Inguinal metastases from testicular cancer

To evaluate the incidence of inguinal metastases in patients with testicular cancer and relapse after initial stage I disease.

Of 695 patients, 14 (2%) with stage I testicular cancer developed inguinal metastases during the follow-up on a surveillance programme. At orchidectomy, one patient had involvement of the tunica albuginea and one a history of cryptorchidism and development of testicular cancer on the contralateral side. The remaining patients had no history of previous surgery in the inguinal region or in the scrotal area, or any other known risk factors for developing inguinal-node metastases. Two patients had a seminoma (0.5%) and 12 (4%) a nonseminoma. The histopathological examination showed that the metastases were in lymph nodes in four patients, the remainder having a more diffuse involvement of the tissue in the inguinal region. At relapse, patients were treated by three or four cycles of bleomycin, etoposide and cisplatin, except those with low-stage seminomas (stage IIa and IIb), who were treated by radiation therapy.

All patients had a complete remission after treatment with chemotherapy or radiotherapy. No patients died or developed a recurrence during the median follow-up of 72 months.

Metastases to the inguinal region are found in approximately 2% of patients with testicular cancer; about a quarter have lymph-node metastases, the rest probably having metastases to the spermatic cord with direct invasion into the surrounding tissue. High ligation of the spermatic cord is therefore important. Chemotherapy for patients with nonseminoma and radiotherapy for patients with seminoma gives excellent results.