. A peripheral cystic component in the lesion was better appreciated on the enhanced MRI images than on CT. Gadolinium-enhanced MRI is reportedly slightly superior to both contrast-enhanced CT and Doppler sonography in the characterization of adnexal masses [
On imaging studies, ovarian metastases may frequently resemble a primary ovarian neoplasm. Therefore, a definitive diagnosis can only be made after surgical removal of the mass and histopathologic examination.