Kanchustambham Venkatkiran, Saladi Swetha
Pulmonary and Critical Care Medicine, University of North Dakota, Fargo, USA.
Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA.
Cureus. 2021 Mar 2;13(3):e13658. doi: 10.7759/cureus.13658.
Adenocarcinoma of the lung can present with distant metastasis, with major metastasis sites being mediastinal lymph nodes, liver, brain, and adrenal glands. Inguinal lymph nodes are an unusual site for distant metastasis of adenocarcinoma of the lung. We discuss the case of a 73-year-old Caucasian female with a medical history significant for hypertension, chronic obstructive pulmonary disease (COPD) who was seen in the primary care clinic for ongoing shortness of breath, worsening cough, and wheezing. She was prescribed a short course of steroids and antibiotics for possible COPD exacerbation. Despite these measures, the patient had worsening pulmonary symptoms and got evaluated in the emergency room. A CT scan of the chest showed right upper lobe bilobed masses and bulky mediastinal lymph nodes resulting in the partial collapse of the lung's right upper lobe. She got admitted to the hospital for further evaluation, and pulmonary service was consulted for possible endobronchial ultrasound-guided biopsy (EBUS) of the mediastinal nodes. During the physical exam, she was found to have a large fungating mass in the right groin. Upon further questioning, she reported that the mass began as a small swelling in the groin three months ago and was evaluated by the primary care physician and received antibiotics for two weeks. During this time, she did not have any worsening pulmonary symptoms. She underwent bedside excisional biopsy of the lymph node; the pathology came back positive for metastatic adenocarcinoma of pulmonary origin. Unfortunately, the patient had a significant worsening of her respiratory distress; she transitioned to comfort measures and passed away three days later. In this article, we report a case of metastatic lung adenocarcinoma with the inguinal lymph nodes' involvement as the site of distant metastasis, followed by a brief review of the occurrence of adenocarcinoma with the inguinal lymph nodes' involvement.
肺腺癌可出现远处转移，主要转移部位为纵隔淋巴结、肝脏、脑和肾上腺。腹股沟淋巴结是肺腺癌远处转移的不常见部位。我们讨论一例73岁的白人女性病例，她有高血压、慢性阻塞性肺疾病（COPD）病史，因持续气短、咳嗽加重和喘息在初级保健诊所就诊。她因可能的COPD加重接受了短期类固醇和抗生素治疗。尽管采取了这些措施，患者的肺部症状仍在恶化，并在急诊室接受了评估。胸部CT扫描显示右上叶双叶肿块和肿大的纵隔淋巴结，导致右上叶部分肺组织萎陷。她因进一步评估入院，并就纵隔淋巴结可能的支气管内超声引导活检（EBUS）咨询了肺科。体格检查时，发现她右腹股沟有一个巨大的溃疡性肿块。进一步询问时，她报告说肿块三个月前开始是腹股沟的一个小肿胀，初级保健医生对其进行了评估，并给予了两周的抗生素治疗。在此期间，她没有任何肺部症状恶化的情况。她接受了淋巴结床边切除活检；病理结果显示为肺源性转移性腺癌阳性。不幸的是，患者的呼吸窘迫明显加重；她转而采取舒适措施，三天后去世。在本文中，我们报告一例以腹股沟淋巴结受累作为远处转移部位的转移性肺腺癌病例，随后对腹股沟淋巴结受累的腺癌发生情况进行简要综述。
