Ovarian carcinoma diagnostic challenge: Large ovarian carcinoma giving umbilical subcutaneous metastases without infiltrating intestines

Abstract

Introduction: The authors present an interesting case of large ovarian carcinoma challenging for diagnosis (with lymphonodal and umbilical subcutaneous metastases, but without infiltrating intestines and therefore causing few symptoms). Case Report: A 63-year-old patient, almost completely asymptomatic, presented with large bilateral adnexal masses. ROMA index was elevated. Abdominal and pelvic MRI scan showed presence of 20-cm mixed-consistency tumors of both ovaries and lymphedema in periumbilical subcutis. Only two parailiacal lymph nodes were enlarged. Patient had total hysterectomy with bilateral adnexectomy, selective lymphadenectomy, and excision of subcutaneous tumor. The right tumor formed the incarceration of the intestines, without infiltrating the intestinal wall. Histopathological analysis diagnosed ovarian serous papillary adenocarcinoma with metastases in lymph nodes and umbilical region subcutis. Conclusion: This report highlights that, although very rare, one of the first ovarian carcinoma manifestations can be its subcutaneous/cutaneous metastases. Additionally, lack of clear symptoms can exist in even at the advanced stage. © 2018 S.O.G. CANADA Inc. All rights reserved.