Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte Dr Albino Aroso - Centro Hospitalar Universitário do Porto, Porto, Portugal
Departamento da Mulher e da Medicina Reprodutiva, Centro Materno Infantil do Norte Dr Albino Aroso - Centro Hospitalar Universitário do Porto, Porto, Portugal.
BMJ Case Rep. 2022 Feb 24;15(2):e247769. doi: 10.1136/bcr-2021-247769.
A 72-year-old woman noted a lump in her left supraclavicular fossa with no other symptoms or other signs on physical exam. A cervical biopsy indicated metastatic carcinoma. On the diagnostic workup: thoracic-abdominal-pelvic CT revealed augmented lymph nodes (LNs) in the retroperitoneum; Positron Emission Tomography-CT showed uptake in the LNs described and in two small areas in the pelvis; blood tests showed elevated CA125 and CA72.4. Another biopsy, considering a para-aortic LN, proved to be metastasis of a high-grade serous carcinoma (HGSC). Gynaecological exam and pelvic imaging were innocent. Diagnostic laparoscopy, including hysterectomy and bilateral adnexectomy, was performed and anatomopathological examination confirmed a HGSC in the fallopian tube (FT), in a tiny focus of 1.5 mm. The patient continued treatment with adjuvant chemotherapy. Literature review indicates that supraclavicular LN as first manifestation of FT carcinoma is not usual, and widespread lymphadenopathies with no macroscopic pelvic disease at diagnosis are even rarer.
一位 72 岁女性在左锁骨上窝发现肿块，体格检查无其他症状或其他体征。颈部活检提示转移性癌。在诊断性检查中：胸腹盆腔 CT 显示腹膜后淋巴结肿大；正电子发射断层扫描 CT 显示所述淋巴结和骨盆内两个小区域摄取；血液检查显示 CA125 和 CA72.4 升高。另一次考虑腹主动脉旁淋巴结的活检证实为高级别浆液性癌（HGSC）转移。妇科检查和盆腔影像学检查均正常。进行了诊断性腹腔镜检查，包括子宫切除术和双侧附件切除术，解剖病理学检查证实输卵管（FT）有 HGSC，直径为 1.5 毫米的微小病灶。患者继续接受辅助化疗。文献回顾表明，锁骨上淋巴结作为输卵管癌的首发表现并不常见，而且在诊断时无明显盆腔疾病的广泛淋巴结病更为罕见。
