Clinical Images
Inguinal Lymph Node Enlargement
Author: Morolake Amole, MD
A 64-year-old male automobile mechanic with no significant past medical history presented to the emergency department for evaluation of rapidly growing bilateral groin masses. The patient stated that he first noticed the masses 4 weeks ago. He reported rapid growth bilaterally with the left mass being larger than the right. Review of systems was otherwise negative. Physical exam was positive only for inguinal node enlargement bilaterally.
CT Abdomen/Pelvis revealed massively enlarged left and right inguinal lymph nodes (Figure 1). The left inguinal lymph node was largest and was centrally hypodense with peripheral enhancement.
Chest X-Ray was performed and revealed numerous nodules scattered throughout both lung fields. CT chest followed and revealed similar findings (Figure 2).
Incisional biopsy of the left inguinal lymph node was performed and sent for cytology with immunohistochemical staining. Results showed tumor cells that were positive for MART1 and S-100. The patient was treated appropriately and scheduled for further management as an outpatient.
MCQ #1: What is the most likely diagnosis?
- Lymphoma
- Metastatic Melanoma
- Colon cancer with metastasis to the lungs
- Incarcerated inguinal hernia
- Lung cancer with metastasis to the inguinal lymph nodes
MCQ #2: What is the recommended treatment for the above condition?
- Radiation
- Chemotherapy
- Surgery
- Immunotherapy
- Surgery and Radiation
Click for MCQ Answer and Discussion
Brief Bio: Morolake Amole is a PGY-2 Internal Medicine resident at the University of South Florida. Her interests include Primary Care, Endocrinology and Health policy. She is specifically interested in complex medical diagnoses in the primary care setting and how health policy affects health outcomes.