ER/PR-positive breast cancer with bilateral ovarian metastases controlled after oophorectomy and aromatase inhibitor

What happened, in summary

This 54-year-old woman developed abdominal fullness in February 2009, years after treatment for left breast cancer. She had previously undergone breast-conserving surgery and axillary lymph node dissection in October 2000. In 2006 she also developed left pleural effusion, but drainage and testing did not show cancer cells, and the fluid fluctuated while she was followed as an outpatient. Her new abdominal symptoms came with abdominal distention and elevated CEA and CA 15-3. PET/CT showed tumors in both ovaries and ascites. She received weekly paclitaxel and intra-abdominal carboplatin, along with repeated drainage of 4,000 to 8,500 mL of ascites, but the ascites was not controlled. Doctors then performed bilateral oophorectomies to confirm the diagnosis and help guide treatment. Pathology showed that the ovarian tumors were positive for estrogen receptor, progesterone receptor, CK7, and gross cystic disease fluid protein-15, and negative for HER2 overexpression and CK20. These findings supported ovarian metastases from her breast cancer rather than a new primary ovarian cancer. No tumor dissemination was seen in the abdomen, and cytology of the ascites did not show cancer cells. After surgery, she was discharged on day 9. Her left pleural effusion disappeared, and CEA and CA 15-3 decreased below the normal upper limit. She continued aromatase inhibitor therapy and remained well with no further recurrence for 40 months after the oophorectomies. The improvement after oophorectomy helped confirm that the ovarian tumors and ascites were driving the clinical problem. The long disease-free interval on endocrine therapy also fit the hormone receptor-positive biology shown by the ovarian tumor testing.