Inguinal Node Swelling Research Articles

Known monster, unknown “avatars”: Pediatric rhabdomyosarcoma case series with uncommon presentation

Rhabdomyosarcoma (RMS) is a rare soft-tissue tumor, accounting for 3% of all childhood cancers. RMS can arise virtually anywhere in the body, as it originates from the embryonal mesenchyme. Embryonal RMS (ERMS) and alveolar RMS are the most prevalent types. In this case series, five children with unusual sites of presentation of ERMS have been reported. The first case is a 6-year-old male who presented with episodes of recurrent hemoptysis for 2 months and computed tomography chest showed lung mass. The second case is a 3-year-old male, who presented with right abdominal distention and was diagnosed as a liver ERMS which is a very rare site for RMS. The third case is a 1-year-old male child who presented with isolated right inguinal lymph node swelling. The fourth case presented with recurrent admissions for respiratory distress requiring intubation and was misdiagnosed as recurrent viral infection, but on further, investigation was diagnosed as a laryngeal ERMS. Our fifth case is a 6-year-old male child who presented with infraumbilical mass, diagnosed as a retroperitoneal ERMS. The 5-year survival rate of such tumors is 70% in children with localized disease who receive combined-modality therapy. Therefore, an awareness of the typical signs and symptoms, radiological features, and histomorphological features in a case of pediatric RMS can help a physician to consider this tumors in the differential diagnoses, even at unusual sites.

Swelling of inguinal lymph nodes in a patient with HIV: a case report

Swelling of inguinal lymph nodes in a patient with HIV: a case report

Anal canal adenocarcinoma with neuroendocrine features accompanying secondary extramammary Paget disease, successfully treated with modified FOLFOX6: a case report

BackgroundAnal canal cancer occasionally accompanies extramammary Paget disease. Although most of them are squamous cell carcinoma, anal canal adenocarcinoma with neuroendocrine features accompanying secondary extramammary Paget disease has never been reported.Case presentationHere, we report a 76-year-old man presented with pruritus in the perianal area. Investigation revealed a fist-sized perianal erythema, diffuse liver tumors, and right inguinal lymph node swelling. Pathological examination of biopsies from the erythema suggested secondary extramammary Paget disease with positive cytokeratin-7 and -20 expressions and negative GCDFP-15 expression. The anal canal tumor was confirmed by digital examination and endoscopy. Biopsies from the anal canal tumor, swollen lymph node, and Paget lesion all showed poorly differentiated adenocarcinoma with neuroendocrine features expressing synaptophysin and chromogranin A. Serum CEA and NSE levels were high, 809.4 ng/ml and 85.8 ng/ml, respectively. After chemotherapy with modified FOLFOX6 for 2 months, the Paget lesion disappeared, and the primary anal canal tumor and liver metastases shrunk remarkably. Serum CEA and NSE levels decreased promptly to within normal ranges.ConclusionsThis is a clinically significant case, as it reveals novel pathological features about anal canal cancer with secondary Paget disease and successfully treated with modified FOLFOX6. Careful pathological investigation and appropriate treatment choice are needed for this rare cancer.

A case of neurosarcoidosis with recurrent brainstem infarction, obstructive hydrocephalus and brainstem atrophy

We report the case of a 42-year-old female with neurosarcoidosis who was hospitalized in year 2017 for gait disturbance. In 2011, she suddenly had vertigo that lasted for a few days. In 2013, she noticed left hemiplegia. A brain MRI revealed an acute infarction on the right side of the upper pons extending longitudinally from the ventral surface. In 2017, she again had left lower limb paralysis. A Brain MRI showed another infarction on the right side of the mid-pons. Hydrocephalus and brainstem atrophy were also noted. The patient was referred to our hospital. Upon neurological examination, she presented with down beat nystagmus, muscle weakness on the left side, and a broad-based spastic gait. CSF findings included an increased number of cells and protein levels with decreased glucose levels. A contrast-enhanced MRI revealed basilar meningitis causing hydrocephalus. A contrast CT scan revealed inguinal lymph node swelling, and scintigram found gallium accumulation. We diagnosed sarcoidosis via a lymph node biopsy. We speculate that chronic basilar meningitis obstructed the patient's branching penetrating arteries inducing infarction together with obstruction of the spinal fluid flow causing hydrocephalus and cerebral atrophy.

