A 48-year-old man comes to the office due to right inguinal discomfort. The patient first noticed "bumps" in his groin when he was dressing in the morning. He does not know how long they have been present but thinks they are relatively new. The patient was treated for gonorrhea several years ago but has no other medical problems. He drinks alcohol occasionally but does not use tobacco or illicit drugs. His mother died of metastatic melanoma. Cardiopulmonary examination is normal. The abdomen is soft and nontender. The right inguinal lymph nodes are enlarged and tender, as are several nodes in the right popliteal area. The distribution of lymphadenopathy in this patient would most likely be seen in which of the following conditions?

Question

A 48-year-old man comes to the office due to right inguinal discomfort.  The patient first noticed "bumps" in his groin when he was dressing in the morning.  He does not know how long they have been present but thinks they are relatively new.  The patient was treated for gonorrhea several years ago but has no other medical problems.  He drinks alcohol occasionally but does not use tobacco or illicit drugs.  His mother died of metastatic melanoma.  Cardiopulmonary examination is normal.  The abdomen is soft and nontender.  The right inguinal lymph nodes are enlarged and tender, as are several nodes in the right popliteal area.  The distribution of lymphadenopathy in this patient would most likely be seen in which of the following conditions?

Quizplus · Accepted Answer

11ec160b_3592_147c_9249_e3b791be8e76_MD0001_00 The lymphatic system of the extremities is divided into the superficial lymphatic vessels, which follow the venous system, and the deep lymphatic vessels, which follow the arterial system. The superficial vessels receive lymph from the skin and subcutaneous tissues, whereas the deep vessels drain both the deep muscles and the superficial vessels. In the lower extremities, the superficial lymphatic system is divided into medial and lateral tracks. The medial track runs along the long saphenous vein up to the superficial inguinal lymph nodes, bypassing the popliteal nodes. Consequently, lesions on the medial foot cause inguinal lymphadenopathy (Choice C). In contrast, lateral lesions, which drain via the lateral track and communicate with the popliteal and inguinal nodes, are more likely to cause lymphadenopathy in both the popliteal and inguinal areas. (Choice A) Lymph from the prostate drains primarily into the internal iliac lymph nodes. (Choice B) Lymph from the scrotum is drained into the superficial inguinal lymph nodes, and lymphatic vessels from the testes mirror the testicular arteries and drain into the para-aortic lymph nodes. (Choice E) In addition to receiving drainage from the lower extremity, the superficial inguinal lymph nodes receive drainage from the scrotum (not testes), perineum, anterior abdominal wall (inferior to the umbilicus), buttocks, and skin of the penis. In contrast, the glans penis and penile urethra drain primarily via the deep lymphatic system into the deep inguinal nodes. The popliteal nodes would not be affected by a lesion on the glans. Educational objective: In the lower extremities, the superficial lymphatic system is divided into medial and lateral tracks. The medial track runs up to the superficial inguinal lymph nodes, bypassing the popliteal nodes. Consequently, lesions on the medial foot cause inguinal lymphadenopathy, whereas lateral lesions are more likely to cause lymphadenopathy in both the popliteal and inguinal areas. __________ References: Lymphoedema of the lower extremities-background, pathophysiology and diagnostic considerations. (http://www.ncbi.nlm.nih.gov/pubmed/20718809)

A 48-Year-Old Man Comes to the Office Due to Right