Henning Thomas Julius, Zouridis Andreas, Soleymani Majd Hooman
Medical Science Division University of Oxford Oxford UK.
Department of Gynaecological Oncology, Churchill Hospital Oxford University Hospitals Trust Oxford UK.
Clin Case Rep. 2024 Sep 3;12(9):e9418. doi: 10.1002/ccr3.9418. eCollection 2024 Sep.
Cardiophrenic metastasis is typically a late stage manifestation of ovarian high grade serous carcinoma. Here we present a case where this was the sole presentation of this disease. This case challenges our current understanding of the natural course of ovarian high grade serous carcinoma.
Ovarian cancer is typically described to spread from its primary site within the fallopian tubes or ovaries into the peritoneal cavity and beyond with cardiophrenic lymph node involvement being considered a late stage disease process. Here we present the case of a lady in her 60s where increased metabolic activity of the cardiophrenic lymph node was picked up in the investigation of an adenocarcinoma of the lung. Post-thoracoscopic resection histopathological analysis of this lymph node showing an epithelial structure with positive immunohistochemical markers PAX8, WT1, ER, and p16 with a p53 wild type-pattern were the sole presenting features of a high grade serous ovarian carcinoma, that was otherwise undetectable by radiological or hematological screening. Only histopathological analysis after modified radical hysterectomy in gynae-oncological fashion were able to identify a 4 mm lesion within the left fallopian tube. This case questions our current understanding of the natural history of ovarian carcinomas.
心膈转移通常是卵巢高级别浆液性癌的晚期表现。在此，我们报告一例该疾病仅以心膈转移为唯一表现的病例。此病例挑战了我们目前对卵巢高级别浆液性癌自然病程的理解。
卵巢癌通常被描述为从其在输卵管或卵巢内的原发部位扩散至腹腔及其他部位，心膈淋巴结受累被视为疾病晚期过程。在此，我们报告一例60多岁女性的病例，在对其肺癌腺癌进行检查时发现心膈淋巴结代谢活性增加。该淋巴结经胸腔镜切除后的组织病理学分析显示，其具有上皮结构，免疫组化标记物PAX8、WT1、雌激素受体（ER）和p16呈阳性，且p53为野生型模式，这些是高级别浆液性卵巢癌的唯一表现特征，而通过影像学或血液学筛查在其他方面均未检测到。仅在以妇科肿瘤学方式进行改良根治性子宫切除术后的组织病理学分析中，才在左侧输卵管内发现一个4毫米的病灶。该病例对我们目前对卵巢癌自然史的理解提出了质疑。
