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Vulvar carcinoma is a rare disease that accounts for 3–5% of all gynecologic malignancies. Breast represents an unusual site of metastasis and only a few cases are reported. We describe the first case of bilateral metastatic breast carcinoma of vulvar origin, at an 80-year-old female patient. Six months after treatment of her primary disease, she presented with bilateral metastatic squamous cell breast carcinoma. Diagnosis was based on clinical, radiological, and histological facts. Breast although rare is another potential site of metastasis in vulvar cancer and thus mammary gland examination should be considered in the follow-up of these patients. Differential diagnosis between primary and metastatic lesions is of utmost importance for appropriate management. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Tumor infiltrating lymphocytes (TILs) and T regulatory cells (Tregs) have been associated with prognosis in ovarian cancer, but their prognostic significance in ascites has not been studied. We performed a prospective study of T lymphocytes isolated from ascites from patients with ovarian carcinoma and we compared them with the respective populations in blood and tumors. Methods: Mononuclear cells from ascites (n =71) and blood were isolated by Ficoll, while tumor lymphocytes (n =20) were obtained upon mechanical dissociation. Phenotypic analysis was performed with flow cytometry. Ascites from 10 patients with cirrhosis was used as control. Results: Tregs containing CD4+CD25+ cells, NK-T containing CD3+CD56+ cells and CD69 and HLADR expression of CD4 and CD8 lymphocytes were significantly increased in tumor ascites compared to blood and control ascites. A selective accumulation of these populations in the ascites of cancer patients, was suggested by the significantly higher ascites/blood (A/B) ratios in cancer patients but not controls. Cancer cell content in ascites was correlated with CD4+CD25+, CD4+CD69+, CD4+HLADR+ and CD8+CD69+ cells. There was no correlation of lymphocyte populations between ascites and samples from peritoneal metastases. Higher tumor grade was associated with increased A/B CD4+CD25+ ratio and reduced CD3+CD56+ cells, while platinum resistance was associated with reduced A/B CD3+CD56+ ratio. Conclusions: There are significant differences of CD3+CD56+ and CD25+CD4+ lymphocytes and increase in lymphocyte activation between blood, ascites and peritoneal metastases from patients with ovarian cancer. The selective accumulation of CD3+CD56+ population in ascites may be a predictive factor for platinum resistance. [Copyright &y& Elsevier]