Lymphatic Path of the Inguinal Lymph Node Metastases in Anorectal Cancer

Abstract

Sentinel lymph node biopsy has been established as a feasible and effective method for defining the inguinal node status in patients with anal adenocarcinoma exceeding the dentate line. We present the axial lymphoscintigraphic image that depicts thoroughly the injection site around the anus, the lymphatic path, and the inguinal sentinel lymph nodes, bilaterally. The distinct springbok pattern was named after the unique horn shape of the African gazelle. This image puts on the map the anoinguinal lymphatic path and highlights the need for complete inguinal lymph node and related lymphatic path dissection in metastatic anal cancer.

Lymphatic Path of the Inguinal Lymph Node Metastases in Anorectal Cancer

“…Because local recurrence, according to our observations, may occur anywhere along the inguinal crease (on the course where the lymphatic vessels appear in the Springbok pattern), colorectal surgeons should consider the possibility of resecting the positive sentinel lymph node and the ipsilateral lymphatic vessel en bloc. 2 As the number of patients with depicted lymphatic drainage of midline anorectal tumors grows, we will gain further insight on the sensitivity and specificity of the Springbok pattern by analyzing further our data and correlate primary lesion location, positive lymph node distribution, and patterns of local recurrence. …”