Su Qing, Han Shichao, Yin Rong, Yang Qiyu, Pan Zhuo
Department of Obstetrics and Gynecology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing 400014, China.
Department of Gynecology, the Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, China.
Int J Surg Case Rep. 2024 Oct;123:110209. doi: 10.1016/j.ijscr.2024.110209. Epub 2024 Aug 27.
Fallopian tube cancer that is characterized only by inguinal lymph node metastasis without intra-abdominal widespread is rare. Here we report a patient with primary Fallopian tube cancer with bilateral inguinal metastases as the first symptom.
A 68-year-old patient with primary Fallopian tube cancer, with painless bilateral inguinal enlargement (7 × 6 cm on the right side, 3 × 2 cm on the left side) as the only manifestation, was confirmed by preoperative biopsy as metastatic high-grade serous denocarcinoma, consider the adnexal or peritoneal source. Pelvic MRI, abdominal CT and PET-CT showed irregular signal foci can be seen in the right adnexal area, with a maximum cross-section of about 7.5 × 7.0 × 4.0 cm, considering malignancy, ovarian cancer may be possible; bilateral pelvic wall, bilateral inguinal, right iliac vessels with hypermetabolic lymph nodes. Serum CA125 level was markedly elevated at 922.40 U/ml and HE4 at 394.50 pmol/L. No abnormality was found in gastrointestinal endoscopy. At exploratory laparotomy, the tumor was confined to the right rear of the uterus, and a solid tumor with a size of about 10 × 6 × 6 cm was seen. The surface was smooth and closely related to the uterus. There was almost no tumor spread in the pelvic abdominal cavity, but there was 50 ml of pale blood-colored peritoneal fluid. The right ovarian capsule was intact. Cytoreductive surgery was performed, postoperative pathology confirmed adenocarcinoma of the right fallopian tube, and the patient received six cycles of paclitaxel plus cisplatin combination chemotherapy were administered, with three 3-weeks intervals between cycles. And subsequent the patient participated in a clinical trial. The work has been reported in line with the SCARE criteria.
Literature review indicates that inguinal lymph node as the first manifestation of fallopian tube cancer is not usual, and with no widespread lymphadenopathies and abdominopelvic cavity are even rarer. This case shows that rare cases with only inguinal lymph node metastasis may occur through the underlying lymphatic and/or hematogenous routes.
The diagnosis of tubal cancer is sometimes complicated and delayed. For elderly women without nonspecific symptoms, especially those with obvious masses, detailed examinations, and imaging studies should be carried out in time. The treatment of tubal cancer is multi-modal. Due to the high risk of recurrence of fallopian tube cancer, the possibility of metastasis after the initial diagnosis is large, so it is very important to receive close and regular follow-up for patients with fallopian tube cancer after treatment. We suggest that more tumor centers study the possible mechanisms, metastasis patterns, biological characteristics, etc. of such patients, and at the same time efforts should be made to early differential diagnosis, and ultimately prolong the survival time of such patients.
仅以腹股沟淋巴结转移为特征而无腹腔内广泛转移的输卵管癌较为罕见。在此，我们报告一例以双侧腹股沟转移为首发症状的原发性输卵管癌患者。
一名68岁原发性输卵管癌患者，唯一表现为双侧腹股沟无痛性肿大（右侧7×6厘米，左侧3×2厘米），术前活检确诊为转移性高级别浆液性腺癌，考虑附件或腹膜来源。盆腔MRI、腹部CT和PET-CT显示右侧附件区可见不规则信号灶，最大横截面约为7.5×7.0×4.0厘米，考虑为恶性，可能为卵巢癌；双侧盆腔壁、双侧腹股沟、右侧髂血管旁有代谢增高的淋巴结。血清CA125水平显著升高至922.40 U/ml，HE4为394.50 pmol/L。胃肠内镜检查未发现异常。在剖腹探查术中，肿瘤局限于子宫右后方，可见一个大小约为10×6×6厘米的实性肿瘤。表面光滑，与子宫关系密切。盆腔腹腔内几乎无肿瘤扩散，但有50毫升淡血性腹腔积液。右侧卵巢包膜完整。进行了肿瘤细胞减灭术，术后病理证实为右侧输卵管腺癌，患者接受了六个周期的紫杉醇加顺铂联合化疗，周期之间间隔三周。随后患者参加了一项临床试验。本研究已按照SCARE标准进行报告。
文献回顾表明，腹股沟淋巴结作为输卵管癌的首发表现并不常见，且无广泛淋巴结病和腹腔盆腔内转移更为罕见。该病例表明，仅发生腹股沟淋巴结转移的罕见病例可能通过潜在的淋巴和/或血行途径发生。
输卵管癌的诊断有时较为复杂且会延迟。对于无特异性症状的老年女性，尤其是有明显肿块者，应及时进行详细检查和影像学研究。输卵管癌的治疗是多模式的。由于输卵管癌复发风险高，初始诊断后转移可能性大，因此对输卵管癌患者治疗后进行密切定期随访非常重要。我们建议更多肿瘤中心研究此类患者的可能机制、转移模式、生物学特性等，同时努力进行早期鉴别诊断，最终延长此类患者的生存时间。
