BMJ Case Reports 2018; doi:10.1136/bcr-2017-221450
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Relevance of enlarged cardiophrenic lymph nodes in determining prognosis of patients with advanced ovarian cancer

  1. Melissa Teo1
  1. 1Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
  2. 2Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore, Singapore
  1. Correspondence to Dr Melissa Teo, melissa.teo.c.c{at}
  • Accepted 2 December 2017
  • Published 13 January 2018


Ovarian cancer often presents at an advanced stage with widespread peritoneal and/or extra-abdominal metastases. Complete cytoreduction is the mainstay of treatment for disease confined to peritoneum. But in patients with distant metastases, the role and rationale is less obvious. One of the the most common sites of extra-abdominal disease is the cardiophrenic lymph node (CPLN). In this paper, we described the management of a patient with International Federation of Gynecology and Obstetrics (FIGO) stage IVB epithelial ovarian carcinoma and widespread peritoneal and extra-abdominal metastases to the CPLN, who underwent complete cytoreduction including excision of enlarged CPLN, following neoadjuvant chemotherapy. We examined the literature to determine the prognostic value of enlarged CPLN and their relevance in managing patients with advanced ovarian cancer and found it as an adverse prognostic factor. Transdiaphragmatic excision of CPLN is feasible without major complications. But as its correlation with overall or progression-free survival is not yet evident, large-scale prospective studies are warranted.


  • Contributors HSN is the main author of the manuscript. GHCT, RN and MT contributed with serial reviews of the draft in writing.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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