Inguinal Lymph Node Metastases from Testicular Tumor

Blanco

et al. 2013

Arch Ital Urol Androl

We report the case of a patient who had undergone polypropylene plug placement 3 years before and referred to our institution with testicular tumor. CT scan demonstrated an enlargement of pelvic lymph nodes on the tumor side while retroperitoneal nodes were normal. Orchifunicolectomy was performed and histopathological examination showed a mixed germ cell tumor involving the tunica vaginalis, rete testis, epididymis and spermatic cord. After surgery the patient was addressed to adjuvant chemotherapy according to PEB scheme. Clinical re-staging showed a decrease of the pelvic bulk disease whereas retroperitoneal nodes were still normal and tumor markers were negative. Left external, internal and common iliac lymphadenectomy as well as left modified template nervesparing retroperitoneal lymph node dissection was performed. Intraoperatively the node bulk was firmly adherent to the external iliac artery and extended until the common iliac bifurcation. In the deeper part of this enlarged and firm lymphatic chain the polypropylene plug placed at the time of hernioplasty was found. Behind the plug all retroperitoneal nodes appeared normal and resulted negative on histopathologic examination. The patient had an unusual metastatization, probably due to the plug.

Section: Discussionmentioning

confidence: 99%

Inguinal polypropylene plug: A cause of unusual testicular tumor pelvic metastasis

Blanco

et al. 2013

Arch Ital Urol Androl

“…The anatomy of lymphatic drainage from the testis and scrotum is well described and mechanisms of dissemination to inguinal nodes are very well documented in patients with previous surgery in the inguinal region [3][4][5][6][7][8][9]. Klein et al [5] reported 22 cases of testicular cancer with inguinal node metastases diagnosed between 1948 and 1982.…”

Section: Discussionmentioning

confidence: 99%

“…Significant variation in this 'regular' anatomical pattern can be created by surgical violation of the scrotum or inguinal region (orchidopexy, relief of hydrocele, trans-scrotal biopsy or varicocelectomy) [3][4][5][6][7][8][9], by extension of the tumour through the testicular capsule or invasion into the epididymis [7]. These patients can develop direct lymphatic drainage to the inguinal nodes.…”

Section: Introductionmentioning

confidence: 99%

Inguinal metastases from testicular cancer

Daugaard¹,

Karas

Sommer

2006

BJU International

OBJECTIVE To evaluate the incidence of inguinal metastases in patients with testicular cancer and relapse after initial stage I disease. PATIENTS AND METHODS Of 695 patients, 14 (2%) with stage I testicular cancer developed inguinal metastases during the follow‐up on a surveillance programme. At orchidectomy, one patient had involvement of the tunica albuginea and one a history of cryptorchidism and development of testicular cancer on the contralateral side. The remaining patients had no history of previous surgery in the inguinal region or in the scrotal area, or any other known risk factors for developing inguinal‐node metastases. Two patients had a seminoma (0.5%) and 12 (4%) a nonseminoma. The histopathological examination showed that the metastases were in lymph nodes in four patients, the remainder having a more diffuse involvement of the tissue in the inguinal region. At relapse, patients were treated by three or four cycles of bleomycin, etoposide and cisplatin, except those with low‐stage seminomas (stage IIa and IIb), who were treated by radiation therapy. RESULTS All patients had a complete remission after treatment with chemotherapy or radiotherapy. No patients died or developed a recurrence during the median follow‐up of 72 months. CONCLUSION Metastases to the inguinal region are found in ≈ 2% of patients with testicular cancer; about a quarter have lymph‐node metastases, the rest probably having metastases to the spermatic cord with direct invasion into the surrounding tissue. High ligation of the spermatic cord is therefore important. Chemotherapy for patients with nonseminoma and radiotherapy for patients with seminoma gives excellent results.

British Journal of Urology

“…Reports that previous scrotal surgery predisposes to inguinal node metastases (Witus et al, 1959;Bowles, 1962;Stein et al, 1985) supported recommendations for hemiscrotectomy and en bloc removal of the spermatic cord and ilio-inguinal nodes for non-seminomatous tumours, or in seminoma for the inclusion of the area in the radiotherapy field (Doornbos et ul., 1975). In a series of 14 patients with non-seminomatous tumours occurring after previous scrotal surgery, treated with chemotherapy and retroperitoneal lymphadenectomy or chemotherapy alone, no patient was found to develop inguinal lymph node metastases (Lanteri et al, 1982).…”

Section: Discussionmentioning

confidence: 99%

“…Scrota1 biopsy of testicular tumours was considered to carry an even graver risk of local recurrence (Dean, 1925). Previous scrotal surgery such as orchiopexy (Witus et ul., 1959;Stein et al, 1985), varicocelectomy (Bowles, 1962) and exploration for torsion altered scrotal lymphatic drainage so as to predispose to dissemination via the inguinal lymphatics. In the absence of scrotal violation the risk of local recurrence of the disease has been considered minimal (Whittle, 1957).…”

Section: Testicular Tumour Unit Royal Marsden Hospital London and Smentioning

confidence: 99%

The Significance of Scrotal Interference in Stage I Testicular Cancer Managed by Orchiectomy and Surveillance

Kennedy

Hendry

Peckham

1986