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Rare Occurrence of Giant Metastatic Inguinal Lymph Nodes in Carcinoma Bladder
Accepted Manuscript Title: Rare Occurrence of Giant Metastatic Inguinal Lymph Nodes in Carcinoma Bladder Author: Ruchir Aeron, Manoj Kumar, Sunny Goel, Ashok Kumar Sokhal PII: DOI: Reference:
S0090-4295(17)30510-1 http://dx.doi.org/doi: 10.1016/j.urology.2017.05.017 URL 20459
To appear in:
Urology
Received date: Accepted date:
18-4-2017 10-5-2017
Please cite this article as: Ruchir Aeron, Manoj Kumar, Sunny Goel, Ashok Kumar Sokhal, Rare Occurrence of Giant Metastatic Inguinal Lymph Nodes in Carcinoma Bladder, Urology (2017), http://dx.doi.org/doi: 10.1016/j.urology.2017.05.017. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1 Type of Article: Images In Clinical Urology Title: Rare occurrence of giant metastatic inguinal lymph nodes in carcinoma bladder. Running Head: Giant Inguinal Metastasis in Bladder Carcinoma All Authors: 1. Dr. Ruchir Aeron - King George’s Medical University, Lucknow [email protected] 2. Dr. Manoj Kumar - King George’s Medical University, Lucknow [email protected] 3. Dr. Sunny Goel - King George’s Medical University, Lucknow [email protected] 4. Dr. Ashok Kumar Sokhal - King George’s Medical University, Lucknow [email protected] Corresponding Author – Dr. Ruchir Aeron Department of Urology, King George’s Medical University, Lucknow, Uttar Pradesh, India, 226003 Email- [email protected] Phone no: +917023947777
Word counts: Abstract (Non-structured): 61 Manuscript Body : 200 (excluding references) Number of references: 3 Number of figures: 2 Informed Consent: Written informed consent was obtained from the patient.
Page 1 of 4
2 Conflict of interests: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study has received no financial support. Acknowledgments: I acknowledge the cooperation of residents of Urology department of King George’s medical university who participated in data collection and evaluation of the patient. We also appreciate the commitment and compliance of the patient who reported the required data.
Authors Contribution: Author Name 1. Dr. Ruchir Aeron -
Contribution Concept, design, supervision, processing, writing manuscript and critical analysis.
2. Dr. Manoj Kumar -
Concept, design, supervision, processing, writing manuscript and critical analysis.
3. Dr. Sunny Goel -
Supervision, processing, writing manuscript and critical analysis.
4. Dr. Ashok Kumar Sokhal - Concept, supervision, writing manuscript and critical analysis.
Abstract Inguinal lymph node metastasis of a bladder cancer is a rare scenario. Till date, only four cases of inguinal lymph node metastasis from bladder cancer have been reported in the literature. We report a rare giant inguinal lymph node metastasis of transitional cell carcinoma(TCC) of bladder in a patient after radical cystoprostatectomy. Chemotherapy and radiotherapy were given, but showed no remission. Key words: inguinal lymph node; transitional cell carcinoma; hematuria; radical cystoprosatectomy
Page 2 of 4
3
A 52-year-old ex-smoker, male presented with painless, gross hematuria. CECT abdomen showed heterogeneous mass(3x2cm) at the right anterolateral bladder wall with no regional lymphadenopathy and distant metastasis. Transurethral resection(TUR) reported high-grade muscle invasive TCC. After 1-month, the patient underwent radical cystoprostatectomy with an ileal conduit. Histopathology revealed urothelial carcinoma(pT2) with free surgical margins and no lymph node metastasis. The patient was lost to follow-up. After 2 years, he presented with right inguinal swelling(Figure 1). CECT pelvis showed bilateral inguinal mass (right–15.8x14.1cm, left–4x4.8cm) with infiltration into underlying muscles and the right femoral
vessels(Figure
2).
FNAC
revealed
metastatic
transitional
carcinoma.
Chemoradiotherapy(4 cycles of Gemcitabine-cisplatin regimen and 60 Gy of irradiation) was administered with no beneficial results.
Carcinoma bladder metastasizes commonly to the internal iliac and obturator lymph nodes.1 However, the involvement of inguinal lymph nodes is a rare entity, with only four cases reported till date.2 Occasionally, vesical perforation during TUR may lead to inguinal node metastasis.3 In our case, as there was no visible perforation during TUR and no nodal involvement on histopathology, inguinal node involvement might have occurred due to micrometastasis
from the primary site. Thus, the patients should be counselled and motivated to adhere to recommended follow-up schedule.
References 1. Smith JA, Jr, Withmoreb WF., Jr Regional lymph node metastases from bladder cancer. J Urol. 1981;126:591–3.
Page 3 of 4
4
2. Ozbek E, Otunctemur A, Dursun M, Somay A. Transitional cell carcinoma with glandular differentiation metastatic to the inguinal lymph node from the urinary bladder. Indian J Urol. 2014;30(1):102-4. 3. Ohguchi N, Sakaida N, Okamura A, Kawakita S, Kawamura H, Matsuda T. Extravesical tumor implantation caused by perforation during transurethral resection of a bladder tumor. Int J Urol. 1997;4:516–8.
Fig 1 (A-B): Large right inguinal mass in a patient of post radical cystectomy with an ileal conduit with urostomy bag in situ. Fig 2: Contrast-enhanced CT of pelvis showing bilateral heterogeneously enhancing inguinal lesions. Right sided inguinal mass is having necrotic changes with infiltration into overlying skin, underlying muscles and femoral vessels (yellow arrow) with adjacent fat stranding.
