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Case Reports

Abstract

Skin involvement by metastatic ovarian carcinoma is exceptionally rare, most commonly presenting as an umbilical nodule (Sister Mary Joseph nodule).  We report a case of metastatic ovarian carcinoma clinically and histologically masquerading as inflammatory breast carcinoma. 

A 40 year old female presented with painful induration of her right breast with a peau d’orange appearance, an inverted nipple, enlarged supraclavicular lymph nodes and 3.3 cm mass in the supero-lateral right breast.  Inflammatory breast carcinoma was suspected clinically.  A punch biopsy of involved skin showed a dermal infiltrate of atypical epithelial cells with no epidermal involvement, morphologically similar to the tumor present in a core biopsy of the right breast mass.  An initial battery of immunostains showed diffuse CK7 positivity; however, only focal expression of GATA-3 was seen raising concern for a different site of origin.  Further review of the patient’s chart revealed a history of high grade serous carcinoma with extensive involvement of adnexal soft tissue, omentum, and stomach.  Subsequent immunostains showed the dermal infiltrate to be positive for PAX-8, WT-1, p16 and p53, supporting origin from the patient’s known ovarian serous carcinoma. 

This case illustrates the importance of clinical and pathologic correlation and the role of immunohistochemistry in determining the origin of a cutaneous metastasis.