J Korean Soc Radiol.  2014 Nov;71(5):249-253. 10.3348/jksr.2014.71.5.249.

Solitary Axillary Lymph Node Metastasis without Breast Involvement from Ovarian Cancer: Case Report and Brief Literature Review

• Choi JI
• Kim SJ
• Park SH
• Kim HS

• KMID: 2208794
• DOI: http://doi.org/10.3348/jksr.2014.71.5.249

Abstract

Axillary lymph node metastasis without breast involvement from ovarian cancer is rare. We report a case of a 68-year-old woman proven as ovarian serous papillary carcinoma and metastatic papillary carcinoma of the omentum on surgical diagnostic laparoscopy. In addition, a hypermetabolic lymph node was detected in left axilla and was considered a reactive benign lesion. Mammography and ultrasonography showed no focal lesion in both breasts, but ultrasonography-guided core needle biopsy for the lymph node revealed metastatic serous papillary carcinoma from ovarian origin. Even with a low incidence of axillary lymph node metastasis without breast involvement from ovarian cancer and only marginally elevated standardized uptake value in positron emission tomography, the possibility of metastasis at axillary lymph node in patients with known primary ovarian cancer must be considered.

MeSH Terms

Aged
Axilla
Biopsy, Large-Core Needle
Breast*
Carcinoma, Papillary
Female
Humans
Incidence
Laparoscopy
Lymph Nodes*
Mammography
Neoplasm Metastasis*
Omentum
Ovarian Neoplasms*
Positron-Emission Tomography
Ultrasonography

Figure

• 

  Fig. 1 Venous phase image of abdominopelvic CT shows bilateral solid and cystic masses (arrows) in both ovaries with massive ascites (*). After the diagnostic laparoscopy, biopsy was proven as ovarian serous papillary carcinoma.

• 

  Fig. 2 Maximum intensity projection (MIP) image (A) of 18F-FDG PET/CT shows hypermetabolic lesions (SUVmax = 4.9 g/mL, black empty arrows) in both ovarian masses consistent with primary malignancy and hypermetabolism (SUVmax = 4.9 g/mL, white empty arrows) in multiple mesenteric nodules which cannot be ruled out peritoneal seeding. Furthermore, MIP image (A) and axial CT image (B) of 18F-FDG PET/CT show hypermetabolism (SUVmax = 2.1 g/mL) in left axilla (arrows) which might be a reactive benign lymph node. Note.-SUVmax = maximum standardized uptake value, 18F-FDG PET/CT = 18F-fluorodeoxyglucose positron emission tomographic/computed tomography

• 

  Fig. 3 Photomicrograph of ovary shows papillary structures lining fibrovascular core with psammoma bodies demonstrating serous papillary carcinoma (H&E stain, × 200).

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  Fig. 4 Left breast MLO view of mammography shows two hyperdense enlarged lymph nodes containing central fatty hilums in left axilla (arrows), the largest one size up to 1 cm. Note.-MLO view = mediolateral oblique view

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  Fig. 5 Ultrasonography and photomicrograph image of the left axillary lymph node. A. Breast ultrasonography shows the largest one of three lymph nodes sized up to 1.4 cm, with eccentric cortical thickening and preserved fatty hilum in left axilla. B. Color Doppler ultrasonography shows lymph nodes with prominent hilar blood flow. C. Photomicrograph of left axillary lymph node shows abnormal papillary structures spreading in subcapsular area, which are similar with ovarian papillary lesion (Fig. 3). Normal lymph node structure is noted in the lower portion (H&E, × 100).

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