Axillary lymph node metastasis as first presentation of peritoneal carcinomatosis from serous papillary ovarian cancer: case report and review of the literature

Ovarian cancer usually spreads into abdominal cavity and to the loco-regional lymph nodes. Extra-abdominal metastases are less frequent and isolated axillary metastases are very rare. The authors describe the case of a 49-year-old woman who was diagnosed with a peritoneal carcinomatosis from ovarian cancer by mean of an enlarged axillary lymph node biopsy, whose histological examination identified as a ovarian cancer metastasis. Patient was treated by peritonectomy and intraperitoneal chemohyperthermic perfusion (HIPEC). Although patients with axillary lymph node metastasis from ovarian cancer are though to be metastatic (FIGO Stage IV), surgical radical treatment and adjuvant systemic chemotherapy can achieve the same prognosis of Stage IIIb-c patients, suggesting they could be a particularly good prognosis subset of patients. Early differential diagnosis between ovarian or breast cancer in axillary lymph node metastasis is crucial but not always very simple, because of the very different course and treatment of these tumours.

HIPEC; Peritonectomy; Ovarian carcinoma; Axillary lymph node metastasis.

[1] Hockstein S., Keh P., Lurain J.R., Fishman D.A.: “Ovarian carcinoma initially presenting as metastatic axillary lymphadenopathy”. Gynecol. Oncol., 1997, 65, 543.

[2] Sugarbaker P.H.: “Peritonectomy procedures”. Ann. Surg., 1995, 221, 29.

[3] Euscher E.D., Silva E.G., Deavers M.T., Elishaev E., Gershenson D. M., Malpica A.: “Serous carcinoma of the ovary, fallopian tube, or peritoneum presenting as lymphadenopathy”. Am. J. Surg. Pathol., 2004, 28, 1217.

[4] Di Giorgio A., Naticchioni E., Biacchi D., Sibio S., Accarpio F., Rocco M. et al.: “Cytoreductive surgery (peritonectomy procedures) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of diffuse peritoneal carcinomatosis from ovarian cancer”. Cancer, 2008, 113, 315.

[5] Chen S.S., Lee L.: “Incidence of para-aortic and pelvic lymph node metastases in epithelial carcinoma of the ovary”. Gynecol. Oncol., 1983, 16, 95.

[6] Dauplat J., Hacker N.F., Nieberg R.K., Berek J.S., Rose T.P., Sagae S.: “Distant metastases in epithelial ovarian carcinoma”. Cancer, 1987, 60, 1561.

[7] Cormio G., Rossi C., Cazzolla A., Resta L., Loverro G., Greco P., et al.: “Distant metastases in ovarian carcinoma”. Int. J. Gynecol. Cancer, 2003, 13, 125.

[8] Zang R.Y., Zhang Z.Y., Cai S.M., Tang M.Q., Chen J., Li Z.T.: “Epithelial ovarian cancer presenting initially with extraabdominal or intrahepatic metastases: a preliminary report of 25 cases and litera-ture review”. Am. J. Clin. Oncol., 2000, 23, 416.

[9] Aydin C., Unalp H.R., Baloğlu A., Inci A.G., Yiğit S., Yavuzcan A.: “Axillary lymph node metastasis from serous ovarian cancer: a case report and review of the literature”. Arch. Gynecol. Obstet., 2009, 279, 203. doi: 10.1007/s00404-008-0669-5. Epub 2008 May 10.

[10] Burghardt E., Girardi F., Lahousen M., Tamussino K., Stettner H.: “Patterns of pelvic and paraaortic lymph node involvement in ovar-ian cancer”. Gynecol. Oncol., 1991, 40, 103.

[11] Eltabbakh G.H., Mount S.L.: “Lymphatic spread among women with primary peritoneal carcinoma”. J. Surg. Oncol., 2002, 81, 126.

[12] Recine M.A., Deavers M.T., Middleton L.P., Silva E.G., Malpica A.: “Serous carcinoma of the ovary and peritoneum with metastases to the breast and axillary lymph nodes: a potential pitfall”. Am. J. Surg. Pathol., 2004, 28, 1646.

[13] Raptis S., Kanbour A.I., Dusenbery D., Kanbour-Shakir A.: “A fine-needle aspiration cytology of metastatic ovarian carcinoma to the breast”. Diagn. Cytopathol., 1996, 15, 1.

[14] Al-Hussaini M., Stockman A., Foster H., McCluggage W.G.: “WT-1 assists in distinguishing ovarian from uterine serous carcinoma and in distinguishing between serous and endometrioid ovarian carcino-mas”. Histopathology, 2004, 44, 109.

[15] Wick M.R., Lillemoe T.J., Copland G.T., Swanson P.E., Manivel J.C., Kiang D.T.: “Gross cystic disease fluid protein-15 as a marker for breast cancer: immunohistochemical analysis of 690 human neoplasms and comparison with alpha-lactalbumin”. Hum. Pathol., 1989, 20, 281.

[16] Monteagudo C., Merino M.J., LaPorte N., Neumann R.D.: “Value of gross cystic disease fluid protein-15 in distinguishing metastatic breast carcinomas among poorly differentiated neoplasms involving the ovary”. Hum. Pathol., 1991, 22, 368.

[17] Singer C., Blankstein E., Koenigsberg T., Mercado C., Pile-Spell-man E., Smith S.J.: “Mammographic appearance of axillary lymphnode calcification in patients with metastatic ovarian carcinoma”. Am. J. Roentgenol., 2001, 176, 1437.