Extra-abdominal Lymph Node Metastases as the First Presentation in Ovarian and Fallopian Tube Carcinomas

Revision of ovarian and fallopian tube cancer presentation as extra-abdominal lymph nodes to understand the diagnostic challenges and prognostic features of these situations. Literature review in PubMed and Cochrane databases using the terms “ovarian cancer,” “fallopian tube cancer,” “extrapelvic lymph nodes,” extra-abdominal lymph nodes,” “distant lymph nodes,” “initial presentation,” “metastases,” and “unusual presentation of ovarian cancer/unusual presentation of fallopian tube cancer” isolated and in conjunction. Articles in English were analyzed regarding revision’s purpose, inclusion, and exclusion criteria and 65 were included in the final document. Statistical data was obtained with Microsoft Excel software analysis. Distant manifestations of ovarian cancer may occur through the lymphatic system and, less frequently, through hematogenous spread. These forms of spread may exist with almost no symptoms related to the primary cancer location and can justify distant disease at the initial presentation. Extra-abdominal lymph node involvement poses a clinical challenge for oncologists and oncologic gynecologists because it may occur with no or mild symptoms, and even in situations where no macroscopic disease is seen in the pelvic cavity. Histology and immunohistochemistry analyses together with a high level of suspicion are paramount to help in the diagnostic workup decisions and in finding a correct diagnosis when an extra-abdominal lymph node is the first manifested sign. Given its rarity and scarcity of information dispersed in a few case reports and small case series, further investigation is needed to understand the particularities of these tumors and their prognostic relevance.