Unusual Initial Presentation of Carcinoma Prostate With Inguinal Lymph Node Metastasis and Lower Limb Lymphedema: A Case Report

Introduction: Prostate adenocarcinoma is clinically diagnosed through symptoms and routine serum PSA levels. Prostate cancer metastasises to the obturator lymph nodes, internal and external iliac lymph nodes. Incidence of inguinal lymph node metastasis is only 9%. Ca Prostate metastasising to inguinal lymph nodes in the absence of primary symptoms is usually uncommon. We report a rare case of metastatic prostate adenocarcinoma without any obvious primary only presenting with lower limb lymphedema secondary to the bulky inguinal lymph node metastasis. A 72-year-old male presented with bilateral i Case Presentation: nguinal swellings along with non-pitting edema of left lower limb for last 6 months. USG showed bilateral inguinal lymphadenopathy. Excisional biopsy with IHC showed metastatic prostatic adenocarcinoma. PET/CT showed no uptake in prostate, and uptake on both side of diaphragm, lower paratracheal, pre-vascular, AP window and subcarinal nodes; along with retroperitoneal, bilateral internal and external iliac and bilateral inguinal lymph nodes. Serum total PSA was 524 ng/ml, and TRUS guided 12 core biopsy of prostate conrmed acinar adenocarcinoma of prostate (Gleason score5+4=9 and Gleason grade group-5) Inguinal secondaries may be the initial presenting symptom in rare Conclusion: cases and should be suspected in old males specially if the patient has lower urinary tract symptoms.