Adenocarcinoma of the Lung With Inguinal Lymph Node Metastasis

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.