PRIMARY LUNG ADENOCARCINOMA PRESENTING AS INGUINAL MASS

Abstract

SESSION TITLE: Medical Student/Resident Lung Cancer Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Metastases to inguinal lymph nodes are common from malignant lesions arising on or in the lower extremity, lower one-half of the trunk, perineum, and male and female reproductive tracts. Inguinal lymph nodes are an unusual site for distant metastasis of adenocarcinoma of the lung. We report a rare case of primary adenocarcinoma of the lung presenting as inguinal mass. CASE PRESENTATION: A 73-year-old Caucasian female with a past medical history significant for hypertension, Chronic obstructive pulmonary disease (COPD), everyday smoker was seen in the primary care clinic for ongoing shortness of breath, worsening cough, and wheezing. She was prescribed a short course of steroids and antibiotics for possible COPD exacerbation. Despite these measures, the patient had worsening pulmonary symptoms and got evaluated in the emergency room. A CAT scan of the chest was done that showed right upper lobe bilobed masses and smaller satellite lesions seen measuring 3.4 and 2.8 cm in the greatest dimension. She got admitted to the hospital for further evaluation, and pulmonary service was consulted for possible endobronchial ultrasound-guided biopsy (EBUS) of the mediastinal nodes. During the physical exam, she was found to have a large fungating mass in the right groin. Upon further questioning, she reported that the mass began as small swelling in the groin three months ago and was evaluated by the primary care and received antibiotics for two weeks. During this time, she did not have any worsening pulmonary symptoms. She underwent bedside excisional biopsy of the lymph node, and the pathology came back positive for metastatic adenocarcinoma of pulmonary origin. A CAT scan of the abdomen revealed Hypoattenuating mass posterior aspect right lobe of the liver and second lesion in the spleen. Unfortunately, the patient had a significant worsening of her respiratory distress and was transitioned to comfort measures and passed away after three days. DISCUSSION: Extra thoracic nodal metastasis to the brain, bone, liver, and adrenal glands were the most common sites from adenocarcinoma of the lung at presentation1. Inguinal lymph nodes are an unusual site for distant metastasis. There have been only two other case reports of the Inguinal lymph node metastasis in adenocarcinoma and both were a sign of disease relapse2. we present the first case of inguinal metastasis from lung adenocarcinoma at presentation. In a retrospective study of 1486 cases of surgically removed NSCLC by Riquet et al., extrathoracic nodal metastases to inguinal lymph node was seen in one case3. Groin metastases are exceptional and no lymphatic vessel continuity can explain their incidence. Therefore, these metastases are systemic in origin. CONCLUSIONS: In conclusion, although extremely rare, metastatic disease to the inguinal region from lung cancer should be considered in the differential diagnosis of any lesion in the groin. Reference #1: Quint LE, Tummala S, Brisson LJ, Francis IR, Krup- nick AS, Kazerooni EA, et al. Distribution of distant metastases from newly diagnosed non-small cell lung cancer. Ann Thorac Surg 1996; 62:246-50. Reference #2: Tasci, Canturk & Dogan, Deniz & çiçek, Ali & Uçar, Ergün & özkan, Metin & Bilgic, Hayati. (2011). A case of lung cancer which presented with saphenous vein thrombosis and inguinal lymph node metastasis. Anatolian Journal of Clinical Investigation. Reference #3: Riquet M, Le Pimpec-Barthes F, Danel C. Axillary lymph node metastases from bronchogenic carcinoma. Ann Thorac Surg 1998; 66:920-2. DISCLOSURES: No relevant relationships by Venkatkiran Kanchustambham, source=Web Response No relevant relationships by Swetha Saladi, source=Web Response