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It is generally recognized that ovarian cancer tends to remain intraabdominal even in advanced cases and that dissemination is usually by invasion of adjacent viscera, diffuse intraperitoneal implantation, and metastatic involvement of aortic and pelvic lymph nodes. Primary ovarian lymphatic drainage occurs via the infundibulopelvic ligament to the paraaortic nodes. The presence of an ovarian tumor extending into adjacent pelvic viscera may allow direct lymphatic continuity with inguinal, external, and common iliac lymph nodes. In the absence of such extension it is traditionally believed that the drainage via the infundibulopelvics is so important that only with its blockage, presumably by tumor emboli, can retrograde drainage to pelvic and inguinal nodes occur. We report a case of a patient presenting with a large metastatic inguinal lymph node from a primary epithelial ovarian cancer without evidence of disseminated intraabdominal disease or gross evidence of pelvic or paraaortic lymph node involvement.

Malignant luteinized thecoma is an extremely rare ovarian tumor. The fifth reported case of this tumor presenting in a 13-year-old epileptic child on anticonvulsant therapy with a rapidly enlarging pelvic-abdominal mass is discussed. At laparotomy, bilateral ovarian involvement, massive ascites, and omental and bowel serosal metastases were present. The pathological diagnosis was difficult with initial diagnoses of ovarian edema, endodermal sinus tumor, and ovarian fibrosarcoma. The final diagnosis of malignant luteinized thecoma was made by recognizing the presence of lutein cells with foamy vacuolated cytoplasm and intracytoplasmic staining for oil red O. Electron microscopy also demonstrated vacuolated cells with multiple fat globules. After surgical debulking the patient was treated with combination chemotherapy with complete response. The similarities of this case to three previously reported bilateral thecomas presenting in children on anticonvulsant therapy is discussed.

Only three cases of primary squamous carcinoma of the ovary have been reported to date. This fourth case serves to illustrate similarities between all known cases of this tumor. This tumor presents primarily as a simple cyst or has a major cystic component. Three of the reported cases (including the present one) had a prior diagnosis of carcinoma in situ of the uterine cervix. Accurate surgical staging and complete tumor excision appear to be optimal therapy for squamous carcinoma of the ovary.

A patient with massive ascites secondary to ovarian carcinoma was found to have a low cardiac ejection fraction as measured by multi-gated acquisition (MUGA) scanning. Because of this low measurement, she was not treated with Adriamycin for fear of cardiac toxicity. Because the MUGA was felt to be incorrect, we performed simultaneous echocardiography and then repeated the MUGA scan after removal of 9000 cc of ascites fluid. The echocardiogram showed an ejection fraction in excess of 50% and the MUGA performed after paracentesis revealed an ejection fraction of 63% (an increase of 133%). We conclude that the MUGA is an inaccurate way to assess cardiac ejection fraction in the presence of massive ascites and that other ways to assess cardiac function should be used when there is need to determine such function in patients with massive ascites.