Non-palpable invasive lobular carcinoma initially diagnosed by inguinal lymph node biopsy

Metastasis from breast cancer to the inguinal lymph nodes or the vulva is a rare event with very few cases reported in literature. A 38-year-old lady presented complaining of progressive abdominal enlargement. Physical examination was unremarkable apart from abdominal enlargement and enlarged right inguinal lymph node. Radiology showed marked ascites, omental thickening, bilateral small ovarian masses, suspicious right inguinal lymph node (LN) as well as breast fibrocystic disease. Cytological examination of the ascitic fluid revealed malignant cells. Core needle biopsy from the inguinal LN suggested metastatic breast carcinoma. Breast MRI showed heterogeneous fibro-glandular tissue and moderate parenchymal enhancement. Random core needle biopsies from the breast led to the diagnosis of invasive lobular carcinoma. The patient received 8 cycles of docetaxel/carboplatin protocol, with partial response. Next, she was maintained on hormonal treatment (Anastrazole) till the ascites re-accumulated. Vulvar nodules appeared whose biopsy revealed infiltration by the same tumoral tissue. She received 6 cycles of Endoxan and Pharmarubicin till regression was achieved, and then she was subjected to Exemestane. Thorough clinical assessment including of all lymph node basins and gynecological assessment are crucial in all breast cancer patients, particularly those with invasive lobular subtypes.