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Inguinal lymph node -- metastasis?

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  • Inguinal lymph node -- metastasis?

    So, I have this lymph node in the left inguinal region -- right on the line between the leg and groin area. It's hard and I can feel it from the outside. I can barely at all feel the corresponding node on the right. It is also a bit tender when I feel it up. I was concerned, so I asked my onc. about it and he sent me to get an ultrasound of it. (US report below). Now, he is giving me the option between going for a biopsy (fine needle aspiration) or just re-do imaging in a couple weeks and see if anything changes. The node looked suspicious only because of a lack of fatty hilum. Any suggestions or advice? Also, I hear it's pretty rare for a metastasis to go to an inguinal node. Am I just getting scared over nothing? I guess the biopsy doesn't sound scary, just the prospect of cancer.


    US report:

    Exam: US PELVIS LIMITED

    History:
    Malignant neoplasm of descended left testis

    Comparison: CT abdomen/pelvis 1/24/2017

    Findings:
    Sonographic evaluation of the left groin was performed with representative
    images for evaluation. Multiple lymph nodes are demonstrated. 2 of these nodes
    demonstrate a lobulated contour of the cortex. This is a nonspecific finding.
    These nodes demonstrate normal fatty hila. The graft there is a rounded node
    with loss of the normal fatty hilum that measures up to 1.0 cm in maximal
    diameter and 0.8 x 0.6 cm in transverse diameter.

    Impression:
    The palpable findings in the left groin represent lymph nodes. At least one of
    these is indeterminate with a rounded morphology, but only measuring 1 cm in
    diameter.
    11/16/16 Went to primary care complaining of testicular pain. Wrongly diagnosed with epididymitis. Told not to worry, it'll go away on its own.
    12/8/16 Diagnosed with TC in left testicle.
    12/9/16 Left I/O.
    1/5/17 Tumor Markers officially back to normal -- Stage 1A with 70% EC.
    1/26/17 Robotic RPLND using left MSKCC template as primary treatment.
    2/2/17 Pathology results: pN0. No current evidence of cancer. They say I still have a 10% relapse chance.

  • #2
    Fine needle aspiration sounds tricky. I'm no doctor but when the needle punctures the area where the suspected cancer is wouldn't that cause some kind of leakage thus, a spread of cancerous cells. Did they give you any more insight on that procedure?

    Comment


    • #3
      Fine needle aspiration sounds tricky. I'm no doctor but when the needle punctures the area where the suspected cancer is wouldn't that cause some kind of leakage thus, a spread of cancerous cells. Did they give you any more insight on that procedure?

      Comment


      • #4
        Fine needle aspiration sounds tricky. I'm no doctor but when the needle punctures the area where the suspected cancer is wouldn't that cause some kind of leakage thus, a spread of cancerous cells. Did they give you any more insight on that procedure?

        Comment


        • #5
          You need to go ahead with the needle biopsy & find out what's going on. Based on some quick searching, you have two factors, the loss of fatty hilum, & the roundness (apparently lymph nodes should be quite oval, 2x as long as wide).I don't believe there is any problem with needle aspiration on lymph nodes, even if it is C, it would tend to spread through the lymph system.
          I had a needle biopsy on my lung 14 years ago, I didn't even feel it, so don't worry about that. If it *is* cancer, you need to find out sooner rather than later, if it is not (more likely, considering the location ), you;ll be able to set your mind at ease. Just go do it.

          Dave
          Jan, 1975: Right I/O, followed by RPLND
          Dec, 2009: Left I/O, followed by 3xBEP

          Comment


          • #6
            2 months after my IO in 2015 I had the same problem in my groin - right inguinal node. Hard and big. I have to say, that from May 2015 after my IO I lost my weight due to the "health" food (I did not eat meat, milk, cheese, etc. ...) so I lost 10kg - but in general I felt very good. But after loosing my weight I found the node (I was scared of any change on my body because of the cancer). I had ultrasound and they said itīs OK and during the next CT scans which I had, this node was always described as OK. Now, I canīt find it with palpable check.
            04/24/2015 – pain in the right testicle – USG confirmed mass, blood results B-HCG = 12, AFP = 6.14, LDH = 9
            05/05/2015 – I/O (100% Embryonal carcinoma, LVI presented)
            05/06/2015 – post-operative CT scan negative
            6/2015 - surveillance (my decision)
            7/2015, 9/2015 - markers negative
            9/2015 - 2nd CT negative (re-check in 2/2016 found node 16x12mm!!)
            10/2015, 1/2016 - markers negative
            2/2016 - 3rd CT scan - 2 nodes (border) - 12x8mm, 13x9mm
            3/2016 - markers negative
            5/2016 - next check - markers
            6/2016 - CT scan...

