Systemic lymphadenopathy as the primary symptom of serous surface papillary carcinoma of the ovary.

Serous surface papillary carcinoma (SSPC) is a distinct type of ovarian cancer; most of the patients present with extensive intraabdominal disease at the time of diagnosis. In a 48-year-old patient with 6-month history of inguinal and then scalene lymphadenopathy, although series workup did not disclose any primary tumor, an exploratory laparotomy was performed because of the abnormally high serum CA-125 level (1024 U/ml) and the pathologic examination of the inguinal node suggesting an ovarian origin. At exploration, there was only a discernible SSPC lesion on the right ovary; no intraperitoneal spread but extensive lymph node metastasis was found. The patient died of disease 30 months after surgery, although adjuvant and salvage chemotherapy was given. Ovarian cancer should be part of the differential diagnosis in a woman with systemic lymphadenopathy but without any evidence of intraabdominal disease.