A 57-year-old woman was admitted due to a pelvic mass in June 2016. Computed tomography (CT) evaluation showed a low-density tumor (13.0 cm x 6.0 cm x 3.8 cm) in the right adnexa (Figure 1A, red arrow). The serum tumor marker tests showed a CA125 level of 208.5 U/mL (<35.0 U/mL), and normal levels of alpha-fetoprotein (AFP), human epididymis protein 4 (HE4), CA19-9 and carcinoembryonic antigen (CEA). She underwent laparoscopic hysterectomy, bilateral adnexectomy, pelvic lymph node dissection, paraaortic lymphadenectomy, omental excision, appendectomy, debulking surgery, with lysis of the pelvic adhesions. The operation was successful, and complete resection (R0) was achieved. The postoperative pathology diagnosed high-grade serous ovarian carcinoma (HGSC) considered stage IIIB. The immunohistochemical results showed CK7 (+), WT-1 (+), ER (+), PAX-8 (+), CA125 (partial +), P16 (scattered +), CK20 (-), Villin (-), CDX-2 (-), PR (-), VIM (-), CEA (-), P53 (-), and Ki-67 labeling index (LI) of approximately 60%. The patient was given eight cycles of paclitaxel (175 mg/m2) and carboplatin (AUC 5) for chemotherapy. Three weeks after the second cycle of chemotherapy, the CA125 value dropped to a normal level. After chemotherapy, the patient was regularly followed up every 3 months. 
On June 31, 2020, CT revealed a nodule (3.2 cm x 3.2 cm) in the left inguinal region (Figure 1B, red arrow) during regular follow-up. Three-dimensional color Doppler ultrasound showed a mixed mass (6.1 cm x 3.1 cm x 5.6 cm) in the left iliac fossa and solid masses (1.5 cm x 1.0 cm, 1.9 cm x 1.4 cm) before the right iliac fossa, with no blood flow signal on either side. Chest and abdominal CT showed no metastasis in other organs of the patient. The CA19-9 and HE4 levels were 44.5 IU/mL and 160.97 pmol/L, respectively. Transabdominal resection of the bilateral inguinal metastases and cytoreductive surgery were performed on August 4, 2020. During the operation, an approximately 6 cm mass was found in the left inguinal area, along with two masses of approximately 1.5 cm and 2.5 cm in the right inguinal area. The majority of the left-sided mass was located in the tendon and ligament between the fascia and rectus abdominis, and its lower boundary was the peritoneum; the mass had a clear boundary and obvious capsule. The right-sided masses were fused into one mass, similar in appearance to the mass on the left (Figure 2A). The lesions on both sides were located near the port site. The postoperative histopathologic examination revealed poorly differentiated adenocarcinoma, which was consistent with the recurrence of ovarian cancer (Figure 2B and C). The immunohistochemical results showed CK7 (+), PAX-8 (+), WT1 (+), ER (SP1) (+), ER (positive control) (+), PR (1E2) (-), PR (positive control) (+), VIM (-), P16 (partial +), CK20 (-), Villin (-), CDX-2 (-), SATB2 (-), TTF-1 (-), P53 (-), and a Ki-67 LI approximately 40%. The patient received four cycles of PLD (30 mg/m2) and carboplatin (AUC 5). At present, this patient is still being followed up, and there have been no signs of recurrence.