Introduction: Ovarian carcinoma usually presents at an advanced stage with diffuse intra-abdominal manifestations. We report a patient who presented with a right groin swelling. Clinical Picture: The only clinical abnormality was an enlarged right inguinal lymph node (3 x 2 cm), for which excision biopsy revealed metastatic adenocarcinoma. A computed tomography (CT) scan showed an enlarged left ovarian lesion (9.0 x 6.4 cm). Treatment and Outcome: Laparotomy with total hysterectomy, bilateral salpingo-oophrectomy and partial omentectomy were performed. Histology confirmed left ovarian adenocarcinoma, consistent with the earlier histology of the right inguinal lymph node. There were no other sites of involvement. Postoperatively, the patient received adjuvant chemotherapy for treatment of FIGO Stage IIIc ovarian carcinoma and is clinically disease free 13 months after surgery. Conclusions: Ovarian cancer presenting with inguinal lymph node metastases is uncommon. Ovarian cancer which manifests solely as a contralateral inguinal lymph node metastasis has not been previously reported. This case illustrates a rare presentation of ovarian carcinoma, and underscores the need to consider ovarian carcinoma in the differential diagnosis of women with inguinal lymphadenopathy.
Ovarian carcinoma is the most frequent cause of death from gynaecological malignancies in the United States. Rates for ovarian carcinoma in Singapore fall between those of Western Europe and those of the rest of Asia, accounting for 5.4% of all female cancers diagnosed between 1998 and 2002 in Singapore.1 A major contributing factor to the high mortality is the lack of symptoms associated with the disease at an early stage. This is in part due to the intra-abdominal location of the ovaries, and that symptoms do not occur until malignancy is widespread. Isolated inguinal lymph node metastasis is an uncommon manifestation of ovarian carcinoma. To date, there have been 3 case reports that bear similarities to our case.2-4 We describe a patient seen at the Singapore General Hospital who presented with an enlarged metastatic (contralateral) right inguinal lymph node from a primary left ovarian adenocarcinoma without evidence of disseminated intra-abdominal disease or gross evidence of pelvic or para-aortic lymph node disease. To our knowledge, such a rare presentation of primary ovarian cancer has not been reported before.
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