Pathology and FollowUp

The sentinel node and the second-tier nodes were step-sectioned and examined with H&E and immunohistochemistry staining (HMB-45, S-100). The sentinel node was found to contain metastatic disease both on H&E and immunohisto-chemistry staining. The second-tier nodes were free of disease.

A superficial groin dissection was performed 4 weeks later. Frozen-section microscopy of Cloquet's lymph node showed no tumor cells. The remainder of the deep compartment was therefore left undisturbed.

Six lymph nodes were recovered from the specimen and examined with H&E and immunohistochemistry staining. No tumor cells were found.

The patient underwent follow-up evaluation at 3-month intervals and was fine initially. At a follow-up visit 1 year later, history and physical examination were uneventful. The right groin was normal. Blood tests were normal with the exception of the tumor marker S-100: 0.31 |J.g/L (normal value, <0.16 |J.g/L).

Figure 18 The positron emission tomography study shows increased ,8F-fluoro-2-deoxyglucose accumulation in an obturator lymph node.

Repeat physical examination was unremarkable again. Chest radiography and liver ultrasound were normal. A positron emission tomography study with the glucose analog 18F-fluoro-2-deoxyglucose was obtained and showed a single hot spot adjacent to the bladder (Fig. 18). Ultrasound confirmed the presence of an enlarged obturator lymph node. An iliac and obturator node dissection was conducted. The 3-cm obturator node was fixed to the surrounding tissues. This node was removed but without margins. Pathological examination revealed the obturator node to be largely replaced by tumor. The disease reached beyond the capsule and the margin was indeed involved. The other 17 nodes were free of disease. Radiotherapy was given to the right groin. Thirteen months later, the patient was clinically disease-free, and the tumor marker level had returned to the normal range.

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