Metastatic serous adenocarcinoma arising in the adnexa uteri and forming pleural cysts on the diaphragmatic pleura.

A 74-year-old woman consulted our hospital complaining of cough that had persisted for the previous 3 months. Chest computed tomographic (CT) scan showed bilateral pleural effusion without any pulmonary lesions. Pleural effusion cytology showed adenocarcinoma. Barium enema, gastroduodenoscopy and abdominal CT did not demonstrate any abnormal findings. Serum CEA, NSE and CYFRA21-1 were 26.8 (cutoff: 5) ng/ml, 43.7 (cutoff: 10) ng/ml and 67.5 (cutoff: 3.5) ng/ml, respectively. After removal of 1,500 ml of pleural effusion, left thoracoscopy showed a few eccentric pleural cysts on the diaphragmatic pleura (Fig. 1). No pleural nodule suggestive of malignancy was recognized. The content of the cyst was clearly serous fluid. Pathologic examination of the cyst showed a small focus of adenocarci-