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Penile and urethral cancer
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Node: Nx: regional nodes cannot be assessedN0: no evidence of regional lymph node metastasesN1: metastasis in a single regional lymph nodeN2: metastases in multiple or bilateral superficial inguinal lymph nodesN3: Metastases in deep inguinal or pelvic lymph nodes, unilateral or bilateral.
Lymph Node
Published in Joseph Kovi, Hung Dinh Duong, Frozen Section In Surgical Pathology: An Atlas, 2019
Joseph Kovi, M.D. Hung Dinh Duong
A 56-year-old man was seen at the clinic with complaints of a non-tender mass in the right inguinal area of 3 weeks duration. On examination, the superficial inguinal lymph nodes on the right side were found considerably enlarged, but not painful. No systemic symptoms were noted. A biopsy was taken. The node measured 15 by 9 by 9 mm and was moderately firm. Microscopically, the basic architecture of the lymph node was intact. The subcapsular, the cortical, and the medullary sinuses were markedly distended by macrophages with abundant pale pink, often vacuolated cytoplasm, and tiny, round nuclei. Some of the macrophages contained brown, granular pigment. No other changes of significance were found (Figure 83).
Radical vulvar surgery
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Most carcinomas of the vulva affect the labia majora and minora. The second commonest site is the clitoris. All these skin areas have a lymphatic drainage which passes in a narrow ray through the groin into the superficial inguinal lymph nodes and then through the cribriform fascia into the femoral nodes, which are in close proximity to the femoral artery and vein immediately below the fossa ovale. While the superficial groin nodes are disparate and variable in their position, the femoral nodes are more constant, lying in close proximity to the vessels. The drainage from the femoral nodes then passes cranially through the inguinal ligament to enter the lymphatics of the external iliac system.
Dosimetric quantification of the incidental irradiation of the ‘true’ (deep) ano-inguinal lymphatic drainage of anal cancer patients not described in conventional contouring guidelines
Published in Acta Oncologica, 2018
Hendrik Dapper, Gregor Habl, Christoph Hirche, Stefan Münch, Markus Oechsner, Michael Mayinger, Christina Sauter, Stephanie E. Combs, Daniel Habermehl
The lymphatic drainage of the anal-canal and the anal-margin is complex and detailed anatomical descriptions are rare and inconsistent. The section above the linea dentata is characterized by perirectal, pelvic and paravertebral lymphatic drainage. Below the linea dentata, especially from the outer section of the anus, the lymphatic drainage follows the medial superficial inguinal lymph nodes [1]. New fluorescence-imaging methods have helped us to define the area of the ano-inguinal lymphatic drainage (AILD) in real-time and transcutaneously [2,3]. Large randomized controlled trials have confirmed a combined chemoradiation (CRT) protocol as a standard treatment for loco-regionally advanced squamous-cell anal cancer (AC) patients [4,5]. Standard contouring guidelines recommend an inclusion of the primary tumor with a 2.5 cm margin into the target volume (CTV). The RTOG Consensus Panel felt that elective coverage of the inguinal and external iliac regions should be routine for anal carcinoma. The recommended extent of the inguinal region (CTV) should be 2 cm caudal to the saphenous/femoral junction [6]. Lee and Lu [7] recommend an elective irradiation of uninvolved inguinal nodes (CTV low risk). Ultimately, up to now there are no recommendations of inclusion of the ano-inguinal drainage (AILD) into the clinical target volume (CTV) by any contouring guidelines.
Penile Sparing Techniques For Penile Cancer
Published in Postgraduate Medicine, 2020
Lymphatic drainage from the penis proceeds in a stepwise fashion from superficial inguinal lymph nodes that lie above the fascia lata, through the sapheno-femoral vein junction, and into the deep inguinal lymph nodes. Drainage continues toward the node of Cloquet and into the iliac nodes of the pelvis. Importantly, there is significant cross-over of the lymphatic drainage into the groin, thereby leading to essentially bilateral lymphatic drainage of the penis into the inguinal lymphatic areas [6].
Sentinel lymph node biopsy based on anatomical landmarks and locoregional mapping of inguinofemoral sentinel lymph nodes in women with vulval cancer: an operative technique
Published in Journal of Obstetrics and Gynaecology, 2023
Fong Lien Kwong, Miski Scerif, Jason KW Yap
Previously, Rob et al. (2007) described the anatomical location of SLNs within the groin. This study preceded the GROINSS-V study and aimed to identify an optimal technique for identifying groin SLNs. The study described three groups of superficial nodes: medial (above and medial to the femoral and saphenous veins), intermediate (in the vicinity of and lateral to saphenous and femoral veins), lateral (an outer third of the groin) and one group of deep nodes located along and medial to the femoral vein. Their results showed that approximately two-thirds of SLNs were located medial to the femoral lymph nodes whilst the rest drained to the superficial intermediate nodes. Our results differed from Rob et al whereby 85.2% of SLNs were identified in the deep femoral nodes (Cloquet’s node) in our cohort compared to 16.1%. Our hypothesis that Cloquet’s node corresponds to the inguinal SLN in the majority of patients is supported by the anatomical lymphatic drainage from the vulva. The superficial inguinal lymph nodes located above the cribriform fascia drain into the deep nodes. The uppermost deep node, ‘Cloquet’s node, is considered the nexus between the inguinofemoral and iliac nodes. Drainage from lateral structures proceeds to the superficial inguinal lymph nodes whilst drainage from the clitoris either converges towards the superficial inguinal lymph nodes or terminates directly into the deep inguinal or iliac nodes (Anon 1961, Sharma and Suneja 2013). It therefore follows that Cloquet’s node is of considerable clinical significance as a candidate for the SLN as it receives lymphatics directly from the clitoris as well as the superficial inguinal nodes which drain the rest of the vulva. Therefore, it was not surprising that most of the SLN found were part of the Cloquet’s nodal group. In contrast, the course of lymphatic drainage in cervical and uterine cancers is less consistent. The FIRES trial (Rossi et al.2017) demonstrated that while the majority of SLN were primarily located along the external iliac (38%), obturator (25%), inframesenteric para-aortic (14%) and common iliac vessels (8%), approximately 17% of SLNs were located outside the boundaries for routine pelvic lymphadenectomy (pre-sacral and internal iliac regions or parametrium). Ultimately, the location of the SLNs in women with vulval cancer is more predictable compared to other gynaecological cancers as 85% of SLNs are located over Cloquet’s area.