A leukemic double-hit follicular lymphoma associated with a complex variant translocation, t(8;14;18)(q24;q32;q21), involving BCL2, MYC, and IGH

Double-hit lymphoma (DHL) is defined as lymphoma with concurrent BCL2 and MYC translocations. While the most common histological subtype of DHL is diffuse large B-cell lymphoma, the present patient had leukemic follicular lymphoma (FL). A 52-year-old man was admitted to our hospital due to general fatigue and cervical and inguinal lymph node swelling. The patient was leukemic and the pathological diagnosis of the inguinal lymph node was FL grade 1. Chromosomal analysis revealed a complex karyotype including a rare three-way translocation t(8;14;18)(q24;q32;q21) involving the BCL2, MYC, and IGH genes. Based on a combination of fluorescence in situ hybridization (FISH), using BCL2, MYC and IGH, and spectral karyotyping (SKY), the karyotype was interpreted as being the result of a multistep mechanism in which the precursor B-cell gained t(14;18) in the bone marrow and acquired a translocation between der(14)t(14;18) and chromosome 8 in the germinal center, resulting in t(8;14;18). The pathological diagnosis was consistently FL, not only at presentation but even after a second relapse. The patient responded well to standard chemotherapies but relapsed after a short remission. This patient is a unique case of leukemic DH-FL with t(8;14;18) that remained in FL even at a second relapse.

Ascending colon cancer with synchronous external iliac and inguinal lymph node metastases but without regional lymph node metastasis: a case report and brief literature review

Lymph node metastasis to the iliac or inguinal region of colon cancer is extremely rare. We experienced a case of ascending colon cancer with synchronous isolated right external iliac and inguinal lymph node metastases but without any regional lymph node metastasis. An 83-year-old woman was admitted to our hospital due to anemia. Colonoscopy and computed tomography revealed an ascending colon cancer and also right external iliac and inguinal lymph node swelling. Further examination by F-deoxyglucose positron emission tomography strongly suggested that these lymph nodes were metastatic. Right hemicolectomy with lymph node dissection along the superior mesenteric artery, and right external iliac and inguinal lymph node dissection were performed. Histological examination revealed that both lymph nodes were metastasized from colon cancer, and there was no evidence of regional lymph node metastasis. The patient has shown no sign of recurrence at 27 months after surgery.

Primary cutaneous nocardiosis in children

Introduction: Reports of paediatric cases of primary cutaneous nocardiosis are rare in Japan. We report the case of a 5-year-old immunocompetent boy with primary cutaneous nocardiosis. Case presentation: One week after injuring his left knee, the boy presented with fever, pain in the left hip joint and gait disturbance. Oral administration of cephalosporin proved ineffective, and he was not able to stand due to pain in the inguinal region. On admission, swelling of the left inguinal lymph nodes and abscess with microsatellite pustules in the left knee were found. Gram-positive bacilli with branching filaments grew in the culture from the drained pustule. They were partially acid fast on Ziehl–Neelsen staining. His symptoms improved after initiating treatment with sulbactam/cefoperazon and sulfamethoxazole/trimethoprim (TMP-SMX). Nocardia brasiliensis was identified from 16S rRNA gene sequencing. TMP-SMX was administered for 5 weeks, and no relapses have occurred as of the 1-year follow-up. Conclusion: N. brasiliensis lives in soil and is the major cause of primary lymphocutaneous nocardiosis. A cutaneous abscess with surrounding microsatellite lesions and lymphadenopathy suggest the possibility of cutaneous nocardiosis. Because growth of Nocardia spp. is very slow, adequate incubation time is necessary.

著明な出血を来した転移性胃腫瘍の1例

A 79-year-old man was aware of the swelling of the groin was admitted to our hospital in April 2014. Systemic computed tomography showed a lung tumor and inguinal lymph node swelling. The lung tumor was diagnosed with adenocarcinoma. He was transported to our hospital in May because he fell from the stairs. The laboratory tests revealed anemia and a large open of BUN/Cre ratio. Therefore he was suspected gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed two submucosal tumors with central ulceration in gastoric corpus. They were diagnosed with metastatic gastric tumors. He was performed a blood transfusion and then discharged. But nine days after he died in hemorrhagic shock. We report a case of metastatic gastric tumor that became a clinical problem.

Adenocarcinoma arising from sacrococcygeal mature teratoma in an adult female: report of a case.

We report a case of adenocarcinoma arising from a sacrococcygeal mature teratoma in an adult female. A 62-year-old female was diagnosed with a presacral tumor 10 years ago. Pelvic computed tomography (CT) demonstrated a presacral heterogeneous tumor, containing multiloculated cystic area and enhanced solid component with calcification. Percutaneous needle biopsy for the solid component of the tumor identified an adenocarcinoma and the patient was diagnosed as having a sacrococcygeal teratoma with malignant transformation. Abdomino-sacral rectal resection with sacral amputation at the upper edge of the S5 was performed. The pathological diagnosis was adenocarcinoma derived from a mature teratoma. The tumor cells had infiltrated the rectal wall. After 7 months, a follow-up CT demonstrated swelling of the right inguinal lymph nodes and a right inguinal lymphadenectomy was performed. Pathological examination showed metastatic lymph nodes. The patient is doing well 21 months after the second surgery, with no signs of recurrence.

