Supradiaphragmatic manifestations of papillary serous adenocarcinoma of the ovary

Extra-abdominal Lymph Node Metastases as the First Presentation in Ovarian and Fallopian Tube Carcinomas

Revision of ovarian and fallopian tube cancer presentation as extra-abdominal lymph nodes to understand the diagnostic challenges and prognostic features of these situations. Literature review in PubMed and Cochrane databases using the terms "ovarian cancer," "fallopian tube cancer," "extrapelvic lymph nodes," extra-abdominal lymph nodes," "distant lymph nodes," "initial presentation," "metastases," and "unusual presentation of ovarian cancer/unusual presentation of fallopian tube cancer" isolated and in conjunction. Articles in English were analyzed regarding revision's purpose, inclusion, and exclusion criteria and 65 were included in the final document. Statistical data was obtained with Microsoft Excel software analysis. Distant manifestations of ovarian cancer may occur through the lymphatic system and, less frequently, through hematogenous spread. These forms of spread may exist with almost no symptoms related to the primary cancer location and can justify distant disease at the initial presentation. Extra-abdominal lymph node involvement poses a clinical challenge for oncologists and oncologic gynecologists because it may occur with no or mild symptoms, and even in situations where no macroscopic disease is seen in the pelvic cavity. Histology and immunohistochemistry analyses together with a high level of suspicion are paramount to help in the diagnostic workup decisions and in finding a correct diagnosis when an extra-abdominal lymph node is the first manifested sign. Given its rarity and scarcity of information dispersed in a few case reports and small case series, further investigation is needed to understand the particularities of these tumors and their prognostic relevance.

Low-Grade Ovarian Serous Adenocarcinoma with Lymph Node Metastasis in Neck

Low-grade ovarian serous adenocarcinoma is rarely encountered in the neck region. The diagnosis of this rare malignancy entity in the neck is challenging for both clinicians and pathologists. A 53-year-old female with a chief complaint of a right lower neck mass that had been growing for approximately 2 weeks. The ultrasound-guided fine needle aspiration cytology favored malignancy. The positron emission tomography/computed tomography scan revealed the clustered enlarged lymph nodes with increased radioactivity uptake in the right neck level V, and strong radioactivity uptake was also displayed in the right ovarian regions. Pelvis magnetic resonance imaging displayed right adnexal complex mass supporting the ovarian cancer. An en bloc resection of the right neck lymph node was conducted. Ovarian serous adenocarcinoma with metastasis of lymph nodes in the neck was confirmed through histopathological findings. This study reviews the clinical features of low-grade ovarian serous carcinoma metastasizing to lymph nodes in neck. Although very rare, ovarian cancer with neck metastasis should be considered in the differential diagnosis of a neck mass lesion. The clinical staging would be relatively high due to the quiet entity of the cancer.

Incidental Detection of Ovarian Cancer as a Solitary Peridiaphragmatic Distant Lymph Node Metastasis without Pelvic Lesions on 18F-FDG PET/CT

The spreading pattern of ovarian carcinoma is unique and unlike most other cancers, because exfoliated ovarian cancer cells primarily disseminate within the abdominal cavity, which are then transported throughout the peritoneum by physiological peritoneal fluid. An initial manifestation of a solitary peridiaphragmatic distant metastatic lymph node without peritoneal involvement is very rare. This study reports a case with an incidentally found single hypermetabolic mass in the peridiaphragmatic space without a pelvic lesion in the baseline staging ¹⁸ F-FDG PET/CT that histologically turned out to be metastatic serous papillary carcinoma due to ovarian cancer. ¹⁸F-FDG PET/CT may allow the identification of the initial manifestation of unexpected distant oligometastatic statuses of an unknown primary ovarian cancer.

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.

Fatal cardiac tamponade following cytoreductive surgery for serous carcinoma of the ovary

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Pericardial effusion may be present early in the disease process in patients with ovarian cancer.

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Even a small pericardial effusion may become clinically apparent in the setting of concomitant pleural effusion(s).

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Cardiac tamponade should be considered in the differential diagnosis of postoperative hemodynamic instability to facilitate timely intervention.

