Abstract
Isolated superficial inguinal metastases without any extended intra-abdominal spread is a rare event in patients with ovarian carcinoma. Here we report an isolated superficial inguinal metastasis in a patient with primary ovarian cancer. A 54-year-old Chinese patient with primary ovarian cancer, had an isolated painless enlarged right groin swelling (3×2cm) as the only manifestation, preoperative pathology confirmed metastatic adenocarcinoma. Gynecologic examination, transvaginal ultrasonography of the abdominopelvic cavity revealed a 5-cm mixed, right adnexal mass. At exploratory laparotomy, there was little intra-abdominal tumor dissemination but 100 ml of faint yellow peritoneal fluid and a 5-cm right ovarian tumor with intact capsule. Staging operation was performed and postoperative pathology confirmed adenocarcinoma located within right ovarian, with no evidence of involvement of other sites. Then the patient received adjuvant chemotherapy for Stage IVB. Five years later, the patient is currently still alive without evidence of recurrent disease. This case indicate that ovarian carcinoma isn’t a disease localized only within the intra-peritoneal cavity, isolated superficial inguinal lymph node metastasis might occur in rare cases via potential lymphatic and (or) hematogenous route under special conditions. We propose the need to investigate the possible mechanisms, risk factors, metastatic patterns, the biology and natural history of such patients in a large-scale and multicenter analysis. Furthermore, efforts should be made for earlier and differential diagnosis and finally prolong survival time for such patients.
Highlights
Ovarian carcinoma is the most frequent cause of death from gynecological malignancies in China [1]
Incidence of inguinal lymph node metastasis Lymph node metastases can be well recognized in ovarian cancer with sampling of retroperitoneal lymph nodes as an integral part of the staging operation [8]
Federation of Gynecology and Obstetrics (FIGO) introduced inguinal lymph node involvement into the definition of stage IVB in ovarian carcinoma since 2013 [7], while patients exhibited metastatic retroperitoneal lymph nodes are classified as stage IIIC even when the primary tumor is limited to the pelvis [9]
Summary
Ovarian carcinoma is the most frequent cause of death from gynecological malignancies in China [1]. Systematic infectious disease that can cause enlarged inguinal lymph node were analyzed, including hepatitis A, hepatitis B, hepatitis C, syphilis, HIV, HSV, and the results were all negative. The patient received fine needle aspiration for the right groin swelling and preoperative pathological examination confirmed a metastatic adenocarcinoma (Figure 2). Postoperative pathologic diagnosis showed a poorly differentiated serous papilliferous cystadenocarcinoma of the right ovary (Figure 3), and right inguinal lymph node metastasis (Figure 4), which consistent with preoperative fine needle aspiration, immunohistochemical staining showed positive cytoplasmic CA125 expression both in ovarian cancer tissues (Figure 5) and in metastatic SILN (Figure 6), cytology of the pelvic fluid showed poor differentiated adenocarcinoma cells (FIGO G3). The rest of pathological diagnosis showed no evidence of disseminated intraperitoneal and retroperitoneal metastatic disease, all pelvic and paraaortic lymph nodes were negative (Figure 7). Five years after the primary diagnosis, this patient is still alive with no evidence of recurrent disease
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