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Figure 2: Contrast-enhanced computed tomography of pelvis showing right
Figure 1: Clinical appearance of right inguinal nodes inguinal nodal mass (marked with arrow) infi ltrating femoral vein

Figure 3: Intra-operative picture of nodal mass infi ltrating femoral vein Figure 4: Reconstructed femoral vein with interposition graft from internal
(site of infi ltration marked with arrow) jugular vein

doing well in the last follow-up one year post-surgery.
All investigations and tumor markers repeated at the last
follow-up in December 2014 were normal.

Discussion
The inguinal area is a relatively uncommon metastatic
site of CUPS. There has been a wide variety of primary
[4]
sites from where inguinal nodal metastasis has been
reported. These include some sites, which are quite distant
from the pelvis (nasopharynx, breast, tracheobronchial
tree, salivary glands, orbit) but most originate in the
pelvis, genitalia or lower limb. [2,5,6] In one of the largest
series, involving more than 2,000 patients with inguinal
nodal metastasis, the primary site could not be identifi ed
in 22 (1%), even after a signifi cant period of follow-up.
[2]
Figure 5: Histopathology picture from lymph node showing squamous cell
carcinoma with areas of transitional cell carcinoma. (×40) In the present case, even after extensive attempts to fi nd
the primary site, the site could not be determined. The
and urine analysis were also done, both of which were fi nal histopathology of this patient showed a mixed
normal. Adjuvant radiotherapy to the bilateral inguinal, picture of squamous and transitional cell carcinoma, with
pelvic, and para-aortic regions with a dose of 55 Gy/25 the former predominating. A literature search revealed no
fractions over 5 weeks was given. The patient tolerated such report of two different histological types of tumors,
the radiotherapy with minimal complications and was squamous and transitional, in the same patient at the

102 Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 2 ¦ July 15, 2015 ¦