What happened, in summary

A 43-year-old woman sought care for a painless umbilical ulcer that had persisted for 1½ months and continued to enlarge despite 2 weeks of antibiotics. Examination found a hard nodule beneath the ulcer and a large pelvic mass.

At surgery, doctors found a 20 cm solid-cystic tumour of the right ovary and a 7 cm tumour of the left ovary. Tumour deposits were also present on the bowel mesentery, omentum and both diaphragmatic surfaces, with enlarged pelvic and para-aortic lymph nodes. She underwent extensive cytoreductive surgery, including hysterectomy, removal of both ovaries and fallopian tubes, pelvic and para-aortic lymph-node dissection, omentectomy, peritoneal stripping, removal of the umbilical nodule and resection of bilateral cardiophrenic lymph nodes. No visible disease remained at the end of surgery.

Pathology showed high-grade serous carcinoma involving both ovaries. Multiple abdominal and pelvic sites contained metastatic carcinoma, and cardiophrenic lymph nodes on both sides were positive. The extra-abdominal cardiophrenic nodal spread classified her disease as Stage IV.

She recovered without major abdominal or pulmonary complications. Her chest tube was removed on postoperative day 4 and she went home on day 11. A planned 6-cycle course of paclitaxel and carboplatin began on postoperative day 25.