Inguinal Node Metastasis Research Articles

C77 Predictors for inguinal lymph node metastasis in patients with penile squamous cell carcinoma- our clinical experience

C77 Predictors for inguinal lymph node metastasis in patients with penile squamous cell carcinoma- our clinical experience

Enhanced Cancer Metastasis in Mice Deficient in Vasohibin-1 Gene

Vasohibin-1 (VASH1) is isolated as an endogenous angiogenesis inhibitor produced by the vascular endothelium. We previously reported that tumor growth and tumor angiogenesis were augmented in VASH1 (−/−) mice. Here we examined whether VASH1 plays any role in cancer metastasis. When Lewis lung carcinoma (LLC) cells were inoculated in the footpad to observe spontaneous metastasis, a significant increase in lung metastasis together with inguinal lymph node metastasis was evident in the VASH1 (−/−) mice. Histological analyses revealed that vessels of the footpad tumor in VASH1 (−/−) mice were more immature, having fewer mural cells. However, when LLC cells were injected into a tail vein, the extent of lung metastasis was unchanged between wild-type mice and VASH1 (−/−) mice. When VASH1 in endothelial cells in culture was knocked-down by siRNA, we observed a decrease in the content of ZO-1, a component of tight junctions, which decrease resulted in increased transmigration of cancer cells across the endothelial cell monolayer. These results indicate that endogenous VASH1 tightens the endothelial barrier and makes tumor vessels resistant to cancer metastasis.

Penoscrotal Extramammary Paget's Disease with Multiple Lymph Node Metastasis

Penoscrotal Extramammary Paget's Disease with Multiple Lymph Node Metastasis

C-reactive protein inhibits lymphangiogenesis and resultant lymph node metastasis of squamous cell carcinoma in mice

Lymph node involvement is the most important prognostic factor in many solid cancers. Recently, we found that patients with esophageal and lung cancer carrying the C-reactive protein (CRP) 1846T/T genotype, which is associated with lower serum CRP levels, are more likely to have lymph node metastasis. We hypothesized that host CRP directly inhibits lymph node metastasis. We inoculated NR-S1M metastatic cells subcutaneously into the backs of C3H/HeN mice. Concurrently, 1 μg of recombinant mouse CRP or phosphate-buffered saline was injected subcutaneously every 3 days for 5 weeks, after which the mice were killed for evaluation. We evaluated lymph node metastasis and lymphangiogenesis in the implanted tumor by using immunohistochemical analysis with anti-pancytokeratin and antilymphatic vessel endothelial hyaluronan receptor-1 antibodies. There was no substantial difference in tumor size between the 2 groups but the lymph nodes were smaller in the CRP group than the control group (P < .044). Immunohistochemical analysis confirmed inguinal lymph node metastasis in 70% (14/20) of control mice, but in only 30% (3/10) of mice in the CRP group. Moreover, the metastatic area within lymph nodes was less in the CRP group (P < .042) and tumoral lymphangiogenesis was decreased in the CRP group (P < .037). CRP appears to inhibit tumoral lymphangiogenesis and lymph node metastasis in mice. These findings suggest that by inhibiting lymph node metastasis, CPR may have therapeutic potential for use against cancer.

Surgical treatment for isolated inguinal lymph node metastasis in lower rectal adenocarcinoma patients improves outcome

No consensus has been formed on the optimal treatment strategy for the prognosis of patients with inguinal lymph node (ILN) metastasis from lower rectal adenocarcinoma. We, therefore, retrospectively analyzed outcomes of patients with ILN metastasis from lower rectal adenocarcinoma. Of 323 patients with lower rectal adenocarcinoma treated at a single institution between November 1993 and March 2010, 10 had synchronous or metachronous ILN metastasis, as confirmed by curative resection (R0) of the primary lesion. Outcomes of these 10 patients were assessed. The 10 patients with ILN metastasis were divided into two groups: group A (two patients who did not undergo ILN resection surgery because of metastases at other sites) and group B (eight patients with no other metastases who underwent surgery). Both patients in group A, with median overall survival of 5.2 months, died due to the other metastases, whereas five out of eight patients in group B survived (P = 0.001). Group B patients were further subclassified into synchronous (group B1) and metachronous (group B2) metastasis (n = 4 each) groups. Two patients in group B1 died of other metastases, which was diagnosed later, whereas three patients in group B2 survived. Some patients with isolated inguinal lymph node metastasis show a good prognosis after lymph node excision and, therefore, should be treated surgically. Patients with metachronous metastases have a better prognosis than patients with synchronous ILN metastases. Nevertheless, assessment of additional patients for prognosis and treatment strategy is warranted.

