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Abstract
Metastasis from breast cancer to the inguinal lymph nodes or the vulva is a rare event with very few cases reported in literature. A 38-year-old lady presented complaining of progressive abdominal enlargement. Physical examination was unremarkable apart from abdominal enlargement and enlarged right inguinal lymph node. Radiology showed marked ascites, omental thickening, bilateral small ovarian masses, suspicious right inguinal lymph node (LN) as well as breast fibrocystic disease. Cytological examination of the ascitic fluid revealed malignant cells. Core needle biopsy from the inguinal LN suggested metastatic breast carcinoma. Breast MRI showed heterogeneous fibro-glandular tissue and moderate parenchymal enhancement. Random core needle biopsies from the breast led to the diagnosis of invasive lobular carcinoma. The patient received 8 cycles of docetaxel/carboplatin protocol, with partial response. Next, she was maintained on hormonal treatment (Anastrazole) till the ascites re- accumulated. Vulvar nodules appeared whose biopsy revealed infiltration by the same tumoral tissue. She received 6 cycles of Endoxan and Pharmarubicin till regression was achieved, and then she was subjected to Exemestane. Thorough clinical assessment including of all lymph node basins and gynecological assessment are crucial in all breast cancer patients, particularly those with invasive lobular subtypes.
 Keywords: Breast neoplasms, Lobular, Vulva, Vulvar metastasis, Neoplasm metastasis
Highlights
The common sites of nodal metastases from breast cancer are the axilla, supraclavicular and infraclavicular fossae, the mediastinum and the internal mammary chain
We present a patient with non-palpable invasive lobular carcinoma diagnosed by biopsy of an inguinal lymph node, which was confirmed by multiple random core biopsies from the breast
In contrast to invasive ductal carcinoma, the lobular type is characterized by the unusual pattern of metastasis to serosal surfaces, gastrointestinal tract and retroperitoneum [3]
Summary
Non-Palpable Invasive Lobular Carcinoma Initially Diagnosed by Inguinal Lymph Node Biopsy. Random core needle biopsies from the breast led to the diagnosis of invasive lobular carcinoma. The patient received 8 cycles of docetaxel/carboplatin protocol, with partial response. She was maintained on hormonal treatment (Anastrazole) till the ascites re-accumulated. Vulvar nodules appeared whose biopsy revealed infiltration by the same tumoral tissue. She received 6 cycles of Endoxan and Pharmarubicin till regression was achieved, and she was subjected to Exemestane. Thorough clinical assessment including of all lymph node basins and gynecological assessment are crucial in all breast cancer patients, those with invasive lobular subtypes
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