Synchronous presentation of invasive ductal breast carcinoma metastasis and ovarian granulosa cell tumor with literature review.

INTRODUCTION

Synchronous tumors involving the ovary are rare, particularly the coexistence of an ovarian granulosa cell tumor (GCT) and a metastatic ductal breast carcinoma within the same adnexa. While GCTs represent only 1–2% of all ovarian neoplasms, ovarian metastases from breast cancer account for up to 40% of secondary ovarian tumors, with a known predilection for invasive lobular subtypes. The synchronous occurrence of metastatic ductal carcinoma and a primary GCT remains exceptionally uncommon. CASE PRESENTATION: We report the case of a 45-year-old woman referred because of with a Luminal B invasive ductal carcinoma of the breast, initially staged T3N1M0. She underwent neoadjuvant chemotherapy, radical mastectomy with axillary lymph node dissection, and adjuvant radiotherapy. A laparoscopic bilateral salpingo-oophorectomy was subsequently performed for hormonal suppression. Histopathological analysis revealed the unexpected coexistence of two distinct tumors within the same adnexal specimen: (1) an ovarian and tubal metastasis from the previously diagnosed breast ductal carcinoma, and (2) an adult-type granulosa cell tumor of the ovary. Immunohistochemistry confirmed the dual origin of the lesions. The postoperative course was uneventful, and systemic imaging showed no other metastatic sites. A multidisciplinary team recommended close surveillance.

CONCLUSION

This case highlights the rare synchronous presentation of two histologically distinct neoplasms metastatic ductal breast carcinoma and a primary granulosa cell tumor within the same anatomical site. It underscores the importance of thorough histological evaluation in patients with a history of breast cancer undergoing therapeutic oophorectomy, even when ovaries appear macroscopically normal.