After three cycles of wTC, the serum CA125 level decreased to the normal range and the relapse lesion could not be palpated. Our patient then underwent neoadjuvant chemotherapy of dose-dense paclitaxel (80 mg/m 2 one-hour intravenous infusion) given on days one, eight, and 15 plus carboplatin in the AUC of 5 mg given on day one of a 21-day cycle (wTC). Surgical resection might have placed our patient at risk of peri-operative mortality. On palpation, the mass was immobile and adhered well to a wide vessel surface. A core needle biopsy showed adenocarcinoma, similar to the findings from the primary OC: our patient had a clinical diagnosis of isolated RSCLN metastasis from OC. Other examinations, such as mammography, chest and abdominal CT, gastroscopy, colonoscopy, and gallium-67 scintigraphy, revealed no abnormal findings. CT demonstrated RSCLN swollen to 15 mm in diameter. The serum CA125 level increased to 69.6U/mL. The results of a breast examination were normal, the thyroid gland was not palpable, and there were no skin lesions. There was no evidence of other lymphadenopathy, ascites, or abdominal masses. After 52 months from the initial surgery, our patient found a firm mass in her right supraclavicular area. Follow-up abdominal and pelvic computed tomography (CT) at the end of chemotherapy showed no evidence of recurrent or residual lesions in the pelvis. Subsequently, our patient underwent six cycles of paclitaxel (180 mg/m 2 three-hour intravenous infusion) given on day one plus carboplatin of the area under the curve (AUC) of 5 mg given on day one of a 21-day cycle (TC). The serum concentration of CA125 decreased to below the normal limit after surgical removal of the tumor. The final diagnosis was stage Ib serous adenocarcinoma. On palpation, the para-aortic lymph nodes were found not to be swollen. The results of a peritoneal washing cytological examination were negative. No evidence of pelvic spread, peritoneal implantation, or ascites was found. The surgery revealed that the tumor originated from her bilateral ovaries. She underwent a bilateral salpingo-oophorectomy, an omentectomy, and a pelvic lymphadenectomy. Her levels of serum cancer-related antigen 125 (CA125) and carbohydrate antigen 19-9 (CA19-9) were 170.0U/mL (normal range is 0 to 35U/mL) and 15.1U/mL (normal range is 0 to 37U/mL), respectively. She had a medical history of vaginal hysterectomy because of a uterine prolapse after menopause at the age of 55 years. A 65-year-old post-menopausal Japanese woman (gravida 2, para 2) with abdominal distension had an ovarian tumor that was 15 cm in diameter.
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