Testicular Seminoma: Early Cutaneous and Inguinal Node Metastases. Clinically isolated case in a subject over 75 Years.

A 75 year male patient presented with severe low back ache and unable to walk since two months. He had swellings in both the groin region and left scrotum for the last eight months, with history of loss of weight. He had undergone right sided herniorraphy for obstructed inguinal hernia one and half years back and was treated conservatively for blunt trauma to the left scrotum six months back. On examination the patient was pale. His blood pressure was 180/100 mm of Hg. He had bilateral enlarged inguinal nodes two on the right side and three on the left, each measuring 3x2 cm, hard, non tender. Skin over the swellings was free. Right inguino scrotal scar measuring 10x 2 cm, healed by primary intention was also seen. (Fig.1) Left testis was enlarged measuring 8 x3 cm, firm, and non-tender. There was no mass in the abdomen/organomegaly/ascites. He had grade-two prostatomegaly. Spine tenderness was elicited over the lumbosacral region. Straight leg raising test was positive. A 3x2 cm cutaneous non tender swelling was noted on the right forearm. (Fig.1 inset). Examination of the other systems was unremarkable. We made a diagnosis of left testicular tumor with bilateral inguinal lymph node metastases with secondaries in the lumbar spine and lipoma over the right. All the relevant laboratory investigations were within normal limits except for lactate de-hydrogenase which was markedly elevated (2165.00u/l).

Patterns of inguinal lymph node metastasis in patients with vulvar cancer

Patterns of inguinal lymph node metastasis in patients with vulvar cancer

Radiation therapy for lymph node metastasis from extramammary Paget's disease

Inoperable patients with lymph node metastasis from extramammary Paget's disease (EMPD) have limited curative treatment options. The aim of this study was to review the efficacy and toxicity of radiation therapy for lymph node metastasis from EMPD. Eight EMPD patients with pelvic and inguinal lymph node metastasis, representing a total of 43 metastatic lymph nodes, underwent radiation therapy. Of these eight patients, two received radiation therapy as an initial treatment for EMPD and six for recurrence only in the lymph nodes after they had undergone surgery. Total doses of 45-61.2Gy (median, 59.4Gy) were delivered to metastatic lymph nodes in 25-34 fractions (median, 33 fractions). Of the 43 metastatic lymph nodes in the eight patients, all but one had no progression at the median follow-up time of 22months. The 2-year local control rates were 86% in all patients and 98% in all metastatic lymph nodes, respectively. No therapy-related toxicities of grade 3 or greater were observed. Radiation therapy is effective and safe, and appears to offer a curative treatment option for lymph node metastasis from EMPD.

Prognostic value of the number and laterality of metastatic inguinal lymph nodes in vulvar cancer: Revisiting the FIGO staging system

Inguinal lymph node (LN) metastasis is an important prognostic factor in vulvar cancer. Our aims were to analyze the prognostic value of LN metastasis with regard to the number of LNs that were involved and their laterality and compare these results with the current FIGO staging system. A retrospective analysis was performed in a series of 234 individuals who underwent inguinal lymphadenectomy for vulvar squamous cell carcinoma from January 1980 to February 2010. The mean age was 68 years. One hundred seven (45.7%) patients had LN metastasis. Despite the FIGO staging, we did not observe any significant difference in the risk of recurrence or death between patients with 1 positive LN and ≥ 2 positive LNs. Moreover, there was no difference in outcome between the presence of 1 and 2 positive LNs. On categorizing patients into 3 groups-absence of LN involvement, 1-2 positive LNs, and ≥ 3 positive LNs-we achieved a significantly better prognostic correlation for progression-free survival, disease-specific survival, and overall survival. Extracapsular spread retained a prognostic role for the risk of recurrence in multivariate analysis. Further, for patients with ≥ 2 positive LNs, the presence of bilateral positive LNs did not negatively impact the risk of recurrence or death compared with those with unilateral positive LNs. Our data suggest that the prognostic effect of bilateral LNs reflects the worse prognosis of multiple positive LNs. Regarding prognosis, LN involvement should be categorized into 2 groups-1-2 positive LNs and ≥ 3 positive LNs.

