Ovarian cancer initially presenting with isolated ipsilateral superficial inguinal lymph node metastasis: a case study and review of the literature

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.

Presentation and Management of Inguinal Lymphadenopathy in Ovarian Cancer

“…Four of our patients were seen even without adnexal mass. Only few case reports of isolated inguinal LN in early ovarian cancer are found in literature [4,5,9]. However, report of ILAP preceding the adnexal mass by 33 months and the present study point towards the under reporting of inguinal lymph nodes and suggest a higher incidence in early ovarian cancer [10].…”

“…Be it the isolated presence of para aortic nodes, or the ILAP, the studies differ in survival outcomes [13,14]. Though complete cytoreduction without increase in perioperative morbidity, a good response to chemotherapy and a 5-year survival of up to 64 % is reported, ILAP is presently staged asIVb [4]. With the limited follow-up, survival outcomes cannot be documented in the present study, but the other aspects mentioned make it significant.…”

“…But very few cases document its occurrence at primary presentation and only some of these describe full cilinico pathological details [4][5][6]. The question that arises is, if we are missing these cases in primary setting.…”

“…ILAP is considered to occur via lymphatic spread along round ligament or through the blood and is staged with other distant metastasis [7]. However, in most case reports of ILAP in ovarian cancer, management included upfront cytoreductive surgery (CRS), in which complete cytoreduction could be achieved and good survival was seen [3][4][5]8]. This controversy demands further studies to confirm its route of spread and refine the staging and management.…”

Blueberries inhibit cyclooxygenase-1 and cyclooxygenase-2 activity in human epithelial ovarian cancer

“…There are numerous symptoms for OC, such as bloating (1), pelvic pain (2) and abdominal swelling (3). A number of areas of the body can be affected by OC by the metastasis of abnormal cells, including the abdomen (4), bowel (5), bladder (6), lymph nodes (7) and liver (8).…”