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Abstract
Introduction/Background The most frequent sites of metastatic involvement of epithelial ovarian cancer (EOC) are the omentum, lymph nodes, gut, and liver. Mucocutaneous metastases occur in less than 5% of cases, having variable clinical presentation and being associated with a reduced overall survival.
Methodology A 42-year-old woman consulted with a 2-month history of a painful fast-growing mass in the right vulvo-vaginal region of easy bleeding with a biopsy reporting clear cell adenocarcinoma (CCC), immunohistochemistry was positive for malignant gynecological neoplasm of ovarian primary. Staging studies demonstrated a perineal lesion with malignant features, with inguino-pelvic, and abdominal lymphadenopathys suspicious of metastatic involvement, and no evidence of organs infiltration.
The patient was taken to surgery by a multidisciplinary team for symptomatic management doing perineal and abdominal approach achieving a complete cytoreduction with no macroscopic residual disease. The anatomopathological study reported CCC in fallopian tubes and perineal mass with nodal disease and surgical margins of specimen free of disease.
Results CCC is the second most common EOC histotype (10% of all cases). Although most cases are diagnosed in early stages, it has an aggressive behavior. Due to its rarity and chemoresistance, the principal therapeutic strategy remains the complete cytoreduction.
Mucocutaneous metastases are late manifestations, being related to a poor prognosis with an average survival of 12 months. Skin lesions may present as umbilical nodes, or as macule-type lesions, nodes, or plaques, being the bulky-mass type lesions extremely rare.
Treatment depends on the location and type of lesion and can be managed during primary or Interval cytoreduction, or with Mohs chemosurgery, external beam radiotherapy (EBRT) and immunomodulators.
Conclusion Mucocutaneous metastases from clear cell EOC are very rare with a wide clinical presentation, conditioning a delayed diagnosis. The appearance of skin lesions in the context of a known malignancy should generate clinical suspicious allowing a prompt diagnosis and management.
Disclosures Nothing to disclose.
