OVARIAN-CARCINOMA INITIALLY PRESENTING AS METASTATIC AXILLARY LYMPHADENOPATHY

Background. Ovarian carcinoma usually presents at advanced stage due t o diffuse intraabdominal disease. Presenting signs and symptoms often relate to the degree of intraabdominal spread. It is rare to have dist ant lymph node metastases, in conjunction with minimal intraabdominal disease, at initial presentation. Case. A 78-year-old woman was noted to have an enlarged axillary lymph node on a routine, screening mammog ram. Biopsy revealed metastatic adenocarcinoma, consistent with primar y breast cancer. Physical examination, diagnostic mammogram, and magne tic resonance imaging of the breasts were normal. A pelvic computed to mography scan revealed a 7-cm complex, right adnexal mass. At explorat ory laparotomy, there was minimal intraabdominal tumor burden; only a 6-cm right ovarian tumor and a single 1.0-cm nodule adherent to the bl adder peritoneum were found. After optimal cytoreductive surgery, she received tamoxifen for presumed metastatic breast cancer. One year lat er, recurrent disease developed in the pelvis. After reexploration and excision of all gross pelvic disease, a revised diagnosis of recurren t ovarian cancer was made, and therapy was changed to carboplatin and paclitaxel chemotherapy. The patient is currently without evidence of disease. Conclusion. Ovarian carcinoma usually presents with signs and symptoms related to the tumor burden within the peritoneal cavity. Th e finding of isolated, distant metastatic lymphadenopathy with minimal intraabdominal disease is very unusual. Immunohistochemical tumor mar kers can help determine the origin of a metastatic adenocarcinoma when the clinical presentation is atypical. (C) 1997 Academic Press.