Case report: CT demonstration of supra-diaphragmatic calcified metastatic nodes from ovarian carcinoma

Rare Distant Metastatic Disease of Ovarian and Peritoneal Carcinomatosis: A Review of the Literature

Background: Although metastases of ovarian and peritoneal carcinomatosis are most commonly found within the peritoneal cavity, there is a number of other rare distant sites that have been reported. Our goal is to provide an evidence-based summary of the available literature considering the rare distant metastatic sites of ovarian and peritoneal carcinomatosis. Methods: A comprehensive search of the literature was conducted, with Medline/PubMed being searched for cases of rare metastatic disease originated from primary ovarian and peritoneal cancer with related articles up to 2019 including terms such as "ovarian cancer", "metastases", "peritoneal" and others. Results: The most common mechanism of ovarian cancer metastases consists of primarily dissemination within the peritoneal cavity, while, rare and distant sites can either occur at the beginning or during the course of the disease and they are usually associated with hematogenous route and lymphatic invasion, having poor prognosis, with the least common sites being skin, bone, CNS, eye, placenta, central airways, rare lymph nodes, intra-abdominal organs, heart and breast. Conclusions: The occurrence of metastatic sites described in this review represents the most common rare distant metastatic sites, and even though their patterns of metastases are still not fully clarified due to the rarity of the reports, they offer valuable information considering the pathophysiology of the disease.

Fixed Size of Enlarged Calcified Lymph Nodes in Esophageal Adenocarcinoma despite Complete Remission

Untreated malignant lymph nodes that are calcified are rare. Publications on such calcifications are restricted to case reports. We present a case of calcified lymph nodes in a patient with adenocarcinoma of the gastroesophageal junction that seemed to be nonresponsive to induction chemotherapy, as they did not decrease in size. However, on pathological examination of the resected lymph nodes no vital tumor cells could be detected anymore. Therefore, we hypothesize that a calcified lymph node is unable to shrink, even after adequate remission on induction chemotherapy. This should be taken into account when clinical decision-making depends on the change in size of an enlarged, calcified lymph node as a measure of treatment effect.

Mammographic Appearance of Axillary Lymph Node Calcification in Patients with Metastatic Ovarian Carcinoma

OBJECTIVE

We describe the mammographic appearance of axillary lymph node calcification in three patients with metastatic ovarian carcinoma.

CONCLUSION

Axillary lymph node calcification may be identified mammographically in patients with metastatic ovarian carcinoma and may be evidence of unsuspected metastatic disease. The pattern of calcification differs from that seen with metastatic breast carcinoma.

Role of chest CT in the follow-up of ovarian adenocarcinoma

OBJECTIVE

We describe the prevalence of metastatic chest disease in ovarian adenocarcinoma as seen on CT. We sought to determine whether routine chest CT added any pertinent information to the follow-up examination of patients with ovarian adenocarcinoma.

MATERIALS AND METHODS

Retrospective review of our tumor registry yielded 96 patients with ovarian adenocarcinoma who had only a single primary malignancy and at least one CT scan of the chest, abdomen, and pelvis. CT scans were reviewed to assess the presence of metastatic chest disease in relation to disease activity in the abdomen and pelvis. Chest CT findings were correlated with the physical examination findings and CA-125 levels and were reviewed in consultation with a gynecologic oncologist to select only those patients with chest abnormalities attributable to metastatic disease.

RESULTS

A total of 266 CT scans were obtained. Forty (41.7%) of the 96 patients had abnormalities attributable to metastatic chest disease on one or more scans. In the absence of disease progression in the abdomen and pelvis, chest disease progression was seen in only six (2.7%) of the 226 follow-up CT scans. Five of the six patients had rising CA-125 levels.

CONCLUSION

Correlation of the findings of abdominal and pelvic CT with the physical findings and the CA-125 levels serves as effective follow-up in patients with ovarian adenocarcinoma. The contribution of additional chest CT in these patients is small.

Supradiaphragmatic manifestations of papillary serous adenocarcinoma of the ovary

AIM

To illustrate unusual patterns of isolated supradiaphragmatic presentation and relapse of papillary serous adenocarcinoma of the ovary.

METHODS

Retrospective study of five women (26-57 years) managed by a specialist gynaecological oncology unit.

RESULTS

Three women relapsed in the neck, mediastinal or axillary nodes 3 to 5 years after complete abdomino-pelvic remission. Two women presented with pleural or cervical lymph node metastases respectively 2 and 13 years before the primary pelvic tumour was discovered. Clinical presentations in these five women mimicked metastatic thyroid and breast cancer and mesothelioma. In four of the five woman supradiaphragmatic nodal disease was heavily calcified.

CONCLUSION

Women with papillary serous ovarian cancer may develop supradiaphragmatic disease without evidence of peritoneal metastasis or primary pelvic tumours. Isolated supradiaphragmatic relapse may occur many years after complete remission of abdomino-pelvic disease. Calcification in supradiaphragmatic lymph nodes should not be assumed to be due to old granulomatous disease as this may be the only clue to relapsing disease. Review of prior histology and use of immunohistochemical stains were valuable in diagnosis of these cases.