title: Stage IV epithelial ovarian carcinoma in an 18 year old patient presenting with a Sister Mary Joseph's nodule and metastasis in both breasts: a case report and review of the literature.
abstract: BACKGROUND
  The most frequent ovarian malignancy in mature women is of epithelial origin. In children and adolescents, it is very rare, and in such cases it mostly concerns tumors of low malignant potential or low stage I tumors.
  
  
  METHODS
  We describe an 18-year-old girl presenting with umbilical metastasis as a first sign of an extremely aggressive stage IV ovarian serous papillary adenocarcinoma without an objective response to chemotherapy and endocrine therapy. She developed metastasis in both breasts and died 28 months after the initial diagnosis.
  
  
  CONCLUSIONS
  This is the first case of a stage IV epithelial ovarian cancer under the age of 20 years. Furthermore, uncommon breast metastasis and a Sister Mary Joseph's nodule have never been described at such young age.
authors: Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E.Kolwijck@obgyn.umcn.nl
authors: Eva
authors: E
authors: Kolwijck
authors: Erik A
authors: EA
authors: Boss
authors: Anne M
authors: AM
authors: van Altena
authors: Louk V
authors: LV
authors: Beex
authors: Leon F
authors: LF
authors: Massuger
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000473:pathology / Q000556:secondary; D000293:Adolescent; D001943:Breast Neoplasms / Q000556:secondary*; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000556:secondary; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology*; D014472:Umbilicus / Q000473:pathology*