Occult lobular breast carcinoma presenting as bilateral ovarian masses: A case report

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Occult breast cancer (OBC) is a challenging condition that most commonly presents with axillary lymphadenopathy. Distant metastases are rare, and ovarian involvement is one of the most frequently misdiagnosed conditions. This report aims to highlight a rare presentation of OBC manifesting as bilateral ovarian metastases. A 55-year-old woman with a history of ulcerative colitis presented with new-onset urinary stress incontinence. During the initial workup, there was an incidental finding of bilateral ovarian masses with malignant features. Elevated ovarian tumor markers initially suggested epithelial ovarian cancer. The patient underwent laparoscopic investigation, and multiple biopsies were obtained. Histopathological examination of the ovarian masses demonstrated features characteristic of invasive lobular carcinoma of breast origin, confirmed by immunohistochemical staining positive for CKAE1/AE3, GATA-3 and GCDFP-15 and negative for markers of primary ovarian and gastrointestinal tumors. The bilateral ovarian involvement and distinct tumor cell cytomorphology suggested a metastatic origin. The patient underwent breast MRI which showed no detectable evidence of a primary breast tumor. The final diagnosis was occult lobular breast carcinoma presenting with bilateral ovarian metastases. Ovarian metastases originating from OBC are rare and present a diagnostic challenge due to the absence of a detectable primary tumor. A multidisciplinary approach incorporating histopathological evaluation and targeted immunohistochemistry is essential for accurate diagnosis and appropriate management. Although rare, OBC can present as bilateral ovarian masses. Enhanced awareness and a comprehensive diagnostic approach are critical for improving patient outcomes. • Occult lobular breast carcinoma (OBC) can present as bilateral ovarian masses, mimic primary ovarian cancer both clinically and histologically. • Elevated ovarian tumor markers and non-specific imaging findings, combined with the absence of a detectable breast lesion on MRI or PET/CT, may mislead the diagnosis toward a primary gynecologic malignancy. • Immunohistochemical profiling (GATA-3, GCDFP-15, ER/PR) is essential in identifying breast origin in metastatic ovarian tumors.

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