Ovarian cancer initially presenting as intramammary metastases and mimicking a primary breast carcinoma: a case report and literature review

BACKGROUND

Ovarian cancer usually spreads intra-abdominally. Supradiaphragmatic metastases are rare, and axillary lymph node metastases are exceptional. Here, we present the first case of ovarian carcinoma detected at screening mammogram as intramammary lymph node metastases.

CASE REPORT

A 44-year-old obese woman underwent core biopsy of a suspicious mammographic finding histologically consistent with lymph node metastases from breast cancer. Serum tumor markers, including CA 125, were normal, and clinical staging was negative. The patient underwent quadrantectomy and axillary dissection that revealed four involved lymph nodes but no primary breast carcinoma. Accurate re-evaluation of the histological specimens suggested the possible ovarian origin of the tumor. An [(18)F]-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography revealed a 33-mm solid mass with intense metabolic FDG uptake in the right groin and a small simple ovarian cyst with normal FDG uptake. The ovarian cyst was removed laparotomically and was malignant on frozen section. Surgical staging revealed a well-differentiated serous ovarian carcinoma microscopically involving the omentum and massively infiltrating the groin node. After chemotherapy, the patient developed metastases in the contralateral axilla that was removed surgically. The patient is alive with no evidence of disease 20 months after surgical removal of the primary tumor.

CONCLUSIONS

Surgeons should be aware that ovarian cancer may rarely metastasize to intramammary and axillary nodes, mimicking a primary breast carcinoma.

Solitary Internal Mammary Lymph Node Metastases Detected by F-FDG-PET/CT in Ovarian Cancer

Internal mammary lymph nodes as solitary site of recurrent ovarian cancer have not been previously described. In this case report, 3 cases of late and very late isolated recurrence in internal mammary lymph nodes are presented. ¹⁸F-FDG-PET/CT allowed the diagnosis which was suspected by the increase of the serum CA-125 level in 2 out of 3 cases. Local treatment, consisting of surgery (in 2 patients) and radiation therapy (in 1 patient), permitted an optimal long-term disease control.

Isolated cardiophrenic angle node metastasis from ovarian primary. report of two cases

Ovarian cancer is the most lethal gynaecologic malignancy. It usually spreads out of the abdomen involving thoraco-abdominal organs and serosal surface. This disease is poorly curable and surgery, at early stage, is supposed to achieve the best survival outcome. In systemic dissemination, chemiotherapy is indicated, sometimes with neoadjuvant aim. The most common clinical expressions of advanced ovarian carcinoma are multiple adenopathy, neoplastic pleuritis, peritoneal seeding and distant metastasis, mainly hepatic and pulmonary. Isolated adenopathy of the mediastinum is rare and isolated bilateral have never been described before. We report two cases of isolated bilateral cardiophrenic angle lymphnode metastasis from ovarian carcinoma, without peritoneal and pleural involvement. Both patients were successfully resected through minimally invasive thoracic surgery. About the role of surgery, few data are available but survival seems to be longer after resection thus, more investigation is required to make the indication to surgery more appropriate in advanced cases.

Significance of tumour calcification in ovarian carcinoma

The purpose of this study was to assess the pattern and significance of tumour calcification in ovarian carcinoma. Patients with calcifying ovarian carcinoma were identified from radiological reports. Their tumour characteristics, serum calcium levels, treatment and survival were compared with a control group of patients with non-calcifying disease. Patterns and distribution of calcification were assessed. Available serial CT scans were reviewed for changes in both soft-tissue and calcified disease according to RECIST (response evaluation criteria in solid tumours) criteria where feasible. Temporal changes in calcification were correlated with changes in soft tissue disease and CA125 levels. The calcified group numbered 122 (22 other patients had calcifying tumour but insufficient clinical data). Calcification in ovarian carcinoma had a prevalence of 8% (144/1721) in our series. There was a significant difference (p<0.001) between the two groups in the distribution of histological type, with serous tumours being more common in the calcified group (74/122 (61%)) than in the controls (509/1498 (34%)). The calcified tumour patients tended to have lower grade disease (p<0.001). No differences between the groups were found for age, treatment or serum calcium levels. Distribution of calcification was diffusely peritoneal in 34 patients, in association with a pelvic mass in 15, nodal in 11 and within the anterior abdominal wall in 2. There was no correlation between changes in calcification on serial CT scans and corresponding CA125 levels. In conclusion, calcification tends to occur most commonly in serous cystadenocarcinomata and in tumours of lower grade. Changes in calcification cannot be used as a marker of disease response.

