Occult metastasis of hormone receptor-positive breast cancer to the ovary: A case report and literature review

Rationale: Breast cancer is the most common malignancy among women worldwide. It typically metastasizes to the bone, lungs, and liver, while ovarian involvement is relatively uncommon. This report aims to illustrate the clinical features, diagnostic approach, and treatment strategies for this rare type of metastasis through a case study, thereby enhancing clinicians’ awareness and management capabilities. Patient concerns: A 32-year-old premenopausal woman presented with a palpable nodule in the left breast. Comprehensive diagnostic evaluation, including mammography, ultrasonography, contrast-enhanced computed tomography, and core needle biopsy, confirmed invasive ductal carcinoma, classified as Luminal A subtype (estrogen receptor/progesterone receptor-positive, human epidermal growth factor receptor 2-negative). Diagnoses: Invasive ductal carcinoma of the left breast (pT3N3M1, stage IV) with ovarian metastasis. Interventions: The patient received 6 cycles of docetaxel/doxorubicin/cyclophosphamide chemotherapy (docetaxel, doxorubicin, and cyclophosphamide), followed by left modified radical mastectomy with axillary lymph node dissection, achieving R0 resection. Laparoscopic bilateral adnexectomy was also performed for ovarian ablation. Final pathology confirmed metastatic breast carcinoma in the ovaries. Outcomes: The patient successfully achieved surgical tumor reduction, recovered well postoperatively, and showed no clinical evidence of disease progression. Lessons: This case highlights the distinct characteristics of ovarian metastases in HR+/HER2− breast cancer and their critical importance in differential diagnosis, particularly in distinguishing them from primary gynecologic tumors. For patients with a history of breast cancer, the presence of pelvic lesions should prompt consideration of metastatic potential to guide appropriate comprehensive treatment.