Metastatic adenocarcinoma of left supraclavicular fossa from occult primary ovarian cancer

Abstract

Most of the metastatic cervical lymphadenopathy results from the upper aerodigestive tract [1]. Asymptomatic primary ovarian cancer in the presence of metastatic left supraclavicular lymph nodes is rare [2]. Whether to identify the primary tumor or to manage Stage IV ovarian cancer represents a clinical dilemma. We report a rare case of metastatic adenocarcinoma of the left supraclavicular fossa resulting from occult primary ovarian cancer. A healthy 53-year-old menopausal woman, parity 2002, presented with a growing lump as large as 8 6 3 cm in her left supraclavicular fossa; she had had the mass for 3 months, which on biopsy was diagnosed as a metastatic papillary tumor (Fig. 1A). She underwent panendoscopy (nasolaryngoscopy, bronchoscopy, gastroenteroscopy) and a series of imaging studies for primary malignancy, which demonstrated only lymphadenopathy in the left axillary region to the supraclavicular region (Fig. 2A). Finally, abdominal computed tomography showed a right pelvic mass measuring 13.5 7.4 10.5 cm with a cystic component and enlarged lymph nodes from the para-aortic to paracaval space. The patient had a gynecological oncology consultation and underwent exploratory laparotomy. The histopathology confirmed papillary serous cystoadenocarcinoma of both ovaries, coexisting with omentum cake and enlarged pelvic lymph nodes. The patient underwent a debulking operation with a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection. However, because of unresectable status of multiple tumor metastases to the para-aortic, axillary, and supraclavicular lymph nodes, the