            Comment


            • #7
              I have an inguinal node that has felt like that my entire life. I wouldn't get too worked up about it.
              6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
              6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
              7/7/15: bHCG 56, AFP 42, LDH 322
              7/13/15 - 9/18/15: 4xEP
              10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
              10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
              4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
              4/20/16: RPLND @ IU - teratoma only!
              1/9/17 all clears up to this date!

              Comment


              • #8
                Hey all,

                Update: I did the fine needle biopsy. It was really difficult and painful. The doctor doing the needle-work said that my lymph node was "hard" which made it difficult for him to get into it to get a good sample, so he had to prick me many times. Very unpleasant. Now, the results came back without anything definitive, but some cells were "atypical". My oncologist says there are 2 reasonable choices here: keep an eye on it and see if it grows (it's still at 1cm) or surgically remove the node. He said that since the node is still small, they would have a hard time doing a core biopsy, so it's one of those two.

                To me, the main question is whether a surgery to remove the node, if it is cancerous, would be curative. I know that lymph node metastases are not common, so there's probably not much data out there on this. If it's not curative anyway, then what's the point of doing the surgery? I could just wait and if it grows or spreads, then do 3xBEP. If it doesn't, then it probably wasn't cancerous anyway. On the other hand, if the surgery could beat it if it is cancer, then I'd love to get the beast out and do another surgery instead of doing 3xBEP. Any knowledge/advice on this? Or how much it means that the FNA was inconclusive. How atypical is it to have "atypical" cells?
                11/16/16 Went to primary care complaining of testicular pain. Wrongly diagnosed with epididymitis. Told not to worry, it'll go away on its own.
                12/8/16 Diagnosed with TC in left testicle.
                12/9/16 Left I/O.
                1/5/17 Tumor Markers officially back to normal -- Stage 1A with 70% EC.
                1/26/17 Robotic RPLND using left MSKCC template as primary treatment.
                2/2/17 Pathology results: pN0. No current evidence of cancer. They say I still have a 10% relapse chance.

                Comment


                • #9
                  Given that your signature shows that an RPLND found no evidence of disease, I think it is quite unlikely that your inguinal node has TC. The RP lymph nodes are typically the first landing spot, so if those are clean there is a very good chance (90% as you indicate in your signature) that TC never exited your testicle. I am no doctor or oncologist though :-)
                  6/5/15: bHCG 27,AFP 8.66, LDH 361, 5.6cm lymph node - Stage IIC
                  6/16/15: Left I/O 85% EC, 10% chorio, 5% yolk sac opinion 2 (mayo) 90% EC, 10% yolk sac
                  7/7/15: bHCG 56, AFP 42, LDH 322
                  7/13/15 - 9/18/15: 4xEP
                  10/1/15: bloodwork normal, ct scan shows 2 lymph nodes 1.0cm
                  10/26/15: 2nd opinion on CT results - lymph nodes normal. Surveillance!
                  4/6/16: 1.7cm X 1.5cm lymph node found with markers normal.
                  4/20/16: RPLND @ IU - teratoma only!
                  1/9/17 all clears up to this date!

                  Comment


                  • #10
                    I really do not know. Seems like too many grey areas here for my comfort. Atypical cells means they really don't know what they are, but just not normal. Currant thinking is that a robotic RPLND might miss things (vs open) so those results are not reassuring to me.It seems intuitive that removing suspected nodes would be a good idea, even if not curative. I don't think that is a major surgery like the RPLND, probably more like the I/O. If it were me, I'd take them out & hope to find out what is or is not going on. JMHO.

                    Dave
                    Jan, 1975: Right I/O, followed by RPLND
                    Dec, 2009: Left I/O, followed by 3xBEP

                    Comment

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