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Intro - Late Recurrence (3 years), Inguinal Lymph Nodes

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  • Intro - Late Recurrence (3 years), Inguinal Lymph Nodes

    Hey All!

    Unfortunately it looks like i'm in a really small section of the TC community. Wanted to post since I haven't seen many (any?) cases other than one research papers specifically on inguinal recurrence that also highlighted the rarity.

    Left I/O January 2016, stage 1B with some LV invasion. Mixed germ cell, 65% seminoma, yolk sac 20%, teratoma 10%, embryonal carcinoma 5%. No positive tumor markers, followup surveillance. No invasion of spermatic cord. My wife is an OB/GYN and good friends with the urologists in our town, so we've been generally pretty good with followup.

    All clear through last checkup in August 2018 until a couple weeks ago when it felt like the scar tissue under my I/O scar was different. Showed it to my wife who told me that there are lymph nodes there. Texted my urologist who got me in for a CT right away, which found:

    "... soft tissue lesion measuring 4.3x4.2cm,... surrounded by some satellite smaller lymph nodes including a left deep inguinal lymph node measuring 1.6x1.5cm... there is also a left external iliac chain lymph node measuring 2.6x2.1cm... that are almost certainly metastatic"

    Nothing in retroperitoneal or bones. One micronodule seen in lungs but that didn't seem to bother anyone.

    LDH levels are elevated (and rising) now, others aren't:
    8/18: 55
    5/16/19: 264
    5/24/19: 305

    Met with local urologist and oncologist. Initial plan was inguinal lymph node dissection + RPLND (suspecting teratoma due to the length of time), which resulted in a referral to the USC Norris Cancer Center where i'm seeing a fantastic urologist/oncologist. Due to the uniqueness of my situation (late recurrence, inguinal, LDH rising), we revised the plan to first biopsy prior to surgery. If seminoma, we'll go forward with BEPx3, if teratoma we'll go forward with inguinal dissection and likely chemo following. Inguinal (groin) lymph nodes are obviously non-standard place to spread, especially given that I had never previously had groin surgery or injury which can influence the lymphatic system.

    He's presenting to the Tumor Board this coming monday, and I've got an ultrasound-guided biopsy scheduled day after tomorrow. Will update as things progress but just wanted to say hey!

    Joe
    Last edited by captjoemcd; 05-30-19, 12:26 AM.
    January 2016, Left I/O stage 1B, some LV invasion. 65% seminoma, yolk sac 20%, teratoma 10%, embryonal carcinoma 5%
    2016-2019 Surveillance, all clear
    May 2019, Late Recurrence, Inguinal (not retroperitoneal) Lymph Nodes. Treatment TBD pending biopsy results

  • #2
    Well, LDH isn't a very good marker, apparently even a hard workout can cause an elevation, as I understand it, but enlarged inguinal nodes need to be checked out. Biopsey sounds like a plan to me, since it's impossible to know what you are dealing with otherwise. It would suck to do chemo & later find it was just teratoma ( which chemo does not attack). Please be aware that these nodes may have nothing to do with TC, but they should be looked into to be sure....
    Jan, 1975: Right I/O, followed by RPLND
    Dec, 2009: Left I/O, followed by 3xBEP

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    • #3
      Joe, good to hear from you. That doctor is amazing, if we are seeing the same one. however he is out of network and I can't see him solely. Saw 4 other doctors in LA who suggested chemo for a secondary primary and this guy said no. I was under the impression that the lymph nodes in the groin were the first place relapses generally occurred? I was wondering if they could be seen or noticed, but I guess in some cases they can.

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      • #4
        Thanks all for reading and the warm welcome

        @Dave - definitely on board with all your points.

        @TC-Hater - the retroperitoneal lymph nodes are the typical relapse spot, which are different from the inguinal. Inguinal lymph nodes are right at the crease where your leg and abdomen come together. Retroperitoneal are behind your intestines and closer to your spine than your belly button, so they generally can't be felt when enlarged. The reason TC spreads to the RP lymph nodes is because that's where the lymph from testes drain, carrying the TC cells. Inguinal lymph node spread is so rare because the lymph from the testes just doesn't go there (unless there's been a previous surgery or injury to the region, which I didn't have).

        Attached is the CT showing my primary enlarged lymph node, which you can clearly feel (and even see at this point). Sorry for the image quality, it's a picture of a computer screen.

        For anyone interested in the paper I referenced, here it is: https://onlinelibrary.wiley.com/doi/...X.2006.06017.x
        January 2016, Left I/O stage 1B, some LV invasion. 65% seminoma, yolk sac 20%, teratoma 10%, embryonal carcinoma 5%
        2016-2019 Surveillance, all clear
        May 2019, Late Recurrence, Inguinal (not retroperitoneal) Lymph Nodes. Treatment TBD pending biopsy results

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        • #5
          Quick update - got the path report (haven't seen doctor yet), which says its seminoma - I think good news although I was looking forward to surgery more than chemo. Almost positive I'll be in for 3xBEP, but at least i'll make it through it!
          January 2016, Left I/O stage 1B, some LV invasion. 65% seminoma, yolk sac 20%, teratoma 10%, embryonal carcinoma 5%
          2016-2019 Surveillance, all clear
          May 2019, Late Recurrence, Inguinal (not retroperitoneal) Lymph Nodes. Treatment TBD pending biopsy results

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