Virchow’s node metastasis: an unusual presentation of ovarian cancer

Ovarian primaries of supraclavicular metastases are extremely rare. The present study reports the case of a 64-year-old female with a left supraclavicular mass without any other symptoms. After performing a fine needle aspiration biopsy for pathological examination and positron emission imaging, she was diagnosed with FIGO Stage IV high-grade serous epithelial ovarian carcinoma. After three cycles of chemotherapy with paxlitaxel and carboplatin, complete response was achieved. There are only a few reports in literature that address patients with the initial symptom of left supraclavicular mass and final diagnosis of ovarian cancer. To the best of the authors' knowledge, this is the first report to describe the successful use of PET/CT to determine the primary site.

Supraclavicular lymph node metastasis; Ovarian cancer presentation; Positron emission tomography.

[1] Jemal A., Siegel R., Xu J., Ward E.: “Cancer statistics”. CA Cancer

J. Clin., 2010, 60, 277.

[2] Jelovac D., Armstrong D.K.: “Recent progress in the diagnosis and treatment of ovarian cancer” CA Cancer J. Clin., 2011, 61, 183.

[3] McGuire W.P., Hoskins W.J., Brady M.F., Kucera P.R., Partridge E.E., Look K.Y., et al.: ‘Cyclophosphamide and cisplatin compared with paclitaxel and cisplatin in patients with stage III and stage IV ovarian cancer’. N. Engl. J. Med., 1996, 334, 1.

[4] Rahman M., Nakayama K., Rahman M.T., Katagiri H., Ishibashi T., Miyazaki K.: “Enlarged Virchow's node as an initial complaint of serous ovarian adenocarcinoma”. Eur. J. Gynaecol. Oncol., 2012, 33, 546.

[5] Cebesoy F.B., Balatt O., Aydin A.: “Virchow's node as a first manifestation of ovarian serous carcinoma: case report”. Eur. J. Gynaecol. Oncol., 2008, 29, 182.

[6] Patel S.V., Spencer J.A., Wilkinson N., Perren T.J.: “Supradiaphragmatic manifestations of papillary serous adenocarcinoma of the ovary”. Clin. Radiol,, 1999, 54, 748.

[7] Moustafa M, Beynon WB.: “An atypical presentation of ovarian cancer”. J. Obstet. Gynaecol., 2002, 22, 455.

[8] Dvoretsky P.M., Richards K.A., Angel C., Rabinowitz L., Stoler M.H., Beecham J.B., Bonfiglio T.A.: “Distribution of disease at autopsy in 100 women with ovarian cancer”. Hum. Pathol., 1998, 19, 57.

[9] Ferretti G., Ranchoup Y., Bost C.,Coulomb M.: “Case report: CT demonstration of supra-diaphragmatic calcified metastatic nodes from ovarian carcinoma”. Clin. Radiol., 1997, 52, 956.

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