An Unusual Case of Cervical Cancer with Inguinal Lymph Node Metastasis: A Case Report and Review of the Literature

Abstract

There is limited data regarding to treatment of cervical cancer patients with isolated non-regional lymph node metastasis. Herein we report a case of cervical cancer with left inguinal lymph node metastasis at the time of diagnosis. A 52-year-old woman referred to gynecologic oncology department with postmenopausal vaginal bleeding history for a year. Gynecological examination revealed a bulky cervical tumor with left parametrial invasion. The biopsy of this lesion revealed a squamous cell carcinoma of the cervix. A pelvic magnetic resonance imaging (MRI) demonstrated a bulky cervical mass with a parametrial extension on left side, in addition to the suspicious lymph nodes in the para-aortic, pelvic and left inguinal chains. The patient was underwent extraperitoneal para-aortic lymph node dissection and left inguinal lymphadenectomy. Histopathological examination of the lymph nodes revealed that there were metastatic lymph nodes in the para-ortic, and left inguinal chains. We planned neoadjuvant chemotherapy consisting of paclitaxel and carboplatin; and we decided to plan adjuvant treatment with respect to the treatment response to the induction chemotherapy. The control computed tomography after 6 cycle of chemotherapy showed that there was a good-partial response; therefore definitive radiotherapy was planned. A month after the radiotherapy pelvic MRI was performed and it showed a complete response. After 38 months of follow-up the patient admitted to the emergency department with ileus. The patient developed sepsis and forty months after the completion of the radiotherapy the patient expired because of septic shock.

Defining the role of high-dose radiation in oligometastatic & oligorecurrent cervical cancer

“…There are no robust guidelines for the management of inguinal node metastases; most of the evidence is based on case reports and individual practices. Being close to pelvic RT fields, the majority of RT oncologists extend the RT fields to include the inguinal nodes with concurrent CTh, with RT doses up to 45 Gy to the pelvis with an additional 9-15 Gy boost are recommended for the involved inguinal nodes and the preferred CTh agent is cisplatin 40 mg/m 2 weekly 43 . The role of neoadjuvant or adjuvant CTh or node dissection is not defined in such a setting.…”