DYNAMIC LYMPHOSCINTIGRAPHY FOR STAGING SCROTAL CARCINOMA

Abstract

A 45-year-old white man presented with a painful, enlarging mass on the scrotum. He had noticed the mass 12 months earlier and that it had progressively enlarged during a 5-month period. He was febrile and had a 5.5 3 4.0 cm. lesion on the left hemiscrotum that had rolled edges, an indurated base and purulent discharge (fig. 1). Shoddy groin adenopathy was noted bilaterally. The patient underwent emergency incisional biopsy and drainage. Pathological examination revealed poorly differentiated squamous carcinoma. Bone scan and computerized tomography of the chest, abdomen and pelvis were negative for metastases. The patient returned from the hospital 17 days later for excision of the mass and staging studies by dynamic sentinel node sampling. Lymphoscintigraphy was performed preoperatively, using technetium sulfur colloid as the tracer via 4 intradermal injections around the primary lesion. Progressive visualization of the ipsilateral and contralateral inguinal nodal chains was noted during a 30-minute period. Isosulfan blue was injected later that day, as described by Horenblas et al and, using the Geiger counter intraoperatively, inguinal nodes were positive on the left side only (fig. 2). Minilaparotomy and bilateral pelvic lymph node dissection were performed. The final nodal pathological examination revealed no carcinoma. The primary cancer was excised with 3 cm. margins and a rotational flap was used for reconstruction of the scrotum. Drains were left in place for 24 hours and the incision healed well. At 9-month followup the patient had no evidence of disease.