Inappetenz, Nachtschweiß, chronisches Ekzem und inguinale sowie axilläre Lymphknotenpakete bei einem 28-jährigen Patienten

A 28-year-old man presented with loss of appetite, night sweats, eczema, and axillary and inguinal lymph node swelling. The tentative diagnosis of malignant lymphoma was made. To confirm the diagnosis, extirpation of a lymph node and a skin biopsy were performed. Systemic treatment with methylprednisolone resulted in an improvement of eczema and lymph node swelling. Because of the histological findings and clinical course, we diagnosed dermatopathic lymphadenopathy, also known as Pautrier-Woringer syndrome.

Spindle cell sarcoma of the epididymis

A rare case of epididymal spindle cell sarcoma in a 68-year-old man is described. The patient was admitted to our hospital with a painless, left intrascrotal mass that had been present for 3 months. Computed tomography revealed a left paratesticular tumor and inguinal lymph node swelling. With a diagnosis of a paratesticular malignant tumor, left high inguinal orchiectomy and lymphadenectomy were performed. Histopathological and immunohistochemical examinations revealed spindle cell sarcoma with a positive surgical margin of the lymph node. The patient was treated with 54 Gy of external beam radiation therapy to the scrotum and the inguinal lymph node. Since the patient’s general condition was poor after recurrence, systemic chemotherapy could not be performed. The patient died 10 months after initial diagnosis.

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.

448 Exuberant Bilateral Inguinal Lymphadenopathies: Less Typical Manifestation of Cat Scratch Disease

IntroductionCat scratch disease(CSD) is caused by Bartonella henselae(BH). Regional lymphadenopathy, located to the neck and/or axilla, is the hallmark of CSD.Case DescriptionA 17-year-old girl presented with a painful right inguinal...

Lymphogranuloma venereum complicated by squamous cell carcinoma: a case report

A 53-year-old man was admitted to the hospital for verrucous hyperplasia on the circular sulcus for 2 years as well as erythematous painful swelling, ulcer and rupture of inguinal lymph nodes for more than 2 months. Physical examination revealed erythematous, indurated and painful swelling of bilateral inguinal lymph nodes. Fluctuation could be felt at the centre of the right swollen inguinal lymph nodes, where several pores were seen with yellowish-white purulent fluid flowing out, giving the appearance of a watering can. Multiple swollen or ulcerative lymph nodes were separated by the inguinal ligament forming the groove sign.There were irregular, indurated, verrucous, proliferative and keratinized lesions sized 1 cm × 2 cm on both sides of the circular sulcus. The right scrotum was obviously swelling. Erythematous, fluctuating swelling, ulcer and rupture of the glans fraenum were also observed with yellowish-white purulent exudates. Neither the secretion from the skin lesions on the surface of bilateral inguinal lymph nodes nor the puncture sample from the right groin was positive for multiple fungal or bacterial culture, acid-fast stain or first culture of C. trachomatis.However, the endogenous plasmid of Chlamydia was successfully amplified by PCR from these samples, and restriction fragment length polymorphism (RFLP) analysis of the major outer membrane protein (MOMP) suggested that the genotype of the Chlamydia strain was L3. Western blot revealed the presence of anti-MOMP antibodies and anti-Pmp H antibodies (titer: ＞ 1: 800) in serum. Culture of C. trachomatis also gave positive results after multiple passage. Biopsy of the verrucous hyperplasia on the right groin is consistent with well-differentiated squamous cell carcinoma of the skin. A diagnosis of lymphogranuloma venereum complicated by cutaneous squamous cell carcinoma was made. Key words: Lymphogranuloma venereum; Carcinoma, squamous cell; Chlamydia trachomatis

Angioimmunoblastic T-cell lymphoma with dual genotype of TCR and IgH genes

A 70-year-old man complained of fever and sore throat accompanied by hoarseness of voice. On physical examination, there was no systemic abnormality but a mild lymphadenopathy of cervical lymph nodes. With laryngoscopy, there was a marked outgrowth of the bilateral palatine tonsils proximal to the vocal cord. The histology of the resected tumor was compatible with angioimmunoblastic T cell lymphoma (AITL), revealing the effacement of normal tonsillar architecture and small to medium-sized neoplastic cell proliferation around marked vascular proliferation and atrophic lymphoid follicles. Tumor cells were positive for conventional T-cell antigens as well as for the follicular helper T-cell marker, PD-1, and CXCL13. Large hodgkinoid cells, but no tumor cells, were positive for latent membrane protein-1 and Epstein–Barr virus-encoded small RNA (EBER)-1 ( in situ hybridization). Non-neoplastic, double positive cells for EBER-1 and CD20 were also scattered. Southern blot analysis revealed dual TCR-Cβ1 and IGH-JH gene rearrangements. Although the swelling of bilateral inguinal and perigastric lymph nodes developed later, the radical resection of tumor and chemotherapy appeared to be effective for the treatment of AITL with clinical stage IIIa. We here report a rare case of AITL involving palatine tonsil as primary site and give a review of the literature.

