BackgroundPenile cancer is a rare malignancy. The extent of lymph node (LN) metastasis is the most important prognostic factor in penile cancer. However, preoperative prediction of LN involvement in clinically non-palpable LN is still a challenge. In absence of a reliable biomarker, attempts are being made to validate imaging characteristics as a predictive tool. The aim of the present study is to assess the primary penile tumor characteristics with diffusion-weighted magnetic resonance imaging (DWMRI) and its correlations with inguinal LN status and tumor positivity in LN dissection specimen within normal sized LNs.MethodsTwenty-six patients with carcinoma penis underwent DWMRI of penis and pelvis. The apparent diffusion coefficient (ADC) values of primary tumor were compared with histological characteristics. Inclusion criteria encompassed all cases of clinically non-palpable inguinal LN and normal sized LN on imaging. All palpable inguinal nodes with pelvic lymphadenopathies were excluded from this study.ResultsThe primary tumor ADC ranged from 0.65 × 10-3 - 1.2 × 10-3 mm2/s (mean: 0.87 × 10-3 ± 0.11 × 10-3 mm2/s). In pT1 and pT3 tumors, mean ADC values were 0.86 × 10-3 ± 0.10 × 10-3 and 0.81 × 103 ± 0.09 × 103 mm2/s, respectively. The mean ADC values for grade 1, grade 2 and grade 3 were 0.89 × 10-3, 0.82 × 10-3 and 0.80 × 10-3 mm2/s, respectively. The ADC value of < 0.95 × 10-3 mm2/s was positively correlated with pathological LN presence within normal sized LN. With mean ADC value of 0.87 × 10-3 ± 0.11 × 10-3 mm2/s, sensitivity and positive predictive values for primary penile cancer were 100% and 84.61%, respectively. The mean ADC value for higher-grade and -stage tumor was low. The sensitivity and specificity of predicting LN metastasis by DWMRI were 87.22% and 80.90%, respectively.ConclusionADC value of primary tumor can help in prediction of LN metastasis in carcinoma penis with clinically and radiologically normal groin.
<p class="abstract">Head and neck cancers rank fifth amongst the most affected cancers in the world. Metastasis to cervical lymph nodes is primarily from sites in head and neck. About 1% of all malignant cervical adenopathies are encountered as metastasis from remote primary site. We present here our experience of four cases in last five years. Patients presented as cervical lymphadenopathy with unknown primary, which on evaluation was found to be of genitourinary source from different sites. It is a single centre retrospective study. We reviewed cancer registry. We found four cases of genitourinary cancer with cervical lymph node metastasis. Patients presented as cervical lymphadenopathy of unknown primary. Among those one papillary renal cell cancer with rhabdoid differentiation, one testicular cancer, two prostate cancer. One case was a 67 year male patient, who revealed papillary renal cell carcinoma with rhabdoid features. Another patient was a male of 31 years, who had left testicular mass with retroperitoneal and cervical lymphadenopathy. Two patients of 68 year and 74 year respectively had metastatic prostate cancer. All patients underwent proper treatment and regularly followed up. Although rare, malignant cervical lymphadenopathy may be the first clinical manifestation of metastasis from genitourinary tumors. Evaluation of genitourinary system must be included in the protocol for uncovering the primary tumor site in cases of isolated cervical adenopathy.</p><p class="abstract"> </p>
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