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J Cancer 2023; 14(17):3176-3181. doi:10.7150/jca.88863 This issue Cite

Review

Inguinal Lymph Node Metastasis as Sole Manifestation of Ovarian / Fallopian Tube Cancer: a Review of the Literature

Sofoklis Stavros¹, Anastasios Potiris¹, Nikolaos Machairiotis¹, Alexandros Fotiou¹, Pavlos Zarogoulidis^2✉, Eirini Drakaki³, Theodoros Karampitsakos¹, Christos Koratzanis¹, Spyridon Michalopoulos⁴, Dionysios Vrachnis⁵, Panagoula Oikonomou⁶, Nikolaou Christina⁶, Charalampos Charalampidis⁷, Stamatios Petousis⁸, Aris Ioannidis⁹, Dimitris Matthaios¹⁰, Ekaterini Domali³, Peter Drakakis¹

1. Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School of the National and Kapodistrian University of Athens, Athens, Greece.
2. Pulmonary Department, General Clinic Euromedica, Thessaloniki, Greece.
3. First Department of Obstetrics and Gynecology, Alexandra Hospital, Medical School of the National and Kapodistrian University of Athens, Athens, Greece.
4. Department of Obstetrics and Gynecology, Medical School of Democritus University of Thrace, Alexandroupolis, Greece.
5. Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Alexandra Hospital, Athens, Greece.
6. Surgery Department, Democritus University of Thrace, Alexandroupolis, Greece.
7. Pathology Department, University of Cyprus, Cyprus.
8. 2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece.
9. Surgery Department, Genesis Private Clinic, Thessaloniki, Greece.
10. Oncology Department, General Hospital of Rhodes, Greece.

✉ Corresponding author: Paul Zarogoulidis, M.D, Ph.D., Pulmonary Department, General Clinic Euromedica, Thessaloniki, Greece. Tel: 00306977271974; E-mail: pzarogcom.

Abstract

Background: Ovarian/fallopian tube cancer is the deadliest gynecological malignancy. Most cases are diagnosed at an advanced stage, typically after the cancer has spread to the peritoneal cavity, or via lymphatic drainage. The presence of distant lymph node metastasis in the inguinal region is a rare manifestation of lymphatic metastasis. Since the 2014 FIGO staging revision, ovarian cancer patients with inguinal metastasis are classified as stage IVB. However, the clinical significance of such an upstaging remains under investigation.

Materials and Methods: Both Scopus and PubMed / MEDLINE databases were utilized, by inputting the following combination of keywords: (Ovarian cancer OR Fallopian tube cancer) AND (Inguinal lymph node AND Metastasis) on June 31^st, 2023. The time of publication and text availability were not considered when searching the databases and all relevant articles in English were initially accepted.

Results: Twelve patients from equal number of case reports were included in our review. Mean age of diagnosis was 56,5 years old, with 3 out of 12 women to be premenopausal at the time of diagnosis. Regarding the histologic type, 67% (8 out of 12) of the cases were serous adenocarcinoma and 4 patients (33%) were diagnosed with fallopian tube malignancy. All patients, except one, were treated with primary cytoreductive surgery. In all patients optimal cytoreductive surgery was achieved. All patients, except one, received adjuvant chemotherapy. Regarding the disease-free survival, mean DFS is calculated approximately at 2 years (23,1 months).

Conclusion: Inguinal lymph node metastases from ovarian / fallopian tube malignancy as initial site of metastasis is extremely rare. However, patients with inguinal masses should be investigated for ovarian / fallopian malignancy. Further investigation ought to be conducted to enlighten the pathway and the oncological significance of inguinal lymph node metastasis in ovarian cancer patients.

Keywords: inguinal lymph node, ovarian cancer, fallopian tube cancer, distant metastasis

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