Skin metastases in epithelial ovarian and fallopian tube carcinoma

Abstract

This study aimed to investigate the clinical features and outcomes of skin metastasis in ovarian and fallopian tube carcinomas.We studied patients with epithelial ovarian or fallopian tube carcinoma who developed skin metastasis from 2001 through 2012, and were also treated with chemotherapy and/or surgery.Skin metastases were classified as umbilical metastasis (Sister Joseph nodule [SJN]) and nonumbilical metastasis. Patients who developed skin metastases at paracentesis sites were excluded.Of the 206 patients treated, 12 (5.8%) developed skin metastasis: 7 developed SJN, and 5 developed nonumbilical metastasis. Six patients had serous carcinoma, 3 had clear cell carcinoma, 2 had endometrioid carcinoma, and 1 had adenocarcinoma. Four patients out of the 7 who developed SJN had skin metastasis at initial diagnosis, and all 4 patients had SJN with concomitant peritoneal dissemination. Of the 4 patients, 3 received chemotherapy, and their survival ranged from 22 to 42 months. Of the 7 patients who developed SJN, 3 patients with stage IIIC disease developed an SJN at recurrence and were treated with surgery and/or chemotherapy. Their survival duration after recurrence ranged from 26 to 43+ months. Five patients developed nonumbilical metastases 3 to 53 months (median 34 months) after initial diagnosis: 3 cases occurred in incisional scars of primary surgery, and 2 in subcutaneous metastasis in the other sites. Survival after recurrence ranged from 56 to 140+ months in 3 patients with incisional scar recurrence, and it was 5 months in 2 other patients.Sister Joseph nodule developed only in patients with peritoneal dissemination, and most patients with SJN survived for >24 months. Nonumbilical metastases occurring in incisional scars of primary surgery may carry a favorable prognosis.

Rare metastatic patterns after malignant transformation of serous borderline tumor of the ovary

“…One additional case, by Banys‐Paluchowski et al, reported a single abdominal subcutaneous implant of a mucinous borderline tumor 9 days after undergoing a laparoscopic unilateral salpingo‐oophorectomy for an ovarian cyst. Consistent with the conclusions of Otsuka et al, this patient's subcutaneous metastasis was likely due to intraoperative seeding of her incision at the time of resection.…”

“…Subcutaneous soft tissue metastasis is a rare feature in gynecologic malignancies, occurring in only approximately 1%‐6% of all epithelial ovarian cancers (EOCs) . Subcutaneous metastases are subdivided by the site of disease into umbilical, also known as Sister Mary Joseph Nodules (SMJN), and nonumbilical.…”

“…SMJNs were always associated with intraperitoneal disease and are believed to be the result of direct extension into the umbilicus, while nonumbilical subcutaneous metastases were frequently located within prior surgical scars, likely a result of seeding during a prior surgical resection. In the cases where nonumbilical subcutaneous metastases were not associated with prior incisional scars, all had concomitant metastatic disease present at other sites …”

Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms

“…SJNs usually develop in patients with gastrointestinal and gynecological cancers [4,5,6,7,8,9,10]. SJN refers to a metastatic cancer of the umbilicus and is named after Sister Joseph, a nurse who frequently assisted Dr. William Mayo at St. Mary’s Hospital in Rochester, Minnesota, USA.…”

“…Skin metastases usually develop at the umbilicus, surgical scars, including laparoscopic port sites, and in the vicinity of metastatic lymph nodes [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46]. Skin metastases are often a late manifestation of the disease; however, in certain cases they may sometimes be the first sign of internal malignancies such as lung, renal, and ovarian cancers [47].…”