<div>A 55-year old postmenopausal lady presented with a painless lump in the
left groin which had progressed to its current size over last one and
half months. Clinically the lump measured 9x9 cm and was hard, immobile,
nontender, non-reducible, with regular margins and there were no other
positive findings on physical examination (Figure 1). Fine needle
aspiration cytology from the lump revealed carcinoma with areas of
necrosis and immunohistochemistry was CK7+ (focal), p53+ (diffuse and
strong), CK20− which suggested “primary ovarian carcinoma”. A PET-CT
was done which showed increased FDG uptake in a normal sized left ovary,
multiple avid para-aortic and pelvic nodes largest measuring 4x2.8 cm
and 7.8X7.9X9.9 cm avid mass in left inguinal area. In view of
unresectable disease in the groin she was planned for neoadjuvant
chemotherapy follow by interval cytoreductive surgery.</div><div>This was an unusual presentation of carcinoma ovary where PET-CT and
immunohistochemistry helped in making a diagnosis. Published literature
suggests that this presentation in lymph nodes without any clinical
disease in the parent organ and peritoneal disease is not a usual
finding (1). Diagnosis and management requires a multidisciplinary
approach. These cases have been traditionally classified as stage IV but
a recent retrospective study suggested that ovarian cancer patients with
stage IV solely due to inguinal nodal metastases have similar survival
as those with pelvic/para-aortic nodal involvement and improved survival
compared to those harboring distant metastases (2).</div><div>References:</div><div>Metwally IH, Zuhdy M, Hassan A, Alghandour R, Megahed N. Ovarian
cancer with metastatic inguinal lymphadenopathy: A case series and
literature review. J Egypt Natl Canc Inst. 2017 Jun;29(2):109-114.</div><div>Nasioudis D, Chapman-Davis E, Frey MK, Caputo TA, Witkin SS, Holcomb
K. Should epithelial ovarian carcinoma metastatic to the inguinal
lymph nodes be assigned stage IVB? Gynecol Oncol. 2017
Oct;147(1):81-84.</div>