The Importance of Metastatic Papillary Serous Carcinoma in Cases of High-grade Encapsulated Papillary Carcinoma of the Breast: An Extremely Rare Case and a Possible Pitfall

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Helen J Trihia
Gabriela Stanc
Nikolaos Charalampakis
Argyri Kayia
Dimitrios Kouzos
Eleftheria Ignatiadou
Kassiani Manoloudaki
Ioannis Provatas


encapsulated papillary carcinoma, metastasis, breast cancer, peritoneal serous carcinoma


Background: Encapsulated papillary carcinoma (EPC) of the breast has a favorable prognosis. High-grade EPCs, triple-negative or HER-2-positive, are dealt with as invasive carcinomas. Breast metastasis associated with serous carcinoma is a late-stage event. The discrimination between the two diagnoses can be very challenging.
Case Presentation: A 79-year-old woman with a history of well controlled high-grade serous papillary carcinoma of the peritoneum went through a total left mastectomy and sentinel lymph node biopsy (SLNB) because of an invasive carcinoma in her left breast. In the lab, a peripheral nodular mass of 4cm was found. Microscopically, large intracystic papillary stalks, with high nuclear grade, surrounded by collagenous tissue were identified compatible with invasive encapsulated papillary carcinoma with positive estrogen receptor. A few months later, the patient was diagnosed with a supraclavicular cervical mass, which on FNB was indicative of metastatic serous papillary carcinoma. Immunohistochemical stains were similar in breast and previously treated peritoneal tumor showed ER+, PAX8+, p53+ (wild type) and high Ki-67 (80%). WT1 was positive only in peritoneal serous carcinoma. GATA-3 was weakly, scarcely expressed in both specimens. The findings pointed to metastatic SPC in the breast, mimicking primary carcinoma of the EPC type.
Conclusion: Pathology of breast metastases and distincion from primary breast cancers is done by a combination of morphological and IHC features. In our case, the lack of clinical history, the type of surgical approach (mastectomy and SLNB), the solitary lesion, the EPC pattern of growth and the diffuse ER+ staining, were indicative of primary breast lesion. Various morphologic growth patterns of metastatic PSC have been described, among which EPC-like needs to be considered.


