title: Inguinal lymph node presenting as the delayed site of metastasis in early stage endometrial carcinoma: Case report.
abstract: BACKGROUND
  Inguinal lymph nodes are the frequent sites of metastasis for malignant lymphoma, squamous cell carcinoma of anal canal, vulva and penis, malignant melanoma and squamous cell carcinoma of skin over lower extremities or trunk. Anatomically, endometrial carcinoma is less likely to spread to the superficial or deep inguinal lymph nodes, thus metastatic involvement of these lymph nodes can easily be overlooked.
  
  
  METHODS
  Here-in we report a case of a 65-year old Saudi morbid obese female, who presented with left inguinal lymphadenopathy as initial delayed site of metastasis almost 19 months after the initial treatment for FIGO IA endometrial carcinoma. Patient underwent left inguinal lymph node dissection. Histopathology confirmed metastatic endometrial adenocarcinoma, positive for cytokeratin (CK-7), estrogen receptor (ER) and progesterone receptors (PR), negative for CK-20 and CDX2. Following the post-surgery recovery, she was given extended field radiation therapy to para-aortic, pelvis and bilateral inguinal lymph nodes with concurrent cisplatin chemotherapy followed by high dose rate brachytherapy.
  
  
  CONCLUSIONS
  Inguinal lymph nodes as delayed site of metastasis in early endometrial carcinoma is extremely rare entity. Incorporation of FDG-PET during the preoperative screening of inguinal nodes may be helpful. The impact of lymph node dissection and adjuvant radiation therapy on survival needs to be established.
authors.affiliation: Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, 59046, Saudi Arabia. Electronic address: saakbar@kfmc.med.sa.
authors.forename: Shomaila Amir M
authors.initials: SA
authors.lastname: Akbar
authors.affiliation: Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, 59046, Saudi Arabia. Electronic address: drmutahirtonio@hotmail.com.
authors.forename: Mutahir A
authors.initials: MA
authors.lastname: Tunio
authors.affiliation: Histopathology, Department of Cytogenetics, Pathology, King Fahad Medical City, Riyadh, 11525, Saudi Arabia. Electronic address: walshakweer@kfmc.med.sa.
authors.forename: Wafa
authors.initials: W
authors.lastname: AlShakweer
authors.affiliation: Women's Specialized Hospital, King Fahad Medical City, Riyadh, 59046, Saudi Arabia. Electronic address: abalobaid@kfmc.med.sa.
authors.forename: AbdulAziz
authors.initials: A
authors.lastname: AlObaid
authors.affiliation: Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, 59046, Saudi Arabia. Electronic address: masiri@kfmc.med.sa.
authors.forename: Mushabbab
authors.initials: M
authors.lastname: AlAsiri
keywords: Early stage endometrial cancer; Inguinal lymph node; Metastasis