ovarian carcinoma is the most common cause of death from gynecological malignancy in europe and in the united states . although the intraperitoneal route of dissemination is considered the most common , it may also metastasize through lymphatic channels and hematogenous spread . metastasis of ovarian serous carcinoma to the axillary lymph node is uncommon with only isolated case reports so far . the present case shows rare occurrence of metastatic serous carcinoma of the ovary to axillary lymph node and role of fine needle aspiration cytology ( fnac ) as reliable , safe and rapid first line diagnostic procedure . she had taken treatment for stage iiic serous papillary carcinoma of the ovary that was diagnosed before 25 months . now she had rise in serum cancer antigen-125 ( ca-125 ) level after 7 months of disease free period . computed tomography abdomen - pelvis showed no residual / recurrent lesion in pelvis and no paraaortic , and external iliac lymphadenopathy was seen . her previous treatment for ovarian carcinoma included three cycles of chemotherapy of paclitaxol and carboplatin , followed by debulking of ovarian tumor and again two cycles chemotherapy for residual disease . serum ca-125 levels were 1,328 u / ml at the time of admission that reduced to 196 u / ml after first cycle of chemotherapy . it was 71 u / ml after surgery and again rose to 204 u / ml after 7 months of disease free period . tumor cells were large , high n : c ratio , vesicular hyperchromatic nuclei , prominent nucleoli and scanty to moderate pale cytoplasm [ figure 1 ] . in the background , tumor necrosis and lymphoid cells are seen along with hemorrhage . on immunohistochemistry ( ihc ) , the tumor cells were positive for cytokeratin 7 , wilms tumor-1 ( wt-1 ) and ca-125 and were negative for estrogen receptor ( er ) , progesterone receptor ( pr ) and gcdf-15 consistent with metastasis of ovarian carcinoma to axillary node . previous biopsy from ovarian carcinoma correlates well morphologically with the current cytological finding [ figure 2 ] . tumor cells arranged in papillaroid pattern having large vesicular hyperchromatic nuclei and prominent nucleoli ( pap , 100 ) section revealed poorly differentiated carcinoma , ovarian biopsy ( h and e , 400 ) tumor cells were large , high n : c ratio , vesicular hyperchromatic nuclei , prominent nucleoli and scanty to moderate pale cytoplasm [ figure 1 ] . in the background , tumor necrosis and lymphoid cells are seen along with hemorrhage . on immunohistochemistry ( ihc ) , the tumor cells were positive for cytokeratin 7 , wilms tumor-1 ( wt-1 ) and ca-125 and were negative for estrogen receptor ( er ) , progesterone receptor ( pr ) and gcdf-15 consistent with metastasis of ovarian carcinoma to axillary node . previous biopsy from ovarian carcinoma correlates well morphologically with the current cytological finding [ figure 2 ] . tumor cells arranged in papillaroid pattern having large vesicular hyperchromatic nuclei and prominent nucleoli ( pap , 100 ) section revealed poorly differentiated carcinoma , ovarian biopsy ( h and e , 400 ) ovarian cancer is a major cause of cancer death in women , usually presenting with diffuse abdominal dissemination . distant hematogenous metastasis is unusual during the course of the disease or rarely at presentation . vascular dissemination occurs to internal organs commonly to the liver , lung , pleura and rarely other organs like central nervous system , bone , skin , spleen , breast . reported 8% of their patients had distant metastasis at initial presentation , and 22% developed them during the course of their diseases , only five of their 162 patients had extra - abdominal spread . they also concluded that distant metastasis occurs in about one - third ( 30% ) of epithelial ovarian carcinoma , and the interval time between diagnosis of ovarian cancer and documentation of distant metastases is the most important prognostic factor . the present case of high - grade serous ovarian carcinoma was of advanced stage and had metastasis to axillary node that occurred after 25 months of its initial presentation . ovarian tumors , such as serous carcinoma , dysgerminoma , endometrioid carcinoma , carcinoid tumor , granulosa cell tumor , and choriocarcinoma have been metastatic in the breast . 77.7% of these cases were of serous carcinoma with synchronous axillary node involvement in < 60 - 67% of these patients . isolated axillary node metastasis such as in our case has been reported in few patients . the use of ihc markers such as gross cystic disease fluid protein-15 , ca-125 , er - pr receptor study , and wt-1 may aid in determining the origin of the tumor . in our case rise in ca-125 level since cytology of breast and ovarian cancer may look similar , the diagnosis may be difficult at the time of diagnosis of axillary node metastasis . comparison of cytomorphology with that of the primary tumor is of great help along with a serum marker as in our case and also suggested by bansal et al . in their study of cutaneous and subcutaneous metastases from internal malignancy . metastatic ovarian carcinoma involving axillary nodes are a rare event ; its recognition and distinction from primary breast carcinoma are of great clinical importance because the treatment and prognosis differ significantly . physician should be aware of the existence of axillary lymph node metastasis in primary ovarian carcinoma cancer . fnac proves to be safe , rapid and reliable diagnostic first line investigative procedure , and its validity is ensured through the correlation with the histology of the previous excised ovarian carcinoma .
metastasization and distinction from mammary carcinoma is of great clinical importance because of different treatment modalities . here 
 , we discuss a case of stage iiic ovarian serous carcinoma , presenting with bilateral axillary nodes metastasis after 25 months interval of its initial presentation . increased serum ca-125 level caused clinical suspicion . computed tomography scan of abdomen and pelvis showed no residual disease or any abdominal lymphadenopathy . 
 mammography of both breast were normal . 
 bilateral axillary nodes were noted . 
 guided fine needle aspiration cytology ( fnac ) and biopsy of ovarian carcinoma to axillary node is a rare event . 
 its recogn done . 
 cytomorphology revealed poorly differentiated carcinoma , compatible to that of primary ovarian tumor . thus , metastatic carcinoma to axillary node from ovary was confirmed . 
 this case illustrates a rare metastatic presentation of ovarian carcinoma and unequivocal role of fnac to provide rapid diagnosis and preferred to be first line diagnostic procedure .