Differentiation of primary ovarian carcinoma from metastatic breast carcinoma

This differential may be difficult if both tumours have similar morphology, the prior breast carcinoma is not available for comparison or the ovarian sampling is limited.

Immunohistochemistry

The useful markers are WT1 (specificity 100%, sensitivity 76%), CA125 (specificity 85%, sensitivity 90%) for ovarian primaries, and GCDFP (specificity 100%, sensitivity 43%) for metastatic breast carcinoma¹.

		Primary ovarian carcinoma		Primary breast carcinoma	Breast carcinoma metastatic to ovary	p
		serous	other
	WT1	31/33 (4+: 24, 3+: 3, 2+: 2, 1+: 2, neg: 2)1	1/9 (0/5 clear cell, 0/2 mucinous, 1/2 endometrioid)1	0/361	0/391	<0.0011
	CA125	32/33 (4+: 18, 3+: 6, 2+: 3, 1+: 5, neg: 1)1	6/9 (4/5 clear cell, 1/2 mucinous, 1/2 endometrioid)1	6/36 (ductal/mixed: 4+: 0, 3+: 0, 2+: 1, 1+: 3, neg: 21, lobular: 1+: 2, neg: 9)1	5/39 (ductal/mixed: 3+: 1, 1+: 1, neg; 18, lobular: 2+: 1, 1+: 2, neg: 16)1	<0.0011
	GCDFP	0/331	0/9 (0/5 clear cell, 0/2 mucinous, 0/2 endometrioid)1	5/36 (ductal/mixed: 4+: 1, 1+: 3, neg: 21, lobular: 1+: 1, neg: 10)1	17/39 (ductal/mixed: 2+: 3, 1+: 5, neg: 12, lobular: 3+: 2, 1+: 7, neg: 10)1	<0.0011
	CEA	7/33 (4+: 0, 3+: 0, 2+: 4, 1+: 3, neg: 26)1	2/9 (1/5 clear cell, 1/2 mucinous, 0/2 endometrioid)1	8/36 (ductal/mixed: 4+: 1, 1+: 7, neg: 17, lobular: neg: 11)1	13/39 (ductal/mixed: 2+: 2, 1+: 6, neg: 12, lobular: 2+: 2, 1+: 3, neg: 14)1	NS1
	MUC1	33/33 (4+: 31, 3+: 2)1	9/9 (5/5 clear cell, 2/2 mucinous, 2/2 endometrioid)1	36/36 (ductal/mixed: 4+: 22, 3+: 2, 2+: 1, lobular: 4+: 10, 2+: 1)1	37/39 (ductal/mixed: 4+: 14, 3+: 2, 2+: 1, 1+: 1, neg: 2, lobular: 4+: 19)1	NS1
	MUC2	6/33 (4+: 0, 3+: 0, 2+: 1, 1+: 5, neg: 26)1	4/9 (2/5 clear cell, 1/2 mucinous, 1/2 endometrioid)1	3/36 (ductal/mixed: 2+: 1, 1+: 3, neg; 22, lobular: neg: 11. minor error in paper)1	12/39 (ductal/mixed: 2+: 1, 1+: 2, neg: 17, lobular: 1+: 9, neg: 10)1	0.051

Reference 1: threshold for positivity was 1% of tumour cells staining. Positivity for WT1 and CA125 with negativity for GCDFP

Management

Primary ovarian carcinoma requires debulking and chemotherapy. Metastatic breast carcinoma does not require debulking and requires a different chemotherapeutic regimen.

Prognosis

The five-year survival of primary ovarian carcinoma varies from 5% to 90%, depending on stage and resectability, compared with less than 10% five-year survival for patients with breast carcinoma metastatic to the ovary.

References

¹ Tornos C, Soslow R, Chen S, et al. Expression of WT1, CA 125, and GCDFP-15 as useful markers in the differential diagnosis of primary ovarian carcinomas versus metastatic breast cancer to the ovary. Am J Surg Pathol 2005; 29:1482-9

This page last revised 21.1.2006.

©SMUHT/PW Bishop