Clinicopathological features and prognostic factors of breast cancer patients with inguinal lymph node metastases: a report of 17 cases

To analyze the clinicopathological features and prognostic factors of breast cancer patients with inguinal lymph node metastases. Seventeen breast cancer patients with inguinal lymph node metastases were treated from January 1999 to December 2010 in our cancer center. All of the patients had a history of breast cancer without other primary cancer. Their clinicopathological characteristics and prognostic factors were surveyed. The frequency of breast cancer cases with inguinal lymph node metastaseis consisted of 0.11% of the total number of breast cancer patients in the same period. Two patients (11.8%) had inguinal lymph node metastasis only, and multi-site metastases were observed in the remaining 15 (88.2%) patients. The number of ER- and/or PR-positive and negative were 10 (58.8%) and 7 (41.2%) cases, respectively, and among the 13 cases who underwent HER-2 test, the number of HER-2-positive was 4 (30.8%). For the 16 patients who underwent surgery, 9 patients were detected with metastatic axillary lymph nodes equal or greater than 4. All of the 17 patients were treated with chemotherapy.The median follow-up time was 156 months. The 5-year overall survival rate was 49.9%. Univariate analysis revealed that metastatic axillary lymph nodes ≥ 4, ER- and(or) PR-negative, adjuvant chemotherapy ≤ 6 cycles, disease stage as III/IV at diagnosis and the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis ≤ 36 months were predictors of shorter PFS (P < 0.05). Metastatic axillary lymph nodes ≥ 4, ER- and(or) PR-negative, adjuvant chemotherapy ≤ 6 cycles, primary recurrence as multiple distant metastases, the period from diagnosis of breast cancer to the occurrence of inguinal lymph nodes metastasis ≤ 36 months and pleural effusion were predictors of shorter OS (P < 0.05). Multivariate analysis revealed that the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis was an independent prognostic factor concerning PFS (P < 0.05). The prognostic factors of breast cancer patients with inguinal lymph node metastases include the number of metastatic axillary lymph nodes, ER and(or) PR status, the cycles of adjuvant chemotherapy, type of primary recurrence, the period from diagnosis of breast cancer to the occurrence of inguinal lymph node metastasis and pleural effusion. Regular and complete physical examination after surgery as well as prompt intensive treatment for high-risk patients may have positive significance in the treatment of such type of patients. However, a type of more reasonable and individualized treatment is warranted in future studies.

The risk factors for the presence of pelvic lymph node metastasis in penile squamous cell carcinoma patients with inguinal lymph node dissection

To evaluate factors in penile squamous cell carcinoma predictive of pelvic lymph node metastasis and survival. Data were collected and analyzed retrospectively in 146 patients with squamous cell carcinoma of penis who underwent bilateral inguinal lymph node dissection in our center between January 1998 and April 2011. Variables recorded included serum squamous cell carcinoma antigen, primary tumor p53 immunoreactivity, histological grade, pathological tumor stage, lymphatic or vascular invasion, absent/unilateral or bilateral inguinal lymph node involvement, number of metastatic inguinal lymph nodes, presence of extracapsular growth and lymph node density. Seventy patients had inguinal lymph node metastasis (LNM). Of these, 33 (47.1%) had pelvic LNM. Primary tumor strong p53 expression, lymphatic or vascular invasion, involvement of more than two inguinal lymph nodes and 30% or greater lymph node density were significant predictors of pelvic LNM. Primary tumor strong p53 expression (odds ratio [OR] 5.997, 95% confidence intervals [CI] 1.615-22.275), presence of extracapsular growth (OR 2.209, 95% CI 1.166-4.184), involvement of more than two inguinal lymph nodes (OR 2.494, 95% CI 1.086-5.728) and pelvic lymph node involvement (OR 18.206, 95% CI 6.807-48.696) were independent prognostic factors for overall survival. Primary tumor expression of p53, lymphatic or vascular invasion, number of metastatic inguinal lymph nodes and lymph node density were all predictors of pathologic pelvic lymph node involvement. Patients with pelvic LNM had an adverse prognosis, with a 3-year overall survival rate of approximately 12.1%. Pelvic lymph node dissection should be considered in these cases.