Page 4 of 4
S0090-4295(17)30510-1 http://dx.doi.org/doi: 10.1016/j.urology.2017.05.017 URL 20459
To appear in:
Urology
Received date: Accepted date:
18-4-2017 10-5-2017
Please cite this article as: Ruchir Aeron, Manoj Kumar, Sunny Goel, Ashok Kumar Sokhal, Rare Occurrence of Giant Metastatic Inguinal Lymph Nodes in Carcinoma Bladder, Urology (2017), http://dx.doi.org/doi: 10.1016/j.urology.2017.05.017. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
1 Type of Article: Images In Clinical Urology Title: Rare occurrence of giant metastatic inguinal lymph nodes in carcinoma bladder. Running Head: Giant Inguinal Metastasis in Bladder Carcinoma All Authors: 1. Dr. Ruchir Aeron - King George’s Medical University, Lucknow [email protected] 2. Dr. Manoj Kumar - King George’s Medical University, Lucknow [email protected] 3. Dr. Sunny Goel - King George’s Medical University, Lucknow [email protected] 4. Dr. Ashok Kumar Sokhal - King George’s Medical University, Lucknow [email protected] Corresponding Author – Dr. Ruchir Aeron Department of Urology, King George’s Medical University, Lucknow, Uttar Pradesh, India, 226003 Email- [email protected] Phone no: +917023947777
Word counts: Abstract (Non-structured): 61 Manuscript Body : 200 (excluding references) Number of references: 3 Number of figures: 2 Informed Consent: Written informed consent was obtained from the patient.
Page 1 of 4
2 Conflict of interests: No conflict of interest was declared by the authors. Financial Disclosure: The authors declared that this study has received no financial support. Acknowledgments: I acknowledge the cooperation of residents of Urology department of King George’s medical university who participated in data collection and evaluation of the patient. We also appreciate the commitment and compliance of the patient who reported the required data.
Authors Contribution: Author Name 1. Dr. Ruchir Aeron -
Contribution Concept, design, supervision, processing, writing manuscript and critical analysis.
2. Dr. Manoj Kumar -
Concept, design, supervision, processing, writing manuscript and critical analysis.
3. Dr. Sunny Goel -
Supervision, processing, writing manuscript and critical analysis.
4. Dr. Ashok Kumar Sokhal - Concept, supervision, writing manuscript and critical analysis.
Abstract Inguinal lymph node metastasis of a bladder cancer is a rare scenario. Till date, only four cases of inguinal lymph node metastasis from bladder cancer have been reported in the literature. We report a rare giant inguinal lymph node metastasis of transitional cell carcinoma(TCC) of bladder in a patient after radical cystoprostatectomy. Chemotherapy and radiotherapy were given, but showed no remission. Key words: inguinal lymph node; transitional cell carcinoma; hematuria; radical cystoprosatectomy
Page 2 of 4
3
A 52-year-old ex-smoker, male presented with painless, gross hematuria. CECT abdomen showed heterogeneous mass(3x2cm) at the right anterolateral bladder wall with no regional lymphadenopathy and distant metastasis. Transurethral resection(TUR) reported high-grade muscle invasive TCC. After 1-month, the patient underwent radical cystoprostatectomy with an ileal conduit. Histopathology revealed urothelial carcinoma(pT2) with free surgical margins and no lymph node metastasis. The patient was lost to follow-up. After 2 years, he presented with right inguinal swelling(Figure 1). CECT pelvis showed bilateral inguinal mass (right–15.8x14.1cm, left–4x4.8cm) with infiltration into underlying muscles and the right femoral
vessels(Figure
2).
FNAC
revealed
metastatic
transitional
carcinoma.
Chemoradiotherapy(4 cycles of Gemcitabine-cisplatin regimen and 60 Gy of irradiation) was administered with no beneficial results.
Carcinoma bladder metastasizes commonly to the internal iliac and obturator lymph nodes.1 However, the involvement of inguinal lymph nodes is a rare entity, with only four cases reported till date.2 Occasionally, vesical perforation during TUR may lead to inguinal node metastasis.3 In our case, as there was no visible perforation during TUR and no nodal involvement on histopathology, inguinal node involvement might have occurred due to micrometastasis
from the primary site. Thus, the patients should be counselled and motivated to adhere to recommended follow-up schedule.
References 1. Smith JA, Jr, Withmoreb WF., Jr Regional lymph node metastases from bladder cancer. J Urol. 1981;126:591–3.
Page 3 of 4
4
2. Ozbek E, Otunctemur A, Dursun M, Somay A. Transitional cell carcinoma with glandular differentiation metastatic to the inguinal lymph node from the urinary bladder. Indian J Urol. 2014;30(1):102-4. 3. Ohguchi N, Sakaida N, Okamura A, Kawakita S, Kawamura H, Matsuda T. Extravesical tumor implantation caused by perforation during transurethral resection of a bladder tumor. Int J Urol. 1997;4:516–8.
Fig 1 (A-B): Large right inguinal mass in a patient of post radical cystectomy with an ileal conduit with urostomy bag in situ. Fig 2: Contrast-enhanced CT of pelvis showing bilateral heterogeneously enhancing inguinal lesions. Right sided inguinal mass is having necrotic changes with infiltration into overlying skin, underlying muscles and femoral vessels (yellow arrow) with adjacent fat stranding.
Page 4 of 4