Hämaturie, Lymphknotenschwellung und Splenomegalie

A 22-year-old patient attended the urological office with unclear bladder symptoms, haemorrhoids and haematuria. Splenomegaly was detected by ultrasound together with the suspicion of a bladder cyst. Computed tomography revealed mesenteric, retroperitoneal and inguinal lymph node swelling. The laboratory diagnostics produced the diagnosis of syphilis. The patient was successfully treated with ceftriaxone and benzylpenicillin benzathine.

Plasmablastic lymphoma of the retroperitoneum in an HIV‐negative patient

Herein is reported a case of plasmablastic lymphoma (PBL) of the retroperitoneum in an HIV-negative patient. This is the first reported case of PBL at this location and of PBL from Japan in the English-language literature. A 76-year-old Japanese man was admitted to hospital with a chief complaint of right inguinal lymph node swelling. Lymph node biopsy indicated large tumor cells with both diffuse and cohesive growth patterns, and conspicuous tumor cell proliferation in lymph node sinuses. The initial pathological diagnosis was metastatic carcinoma. The patient died approximately 1 month after admission, and autopsy showed that the main lesion was a very large retroperitoneal mass. On histology diffusely proliferated plasmablast-like or immunoblast-like tumor cells were identified, which were positive on immunohistochemistry for CD138 and negative for B-cell and epithelial markers. Approximately 90% of the tumor cells were positive for Ki-67. Tumor cells were diffusely positive for EBV-encoded small RNA on in situ hybridization. The autopsy findings suggested a diagnosis of PBL. Accordingly, PBL should be considered as a differential diagnosis when lymph node biopsy findings resemble those of the present patient.

CNS lymphomatoid granulomatosis with lymph node and bone marrow involvements

Lymphomatoid granulomatosis (LYG) in the CNS is an uncommon lymphoproliferative disease with characteristic angiocentric lymphoreticular proliferative and granulomatous lesions exhibiting low-grade malignant potential. Here we report a rare case of CNS-LYG, which disseminated to the lymph node and bone marrow. A 50-year-old man was diagnosed with CNS-LYG based on brain biopsy showing perivascular infiltration of CD3-positive small T-lymphocytes without overt nuclear atypism. Eight months after the initial neurological symptoms, inguinal lymph node swelling was found and histopathologically diagnosed as peripheral T-cell lymphoma. TCRgamma-gene rearrangement study using both paraffin-embedded specimens of brain and inguinal lymph node demonstrated an identical clonal band. Considering the clinical course, we concluded lymph node involvement of CNS-LYG, suggesting the malignant potential of CNS-LYG.

Significance of sentinel node biopsy in the management of squamous cell carcinoma arising from recessive dystrophic epidermolysis bullosa

The most life-threatening complication developing in patients with recessive dystrophic epidermolysis bullosa (RDEB) is squamous cell carcinoma (SCC). To improve patient prognosis, early detection of regional lymph node metastasis is required. Herein, we report a patient diagnosed with non-Hallopeau-Siemens RDEB who developed SCC on the left foot with inguinal lymph node swelling. Use of the sentinel node biopsy (SNB) technique favorably minimized defective damage to the inguinal region in this case. Genetic analysis identified one novel COL7A1 mutation, a maternal c.238G > C (p.A80P) and one previously reported mutation, a paternal c.3631C > T (p.Q1211X). A published work review demonstrated that no COL7A1 mutations specific for SCC development in RDEB have previously been identified. It remains unclear if SNB in combination with gene diagnosis is beneficial for the management of SCC in RDEB patients, however, because of the limited number of case reports. To address this issue, COL7A1 mutational analysis should be performed in as many cases of RDEB as possible.

Primary Malignant Melanoma of the Female Urethra

A case of primary urethral malignant melanoma of a 69-year-old Japanese woman is presented. A hemorrhagic tumor measuring 1 cm in diameter was diagnosed by the stamp method. Clinically, the primary lesion was a T4 tumor infiltrating to the bladder neck, vagina, and vulva. Computed tomography did not detect any inguinal lymph node swelling or metastases to other sites. We selected radical extirpation, including cystectomy, ureterostomy, and bilateral inguinal and pelvic lymph node dissection. Although she subsequently underwent immunochemotherapy, consisting of dacarbazine, nimustine, vincristine, and beta-interferon, she died of the cancer 14 months postoperatively.