High-Grade serous carcinoma of the fallopian tube: two cases presenting as inguinal lymph node metastasis

Primary fallopian tube high-grade serous carcinoma (HGSCa) has historically been considered an uncommon neoplasm. Recent evidence, however, suggests that most extrauterine HGSCa arise within the fimbriae of the fallopian tube, via an intraepithelial precursor lesion known as serous tubal intraepithelial carcinoma (STIC), which is thought to metastasise to the ovary and pelvic peritoneum. HGSCa typically present with advanced disease and the prognosis is notoriously poor. Presentation of HGSCa as lymph node metastasis is distinctly unusual, even more so in the absence of detectable pelvic disease. We describe two cases of HGSCa of fallopian tube origin presenting as inguinal lymph node metastasis, both with clinically silent pelvic disease at presentation. Although an uncommon mode of presentation, these cases reinforce the need to maintain a high index of suspicion for HGSCa, even in the absence of gynaecological symptoms. Accurate diagnosis is achievable with careful morphological assessment teamed with an immunoperoxidase panel which includes Wilms’ tumour 1 (WT1) and may provide an opportunity for definitive surgery before bulky pelvic disease supervenes. This new model of tumourigenesis of HGSCa may have significant implications for the management of BRCA mutation carriers and potentially all women undergoing pelvic surgery.

Ovarian carcinoma in normal size ovaries with inguinal lymph node metastasis: a case report inhibitor-like mechanism

Introduction Ovarian cancer is the most frequent cause of death among the cases of gynaecological cancers [1,2]. It represents tumors of epithelial, germ cell or sex cord stromal origin. Approximately 90% of ovarian tumors are epithelial in origin and poses significant therapeutic challenges as symptoms are more pronounced only in advanced

人工肛門部に発生し左鼠径リンパ節転移を伴った異時性多発大腸癌の1例

人工肛門部に発生し左鼠径リンパ節転移を伴った異時性多発大腸癌の1例

Early Marjolin’s ulcer developing in a penile human bite scar of an adult patient presenting at Bugando Medical Centre, Tanzania: A Case Report

Marjolin’s ulcer is a rare but well documented cutaneous malignancy that arises in a scar or chronic ulcer, and is characterized by an aggressive course. The latent period from the injury to the appearance of cancer has been reported to be 25-40 years. Early occurring Marjolin’s ulcer has rarely been described in the literature and its development in a penile human bite scar is still rare. We report a rare case of a 33 year-old patient who presented with an early appearance of Marjolin’s ulcer developing in a penile human bite scar. On histological examination it was found to be poorly differentiated squamous cell carcinoma. He was managed by total penile amputation. Five months after surgery, the patient presented to our surgical outpatient clinic with inguinal lymph node metastases and distant metastases to the lung, liver and bones. However, the patient died shortly after admission. This report highlights the possibility of early appearance of Marjolin’s ulcer arising from a chronic ulcer or healed scar in an unusual sites such as the penis. It is therefore recommended that all chronic ulcers should be thoroughly investigated at presentation, to avoid labelling malignancies ‘chronic ulcers’, leading to delay in appropriate treatment. Early recognition and aggressive treatment of Marjolin's ulcers and close follow-up are urgently needed to improve outcomes in our environment.

Curatively resected isolated inguinal lymph node metastasis from cecum cancer: report of a case

We herein report the case of a curatively resected solitary inguinal lymph node metastasis from cecum cancer. Our patient was a 67-year-old male with cecum cancer with abdominal wall invasion. Three years after surgery, inguinal lymph node swelling was detected by a computed tomography examination. Further examination revealed no other metastases. Surgical resection was performed to remove the lesion, and microscopic examination revealed that cancer cells had metastasized. No recurrence was detected 3 years after the salvage surgery. Inguinal lymph node metastasis of cecum cancer has not been reported in the literature, but in our case salvage surgery resulted in a good outcome.

