Metastatic involvement of inguinal lymph nodes as the first sign of endometroid carcinoma of the fallopian tube

Manifestation of ovarian carcinoma in the form of inguinal lymph node involvement represents a rare clinical situation described only by a limited number of case reports. Similarly, extraperitoneal dissemination of the tumor in the absence of advanced abdominal disease is uncommon. We report a 58-year-old female patient with a positive family history of ovarian cancer referred for lymph node enlargement in the left groin and elevation of CA 125. An ultrasound examination of the patient’s left groin revealed an enlarged lymph node of a size 4 × 3 cm, the biopsy of which confirmed a metastatic adenocarcinoma with origin in the female genital area (müllerian epithelium). The finding was suggestive of high-grade endometroid carcinoma. The patient subsequently underwent a PET/CT, with lesions suspect for the presence of viable malignant tissue in the left ovary (which was of normal size) and a lymph node conglomeration in the left groin. The patient was indicated for a radical cytoreductive surgery resulting in no macroscopic residual disease. Definitive histological examination confirmed high-grade endometroid adenocarcinoma of the left fallopian tube of histopathological stage FIGO IVB pT2b pN0 (17/0) pM1 (inguinal lymph node). The patient was diagnosed with somatic BRCA1 mutation. The patient was indicated for adjuvant chemotherapy with paclitaxel/carboplatin, 16 cycles were administered, and for subsequent maintenance therapy with PARP inhibitor. Currently, one year after the primary cytoreductive procedure, the patient is in complete remission of the disease. Key words: fallopian tube cancer – lymphatic spread – inguinal lymph node metastases