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Relapse After More Than 20 Years of Follow-Up for Epithelial Ovarian Carcinoma

Benjamin Zylberberg, MD^*, Dominique Dormont, MD, PhD, Patrick Madelenat, MD^* and Emile Daraï, MD, PhD^*

*Service de Gynécologie, CHU Bichat, Paris, France; and CEA, Service de Neurovirologie, CRSSA, Fontenay aux Roses, France

Address reprint requests to: Dr. B. Zylberberg, Service de Gynécologie, CHU Bichat, 46, rue H. Huchard, 75018 Paris, France; e-mail: b-zyl{at}club-internet.fr.

BACKGROUND: Very late relapse of ovarian cancer is unusual and may present with atypical symptoms.

CASES: We diagnosed 3 cases of relapse occurring after more than 20 years of follow-up. In the first case, the first recurrence was diagnosed by an appendicitis syndrome. With the second recurrence, small pelvic nodules were detected by fluorodeoxyglucose scintigraphy, whereas other imaging method results were negative. In the second case, a nodule in the axilla revealed the recurrence, and imaging methods confirmed multiple metastasis. In the third case, the patient presented with paroxysmal abdominal pain, and fluorodeoxyglucose scintigraphy showed a tiny lesion.

CONCLUSION: Late relapses of ovarian cancer raise the issue of regrowth of dormant cells or the development of a new primary cancer. The absence of family history and BRCA gene mutations in these 3 patients favor late recurrence. Fluorodeoxyglucose scintigraphy was useful for diagnosis, particularly of small lesions not visible by classic imaging methods.