Is CDX2 immunostaining useful for delineating anorectal from penile/vulvar squamous cancer in the setting of squamous cell carcinoma with clinically unknown primary site presenting with histologically confirmed inguinal lymph node metastasis?

AimsPenile, vulvar and anal squamous cell carcinomas (SCCs) share histomorphological overlap and are prone to lymphatic dissemination into inguinal nodes. Anal SCCs might derive from the anorectal zone (ARZ), anal...

Diagnosis of Inguinal Lymph Node Metastases Using Contrast Enhanced High Resolution MR Lymphangiography

Inguinal lymph nodes can be the first or the only clinical signs of tumor metastases. The aim of the study was to evaluate the role of contrast-enhanced high-resolution magnetic resonance (MR) lymphangiography in diagnosis of inguinal lymph node metastases. The study enrolled 26 patients with inguinal lymph node metastases. Contrast-enhanced lymphangiography was performed using a 3.0T MR unit after intracutaneous injection of gadobenate dimeglumine into the interdigital webs of the dorsal foot. Images of inguinal lymph nodes were acquired before and after contrast injection. All patients exhibited edema in the subcutaneous layer with significant dilatation of lymphatic collectors in the affected lower limbs on MR images. Before contrast injection, the outline and structure of the affected nodes were unclear on T2 weighted images. Structural changes became evident on postinjection T1-weighted images. Nodal involvement on contrast enhanced MR lymphangiograms was characterized as: 1) heterogeneous structure with partial or marginal enhancement of the node indicating partial occupation by tumor; 2) homogeneous structure of the node without contrast enhancement, indicating total occupation with metastasis, with increase or no change in size; and 3) heterogeneous structure with punctiform nodal enhancement indicating diffuse growth of tumor within the node. Further examinations confirmed the diagnoses of inguinal lymph node metastases of either regional or distal tumors. Contrast-enhanced high-resolution MR lymphangiography was a sensitive modality in the diagnosis of malignant peripheral lymphedema and the identification of inguinal lymph node metastasis in patients with various tumor origins.

Extraskeletal osteosarcoma with synchronous regional lymph node and soft tissue metastasis: a rare presentation of an uncommon tumour

Extraskeletal osteosarcoma is a rare soft tissue neoplasm arising from mesenchymal elements with characteristic production of osteoid. These tumours are known to have high rate of distant metastasis and dismal prognosis. We present a rare case of extraskeletal osteosarcoma arising in medial aspect of knee joint with synchronous inguinal node and soft tissue metastasis. The patient was initially diagnosed as myositis ossificans at an outside institute and excised without prior imaging or biopsy. The patient presented to our hospital with recurrent lesion along with palpable inguinal lymph nodes and soft tissue metastasis in thigh. The patient underwent neoadjuvant chemotherapy and wide excision of the primary lesion, soft tissue metastasis and complete groin node dissection. We also discuss the importance of PET scan and intra-operative ultrasonography in the management of these lesions.

Prognostic Indicators in 35 Patients with Extramammary Paget's Disease

Extramammary Paget's disease (EMPD) is an uncommon skin tumor that usually occurs in the genital area. Few studies on EMPD have been conducted. To evaluate the clinical and pathologic features, treatments, recurrence, survival rates, and prognostic factors of EMPD. A total of 35 (27 men and 8 women) patients with EMPD was analyzed. The average age of the patients was 73.4years. Twenty nine Of the 35 patients had lesions in the genital area, one in the genital and perianal area, three in the axillary area and two in the perianal area. Eighteen patients had in situ lesions, five had inguinal lymph node metastases and two had distant metastases at the time of diagnosis. Surgical resection was performed in 30 cases and radiation therapy, was administered in three cases. Six patients died of EMPD, and the overall 5year survival rate was 75%. The presence of a nodule on the primary lesion, clinically palpable lymph nodes, the level of tumor invasion, and lymph node metastases were found to be significant prognostic factors in the 35 EMPD cases at our institution.