A rare presentation of high-grade serous ovarian carcinoma with ulcerating inguinal lymph node metastasis: a case report.

High-grade serous ovarian carcinoma (HGSOC) typically spreads within the peritoneal cavity, and metastatic spread to extraperitoneal lymph nodes, particularly the inguinal region, is rare. Herein, we present a case of a 47-year-old premenopausal woman who presented with an enlarging, ulcerating right inguinal mass. Imaging revealed a necrotic inguinal mass, with no significant intra-abdominal findings. Surgical excision was performed, and histopathology confirmed metastatic HGSOC. She then underwent neoadjuvant chemotherapy, followed by radiotherapy. She then underwent robotic-surgical staging. Histopathological analysis showed bilateral ovarian involvement with multiple tumor foci. Genetic testing identified a BRCA1 mutation, leading to adjuvant maintenance therapy with Olaparib. This case emphasizes the importance of considering ovarian carcinoma in the differential diagnosis of unusual inguinal lymph node masses, even without a visible ovarian mass. Early detection, genetic testing, and a multidisciplinary approach are essential for optimizing patient outcomes in advanced HGSOC with atypical metastasis.