METASTATIC INGUINAL LYMPH NODES IN NON-SEMINOMATOUS GERM CELL TESTICULAR TUMOUR WITH PREVIOUS HISTORY OF ORCHIOPEXY

Abstract

The lymphatics from testicles accompany the testicular vessels, exit the testis and course along the inguinal ring along spermatic vein and drain into the retroperitoneal lymph nodes between the lower dorsal and lumbar vertebra around the aorta, IVC and renal hilum. In testicular tumours, metastatic retroperitoneal lymph nodes occur in pre and para-aortic, pre and paracaval and at renal hilum. The iliac and inguinal lymph node involvement occasionally occurs in a secondary retrograde fashion when there are bulky retroperitoneal lymph nodes. Inguinal lymph nodal  metastasis in testicular tumour is a rare occurrence and can occur due to altered lymphatic drainage following inguinal and or scrotal surgery. The testicular lymphatics are disrupted or damaged during orchiopexy, orchiectomy, hydrocele repair, varicocelectomy or hernia repair. These lymphatics seek new collateral vessels for drainage. These injured lymphatics from scrotal incisions re-anastomose with the testicular lymphatics providing a direct route of spread to the inguinal lymph nodes. We report a case of a 36- year old male patient, who presented with left testicular neoplastic mass with multiple metastatic left inguinal lymph nodes. There was previous history of left orchiopexy for undescended left testis in childhood.