Ovarian serous carcinoma presenting with mediastinal lymphadenopathy 20 months before the intraabdominal mass: Role of immunohistochemistry

INTRODUCTION

Metastatic involvement of the mediastinal lymph nodes is an extremely uncommon finding in epithelial ovarian cancers.

CASE REPORT

A 63-year-old woman was admitted to hospital for dyspnoea due to an anterior mediastinal mass. The surgical biopsy showed a 6-cm metastatic lymph node with a papillary pattern, scattered psammomas and immunoreactivity for WT1, Cytokeratin 7, EMA and negative for E-cadherin, GCFDP-15, Thyroglobulin, Cytokeratin 20, Cytokeratin 5/6, CEA, Vimentin, Calretinin, TTF1. After 20 months a follow-up CT identified an ovarian mass with the same histological pattern and immunoreactivity of the mediastinal nodule.

RESULTS

Immunohistochemistry, especially WT1, is useful in assessing the ovarian origin of an unusual metastasis particularly if it is the first presentation of the disease.

Serous Borderline Tumor of the Ovary Presenting With Cervical Lymph Node Involvement

Supradiaphragmatic lymhadenopathy is extremely rare in patients with a serous borderline ovarian tumor (BOT), and clinically difficult to recognize. We describe 3 cases of serous BOT that primarily presented with arm thrombosis due to supradiaphragmatic lymphadenopathy. In all the 3 cases, fine needle aspiration cytology initially indicated metastatic adenocarcinoma. The primary tumor was not immediately apparent, and multiple diagnostic examinations had to be done before the definitive diagnosis of serous BOT, International Federation of Gynecology and Obstetrics stage IV could be made. In the meanwhile, erroneous therapies had been given in 1 case. After surgical removal of the adnexal masses and full surgical staging, all the 3 patients remained free of disease after a follow-up period of 48 to 84 months. In conclusion, supradiaphragmatic lymph node involvement can be present in patients with serous BOTs, and can even be the presenting symptom. When fine needle aspiration cytology of such a lymph node is compatible with adenocarcinoma of unknown primary, serous BOT should be included in the differential diagnosis and pelvic examination should be performed.

Ovarian cancer: what's new, where next?

The recent RDOG studies have confirmed the value of CT in the management of ovarian cancer. However we now know that metastases to the ovary may exactly mimic primary cancer. This demands a firm histological diagnosis when surgery is not planned and especially with a history of breast and gastrointestinal tract cancer. CT guided needle biopsy can provide this.

Calcification in lymphoma occurring before therapy: CT features and clinical correlation

OBJECTIVE

Calcification in lymphoma occurring before therapy is rare. We assessed the prevalence, CT features, and clinical significance of calcification in nodes and masses in patients with lymphoma occurring before therapy.

SUBJECTS AND METHODS

CT of the chest, abdomen, and pelvis of 956 newly diagnosed patients with lymphoma was evaluated prospectively for calcifications in enlarged lymph nodes and lymphoma masses. Findings were correlated with histologic type of disease, tissue parameters, and clinical course. Calcifications were further evaluated on follow-up CT.

RESULTS

Of 956 patients with lymphoma (704 with non-Hodgkin's lymphoma and 252 with Hodgkin's lymphoma), eight patients (0.84%) showed calcifications in involved sites, seven of whom had non-Hodgkin's lymphoma and one of whom had Hodgkin's lymphoma. Calcifications were present in lymph nodes and masses in the mediastinum in five patients, in the retroperitoneum in two patients, and in the adrenal in one patient. All eight patients had the aggressive type of lymphoma. Four patients later relapsed, one of whom died. A fifth patient died after only minimal response to treatment.

CONCLUSION

Calcification in patients with lymphoma occurring before therapy is rare as opposed to that in lymphoma after therapy. It occurred in our patients more often in the mediastinum, in patients with non-Hodgkin's lymphoma rather than in patients with Hodgkin's lymphoma, and only in patients with the aggressive type of disease.

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.