Lymphatic Drainage in Penile Cancers

The pattern of lymphatic spread in penile carcinomas depends on the location of the primary lesion.

• Skin of the penis and prepuce: Lymphatics drain primarily into the superficial inguinal lymph nodes (pink arrows).
• Glans penis: Lymphatics drain into the deep inguinal (blue arrows) and external iliac lymph nodes. May also drain into the superficial inguinal lymph nodes.
• Erectile tissue: Lymphatics drain into the internal iliac lymph nodes. Metastasis to pelvic lymph nodes is uncommon in the absence of inguinal lymphatic involvement.
• Penile urethra : Lymphatics drain into the internal iliac lymph nodes. Metastasis to pelvic lymph nodes is uncommon in the absence of inguinal lymphatic involvement.

The superficial inguinal lymph nodes (pink arrows) are found along the anterior and medial aspects of the saphenofemoral junction between the Scarpa fascia and the fascia lata. The deep inguinal lymph nodes (blue arrows) are medial and lateral to the femoral vein and deep to the fascia lata and receive afferent lymphatics from the superficial nodes.

Bilateral lymphadenopathy can be seen with a unilateral tumor because of communication between left and right lymphatic vessels.

References

• Paño B, Sebastià C, Buñesch L, Mestres J, Salvador R, Macías NG, Nicolau C. Pathways of lymphatic spread in male urogenital pelvic malignancies. Radiographics. 2011 Jan-Feb;31(1):135-60.
• Singh AK, Saokar A, Hahn PF, Harisinghani MG. Radiographics. 2005 Nov-Dec;25(6):1629-38. Imaging of penile neoplasms. Mehta A, Bansal SC. Diagnosis and Management of Cancer. Chapter 32: Cancer of the penis. In Diagnosis and Management of Cancer. Jaypee Brothers Publishers, 2004.