title: Supradiaphragmatic manifestations of papillary serous adenocarcinoma of the ovary.
abstract: OBJECTIVE
  To illustrate unusual patterns of isolated supradiaphragmatic presentation and relapse of papillary serous adenocarcinoma of the ovary.
  
  
  METHODS
  Retrospective study of five women (26-57 years) managed by a specialist gynaecological oncology unit.
  
  
  RESULTS
  Three women relapsed in the neck, mediastinal or axillary nodes 3 to 5 years after complete abdomino-pelvic remission. Two women presented with pleural or cervical lymph node metastases respectively 2 and 13 years before the primary pelvic tumour was discovered. Clinical presentations in these five women mimicked metastatic thyroid and breast cancer and mesothelioma. In four of the five woman supradiaphragmatic nodal disease was heavily calcified.
  
  
  CONCLUSIONS
  Women with papillary serous ovarian cancer may develop supradiaphragmatic disease without evidence of peritoneal metastasis or primary pelvic tumours. Isolated supradiaphragmatic relapse may occur many years after complete remission of abdomino-pelvic disease. Calcification in supradiaphragmatic lymph nodes should not be assumed to be due to old granulomatous disease as this may be the only clue to relapsing disease. Review of prior histology and use of immunohistochemical stains were valuable in diagnosis of these cases.
authors.affiliation: Department of Radiology, St James's University Hospital, Leeds, UK.
authors.forename: S V
authors.initials: SV
authors.lastname: Patel
authors.forename: J A
authors.initials: JA
authors.lastname: Spencer
authors.forename: N
authors.initials: N
authors.lastname: Wilkinson
authors.forename: T J
authors.initials: TJ
authors.lastname: Perren
mesh_terms: D000328:Adult; D001365:Axilla; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D002968:Clavicle; D018283:Cystadenocarcinoma, Papillary / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D053552:Keratin-7; D007633:Keratins / Q000097:blood; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009333:Neck; D010051:Ovarian Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; C507497:KRT7 protein, human; D053552:Keratin-7; D007633:Keratins