Ovarian cancer metastasis to axillary node without breast involvement: a rare case

Ovarian cancer is the most lethal gynaecological cancer globally. Despite advanced multimodality treatment 5year survival is around 50% and its only 31% in stage IV cancers. There is no clearly defined precursor lesion. The events which led to metastasis is not clearly understood. Epithelial ovarian cancers (EOC) are the most common type of ovarian malignancy. Stage IV ovarian cancer incidence are raising day by day. Peritoneum is the most common site of recurrence followed by nodes and intra-abdominal metastasis. Distant metastasis outside abdomen is rare. Moreover, ovarian cancer with metastasis to axillary lymph node is very rare presentation specially when breast is not involved. We like to report a case of 54year old lady, who was admitted with persistent Right axillary lymph nodal mass. She had a history of High grade serous ovarian cancer stage IVB which was detected and treated 3 years back with neoadjuvant chemo followed by interval cytoreductive surgery followed by Adjuvant multiple line of chemo and maintenance bevacizumab. During follow up, patient had increased Ca-125, and PET CT suggestive of persisting right axillary LN with retroperitoneal LN and right external iliac node. The axillary node was biopsied and found to be metastatic High-grade Serous Ovarian Carcinoma, but mammography showed no abnormality in bilateral breasts. Patient received 2nd line chemotherapy. Secondary Cytoreductive Surgery and HIPEC (cisplatin) and Right Level I ALND done in Department of Surgical Oncology AIIMS, New Delhi. Intraoperatively 3 × 3 cm Right axillary level I single node found. Excision of metastatic axillary node shows excellent result. This case highlights the importance of meticulous evaluation of patient presenting with axillary lymphadenopathy to rule out possibility of ovarian cancer. Additionally, axilla should also be considered as a possible site of metastasis in a known case of carcinoma ovary for effective treatment planning.