title: Ovarian cancer initially presenting as intramammary metastases and mimicking a primary breast carcinoma: a case report and literature review.
abstract: BACKGROUND
  Ovarian cancer usually spreads intra-abdominally. Supradiaphragmatic metastases are rare, and axillary lymph node metastases are exceptional. Here, we present the first case of ovarian carcinoma detected at screening mammogram as intramammary lymph node metastases.
  
  
  METHODS
  A 44-year-old obese woman underwent core biopsy of a suspicious mammographic finding histologically consistent with lymph node metastases from breast cancer. Serum tumor markers, including CA 125, were normal, and clinical staging was negative. The patient underwent quadrantectomy and axillary dissection that revealed four involved lymph nodes but no primary breast carcinoma. Accurate re-evaluation of the histological specimens suggested the possible ovarian origin of the tumor. An [(18)F]-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography revealed a 33-mm solid mass with intense metabolic FDG uptake in the right groin and a small simple ovarian cyst with normal FDG uptake. The ovarian cyst was removed laparotomically and was malignant on frozen section. Surgical staging revealed a well-differentiated serous ovarian carcinoma microscopically involving the omentum and massively infiltrating the groin node. After chemotherapy, the patient developed metastases in the contralateral axilla that was removed surgically. The patient is alive with no evidence of disease 20 months after surgical removal of the primary tumor.
  
  
  CONCLUSIONS
  Surgeons should be aware that ovarian cancer may rarely metastasize to intramammary and axillary nodes, mimicking a primary breast carcinoma.
authors.affiliation: Department of Gynecology, Perinatology and Human Reproduction, Italy. tommaso.susini@unifi.it
authors.forename: Tommaso
authors.initials: T
authors.lastname: Susini
authors.forename: Simone
authors.initials: S
authors.lastname: Olivieri
authors.forename: Cecilia
authors.initials: C
authors.lastname: Molino
authors.forename: Francesca
authors.initials: F
authors.lastname: Castiglione
authors.forename: Ketty
authors.initials: K
authors.lastname: Tavella
authors.forename: Riccardo
authors.initials: R
authors.lastname: Viligiardi
mesh_terms: D000328:Adult; D001940:Breast; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008207:Lymphatic Metastasis; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18