Abstract Introduction Pleural effusion is a broad diagnosis that can either be benign or, unfortunately, malignant. Pleural effusion as an initial presentation of ovarian cancer is a rare phenomenon. Metastasis of ovarian cancer typically occurs in the abdominal cavity; however, due to the permeability of the pleural membranes, the lungs also can be a site of extra-abdominal metastasis. We present a case of an elderly female who was admitted for acute hypoxic respiratory failure and discharged with a diagnosis of ovarian cancer. Case The patient was a 76-year-old female with a history of hypertension, dyslipidemia, and other comorbidities who presented with a chief complaint of shortness of breath. Her symptoms had been present for 5 days and were associated with a dry cough and generalized weakness. Urgent care initially placed the patient on doxycycline, prednisone, and guaifenesin, which did not provide relief. CT chest showed a dense consolidation of the right middle and lower lobes with air bronchograms and a moderate to large right pleural effusion. Pulmonology was consulted, and a chest tube was placed with a total of 550 cc removed from the thoracic cavity. Cytological studies showed neoplasia with large atypical epithelial cells that were positive for CK7, EMA, MOC-31, PAX8, P16, and Vimentin. CK5/6 and Calretin were positive in scattered mesothelial cells between the atypical aggregates. The findings were suggestive of metastatic adenocarcinoma of primary gynecologic origin. Oncology was consulted, and the patient was diagnosed with AJCC stage IVA adenocarcinoma of the ovary with malignant pleural effusion and peritoneal carcinomatosis. Discussion Ovarian cancer is a leading cause of gynecologic cancer-related deaths worldwide. It is often diagnosed at an advanced stage due to vague or nonspecific abdominal symptoms. A rare but clinically significant presentation is a pleural effusion, which may precede or completely overshadow abdominal symptoms. This manifestation highlights the disease’s capacity for distant spread and reflects its insidious progression. Patients usually present with progressive dyspnea, shortness of breath, or nonproductive cough, which is often attributed to a primary pulmonary or cardiac condition. The involvement of the lungs in ovarian cancer results from transdiaphragmatic spread via the lymphatic system or peritoneum, which is more prominent on the right side. The tumor cells migrate through the lymphatic system, resulting in right-sided pleural effusions. Markers such as PAX8 and CK7 are frequently utilized to confirm an ovarian origin, while negative staining for markers like TTF-1 helps exclude pulmonary origin. This abstract is funded by: None
Joseph et al. (Fri,) studied this question.