A 23-year-old man comes to the physician complaining of right-sided testicular swelling. He first noticed the swelling 1 week ago while getting ready for work. He denies any testicular pain or history of trauma. However, he has noticed a heavy, pressing sensation involving his scrotum and lower abdomen. Physical examination reveals asymmetric swelling of the right testis, and subsequent ultrasonography shows a solid testicular mass. If malignant, this patient's tumor is most likely to spread to which of the following lymph node groups?

Question

A 23-year-old man comes to the physician complaining of right-sided testicular swelling.  He first noticed the swelling 1 week ago while getting ready for work.  He denies any testicular pain or history of trauma.  However, he has noticed a heavy, pressing sensation involving his scrotum and lower abdomen.  Physical examination reveals asymmetric swelling of the right testis, and subsequent ultrasonography shows a solid testicular mass.  If malignant, this patient's tumor is most likely to spread to which of the following lymph node groups?

Quizplus · Accepted Answer

11ec160b_358f_0734_9249_d1503d9cd4a2_MD0001_00 In general, the lymph drainage from a particular organ follows the path of the arterial supply to that site. During fetal development, the testes originate within the retroperitoneum and establish their arterial supply from the abdominal aorta. The testes subsequently descend through the inguinal canals into the scrotum, taking with them their arterial, venous, and lymphatic supplies. Thus, lymph from the testes drains through lymph channels directly back to the para-aortic (retroperitoneal) lymph nodes. (Choice A) The superficial inguinal lymph nodes are located on the anterior thigh inferior to the inguinal ligament. These nodes drain nearly all cutaneous structures inferior to the umbilicus, including the external genitalia and the anus up to the pectinate line. (Choice B) The deep inguinal nodes reside under the fascia lata on the medial side of the femoral vein. They receive afferents from the superficial inguinal nodes and deep lymphatic trunks along the femoral vessels. The lymphatics from the glans penis and clitoris also drain directly to these nodes. (Choice C) The external iliac nodes drain the superficial and deep inguinal nodes and the deep lymphatics of the abdominal wall below the umbilicus. (Choice D) The common iliac nodes are located alongside the common iliac artery and drain the internal and external iliac nodes. (Choice E) The inferior mesenteric nodes drain the structures supplied with arterial blood by branches of the inferior mesenteric artery (eg, the left colic, sigmoid, and superior rectal arteries). Thus, these nodes drain the descending and sigmoid colon as well as the upper part of the rectum. Their efferents drain to pre-aortic nodes. Educational objective: Lymph from the testes drains through lymph channels directly back to the para-aortic lymph nodes. In contrast, lymph from the scrotum drains to the superficial inguinal lymph nodes.

A 23-Year-Old Man Comes to the Physician Complaining of Right-Sided