Metastatic inguinal nodes from an unknown primary neoplasm. A review of 56 cases

Abstract

Fifty-six cases of this uncommon neoplastic manifestation are presented. These cases represent 0.065% of 86,589 new cases of malignant disease seen at The Princess Margaret Hospital from 1968 to 1982. There were 29 men and 27 women. The median age at presentation was 58 years. Three major groups were identified: inguinal disease, 24 cases; unilateral inguinal plus iliac disease, 16 cases; local plus systemic disease, 16 cases. Pathologic subtypes were anaplastic, 24; squamous, 11; adenocarcinoma, nine; melanoma, nine; and others, three. Survival at 5 years for all patients was 27%. Among 40 patients who presented with inguinal and inguinal plus iliac disease, survival was 37.5% at 5 years. Initial treatment following biopsy was radiation in 35, lymph node dissection in eight, and chemotherapy in four. Excisional biopsy only was performed in nine cases. There were no treatment-related deaths. The findings observed in this study, in which radiation therapy was employed as initial management in the majority of cases, suggests that radiation therapy is a valid alternative to surgery in the management of this disease.

Metastatic transitional cell carcinoma to the inguinal lymph nodes from an unknown primary: A case report

“…The inguinal area is a relatively uncommon metastatic site for CUP [7,8]. The inguinal nodes are affected by a wide variety of metastases, mainly from the pelvis, genitalia, or lower limb but also more distant sites such as the nasopharynx, breast, tracheobronchial tree, salivary glands, and orbit [2,7,8].…”

“…The inguinal nodes are affected by a wide variety of metastases, mainly from the pelvis, genitalia, or lower limb but also more distant sites such as the nasopharynx, breast, tracheobronchial tree, salivary glands, and orbit [2,7,8]. The diagnostic evaluation of patients with CUP should be directed by the histopathological findings and be multi-modal.…”

“…However, validation of the accuracy and clinical value of MTP has been difficult because the anatomic primary site in most patients is never identified [9]. Zaren et al examined over 2000 patients with metastases in the inguinal lymph nodes and reported that the primary site could not be identified in 22 (1%), whereas Guarischi et al examined 56 similar patients in whom the primary site could not be identified at all [4,8]. In our case, even after extensive attempts to find the primary site, the site of the primary tumor could not be determined.…”

Surgical Management of M etastatic groin lymphadenopathyRetrospective study of 50 Cases in Regional Cancer Center

“…General examination to exclude generalised lymphadenopathy or metastatic disease should be undertaken. It is relatively uncommon to have an unknown primary lesion manifest as a palpable metastatic inguinal node (5) . Detection of palpable lymphadenopathy in a patient with possible malignancy should trigger an urgent referral to an appropriate specialist.…”

Cancer of Unknown Primary: Changing Approaches. A Multidisciplinary Case Presentation from the Joan Karnell Cancer Center of Pennsylvania Hospital

“…Squamous cell carcinoma of unknown primary may occasionally present in the inguinal nodes [38]. In those cases, careful search for an anal, cutaneous, or gynecologic primary should be undertaken.…”