Femoral metastasis of papillary carcinoma of the ovary -A rare incidental finding

Abstract

Epithelial ovarian cancer normally spreads transcoelomically via the peritoneal cavity and then, in more advanced stages, to the intra-abdominal lymph nodes and the liver and lung parenchyma. Bone metastasis is an extremely rare initial presentation in patients with primary carcinoma of the ovary and is associated with poor prognosis. Herein we report a rare case of femoral metastasis of papillary carcinoma of the ovary in a 49-year-old female, who presented to the orthopaedics clinic with complaints of pain and swelling around the left knee joint since 2 months. X ray and MRI of left leg showed a diffuse soft tissue swelling and osteolytic lesions in the lower femur around the condyles with focal cortical destruction. Fine needle aspiration biopsy of the lesion was suggestive of metastatic adenocarcinoma. Subsequent ultrasonography of the lower abdomen showed a hypoechoic shadow in the left ovary. Local surgical excision with left oopherectomy was performed. After histopathologic and immunohistochemical examination from both the sites, a final diagnosis of primary papillary adenocarcinoma of the ovary with femoral metastasis was given. She was treated with 6 cycles of adjuvant combination chemotherapy of Paclitaxel 150 mg/m2and Cisplatin 50 mg/m2 and a good response was seen. This case is unique in presentation of bony femoral metastasis with silent epithelial ovarian carcinoma. Keywords: Bone, Femur, Metastasis, Ovarian cancer, Immunohistochemistry.