An Aggressive Tumoral Metastasis to Groin Arising from Perianal Squamous Cell Carcinoma: Management of a Unique Case
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CASE REPORT
An Aggressive Tumoral Metastasis to Groin Arising from Perianal Squamous Cell Carcinoma: Management of a Unique Case Dicle Aksoyler 1
&
Fatih Dogan 1 & Arda Aybars Pala 2 & Mahmut Aslan 3
Received: 22 September 2019 / Accepted: 27 March 2020 # Indian Association of Surgical Oncology 2020
Keywords Femoral artery invasion . Musculocutaneous flap . Metastasis . Tumor . Wound
Introduction
Case Report
Recurrences after radical surgery and adjuvant radiotherapy in the groin region can be challenging and demanding for both the surgeons and patients. Improvements in imaging procedures in the recent years have enabled tumors to be easily diagnosed during the early stages. Conversely, due to the lack of facilities or the low socioeconomic status of the patient population, tumors are being diagnosed in late stages with poor surgical outcomes, particularly in developing or underdeveloped countries. We present a rare case with the aim of illustrating accomplished surgical resection followed by vascular reconstruction of recurrent squamous cell carcinoma in the groin region involving the femoral artery. To our knowledge, this is the only case in the literature to report such an invasion due to inadequate lymph node dissection after primary anal squamous cell carcinoma.
A 55-year-old man presenting a giant ulcer in the groin region was referred to our clinic. The patient had been operated on for squamous cell carcinoma in the anal region because of a chronic pilonidal fistula formation and progression 2 years ago. After the reconstruction of the defect using skin graft, the patient was treated with adjuvant radiotherapy. After 1 year, metastatic lymph nodes were noticed in the right inguinal region during regular controls. Consequently, inguinal lymph node dissection was also performed by his primary surgeon, and the patient was referred to the oncologist to receive the required chemoradiotherapy. However, the patient did not follow the adjuvant therapy protocols, and he suffered from progressive ulcers for 6 months, after which he visited our clinic with a giant fistulized ulcer measuring 5 × 4 cm extending into the scrotum and inguinal area (Fig. 1). Distant metastases were excluded by positron emission tomography. Computed tomography of the pelvis and abdomen revealed increased soft tissue density in the right groin involving the adventitia of the right femoral artery. Following consultations with cardiothoracic surgeons, general surgeons, and urologists, the patient was operated. The mass was extirpated with 2-cm borders along with a 6-cm segment of the femoral artery; furthermore, the remaining ilio-iliac lymph nodes, the right testicle, and the inguinal cord were also added to the specimen (Fig. 2). After obtaining frozen samples from different borders, the 6-cm common femoral artery defect was first reconstructed using the GorePropaten(®) vascular graft. Then, a polypropylene mesh was used for preventing any incisional or inguinal hernia in the donor area and the inguinal region (Fig. 3). The defect me
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