1. WHO Classification of Breast Tumours, 5th edition. 2019. ISBN: 978-92-832-4500-1.
2. Rakha EA, Varga Z, Elsheik S, et al. High-grade encapsulated papillary carcinoma of the breast: an under-recognized entity. Histopathology. 2015;66 (5):740-6. doi: 10.1111/his.12591.
3. Liu X, Wu H, Teng L, et al. High-grade encapsulated papillary carcinoma of the breast is clinic-pathologically distinct from low/intermediate grade neoplasms in Chinese patients. Histol Histopathol. 2019;34(2):137-47. doi: 10.14670/HH-18-026. Epub 2018 Jul 13.
4. Sun J-Y, Gebre W, Dong Y-M, Shaun X, Robbins R, Podruma A. Primary peritoneal carcinoma metastasizing to breast: a single case report and literature review from clinic to biology. Cancer Biol Med. 2016;13(3):389-95. doi: 10.20892/j.issn.2095-3941.2016.0058.
5. Recine MA, Deavers MT, Middleton LP, Silva EG, Malpica A. Serous carcinoma of the ovary and peritoneum with metastases to the breast and axillary lymph nodes: A potential pitfall. Am Surg Pathol. 2004;28:1646-51. doi: 10.1097/00000478-200412 000-00015.
6. Khalifeh I, Deavers MT, Christofanilli M, Coleman RL, Malpica A, Gilcrease MZ. Primary peritoneal serous carcinoma presenting as inflammatory breast cancer. Breast J. 2009;15:176-81. doi: 10.1111/j.1524-4741.2009.00693.x.
7. Bombonati A, Lerwill MF. Metastases to and from the breast. Surg Pathol Clin. 2012,;5(3):719-47. doi: 10.1016/j.path.2012.06.004.
8. Buisman FE, van Gelder L, Menke-Pluijmers MB, Bob H. C. Bisschops B.H.C, Peter W. Plaisier P.W, and Westenend P.J: a single institution’s experience of a diagnostic challenge with important therapeutic consequences-a retrospective study. World J Surg Oncol. 2016;23;14(1):166. doi: 10.1186/s12957-016-0915-4.
9. Lee AH. The histological diagnosis of metastases to the breast from extramammary malignancies. J Clin Pathol. 2007;60(12):1333-41. doi: 10.1136/jcp.2006. 046078.
10. Alvarez RH, Gong Y, Uedo NT, et al. Metastasis in the breast mimicking inflammatory breast cancer. J Clin Oncol. 2012;1;30(22):e202-6. doi: 10.1200/ JCO.2011.40.2230.
11. Lee S H, Park J M, Kook S H, B K Han, W K Moon. Metastatic tumors to the breast: mammographic and ultrasonographic findings. J Ultrasound Med. 2000;19(4):257-62. doi: 10.7863/jum.2000.19.4.257.
12. Williams SA, Ehlers RA, 2nd, Hunt KK, et al. Metastases to the breast from nonbreast solid neoplasms: presentation and determinants of survival. Cancer. 2007;15;110(4):731-7. doi: 10.1002/cncr.22835.
13. Watson GA, Greally M, Murphy DJ, Doyle A, Quinn C, Walshe JM. A rare case of metastatic peritoneal adenocarcinoma presenting as breast cancer. Oncol Cancer Case Rep. 2016;2(2):1-3. doi:10.15436/2377-0902.16.1014.
14. Tempfer C.B, El Fizazi N, Ergonenc H, Solass W. Metastasis of ovarian cancer to the breast: A report of two cases and review of the literature. Oncology Letters. 2016;11:4008-12. doi:10.3892/ol.2016.4514.
15. Harada Y, Kubo M, Kai M, Yarrada M, Zaguirre K, Obgarri T, Yahata H, Ohishi Y, Yamamoto H, Oda Y and Nakamura M. Breast metastasis from pelvic high-grade serous adenocarcinoma: a report of two cases. Surgical Case Reports. 2020;6:317-25. doi: 10.1186/s40792-020-01090-7.
16. Park S, Cho E.Y, Oh Y.L, Park Y.H and Kim H-S. Primary Peritoneal High-grade Serous Carcinoma Misinterpreted as Metastatic Breast Carcinoma: A Rare Encounter in Peritoneal Fluid Cytology. Anticancer Research. 2020;40(5):2933-9. doi: 10.21873/anticanres.14271.
17. Girgin G.S, Burcin R. Breast Metastasis of Primary Peritoneal Carcinoma Demonstrated on FDG PET/CT. Clinical Nuclear Medicine: 2021;46(9):pe473-74. doi: 10.1097/RLU.000000000 0003642.
18. Ozguroglu M, Ersavasti G, lvan S, et al. Bilateral inflammatory breast metastases of epithelial ovarian cancer. Am J Clin Oncol. 1999;22(4):408-10. doi: 10.1097/00000421-199908000-00018.
19. Nomoto K, Nakajima T, Miwa S, Hayashi S, Tsuneyama K. Primary peritoneal serous papillary carcinoma that metastasized to an axillary lymph node in a woman with a history of breast cancer: A case report and diagnostic pitfalls. Human Pathology: Case Reports. 2015;2:90-93. doi: 10.1016/j.ehpc. 2015.03.003.
20. Berker B, Ortac F, Ataoglu O. Axillary lymphadenopathy as the primary presentation of primary peritoneal carcinoma. Gynecol Obstet Invest. 2002;54:232-236.doi: 10.1159/000068387.
21. Eltabbakh GH, Werness BA, Piver S, Blumenson LE. Prognostic factors in extraovarian primary peritoneal carcinoma. Gynecol Oncol. 1998;71:230-9. doi: 10.1006/gyno.1998.5090.
22. Goldstein NS, Bassi D, Uzieblo A. WT1 is an integral component of an antibody panel to distinguish pancreatobiliary and some ovarian epithelial neoplasms. Am J Clin Pathol. 2001;116:246-252. doi: 10.1309/8X4T-35B7-7529-QE7X.
23. Mhawech-Fauceglia P, Kay B, Li C.J, Lin Y.G. Metastatic ovarian papillary serous carcinoma to the breast: Diagnosis and pitfalls. Gynecologic Oncology Reports. 2013;4:35-37. doi: 10.1016/j.gynor. 2012.12.008.
24. Lotan T.L, Ye H, Melamed J, Wu X-R, Shih I-M, Epstein J.I. Immunohistochemical panel to identify the primary site of invasive micropapillary carcinoma. Am J Surg Pathol. 2009;33(7):1037-1041. doi: 10.1097/PAS.0b013e3181962dcd.
25. Nonaka D, Chiriboga L, Soslow RA. Expression of PAX8 as a useful marker in distinguishing ovarian carcinomas from mammary carcinomas. Am J Surg Pathol. 2008;32:1566-71. doi: 10.1097/PAS.0b0 13e31816d71ad.
26. Reyes M.C, Arnold A.G, Kauff N.D, Levine D.A. Invasion patterns of metastatic high-grade serous carcinoma of ovary or fallopian tube associated with BRCA deficiency. Modern Pathology. 2014;27: 1405-11. doi: 10.1038/modpathol.2013.237.
27. Rakha E.A & Ellis I.O. Diagnostic challenges in papillary lesions of the breast. Pathology. 2018;50(1):100-10. doi: 10.1016/j.pathol.2017.10. 005.

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