open access

Vol 81, No 4 (2022)
Original article
Submitted: 2021-05-29
Accepted: 2021-09-14
Published online: 2021-09-28
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Superficial lymphatic drainage of the vulva and its relation to the regional nodes: an experimental study

D. Pavlista1, O. Eliska2
·
Pubmed: 34590298
·
Folia Morphol 2022;81(4):917-922.
Affiliations
  1. Gynaecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
  2. Institute of Anatomy, First Faculty of Medicine, Charles University in Prague, Czech Republic

open access

Vol 81, No 4 (2022)
ORIGINAL ARTICLES
Submitted: 2021-05-29
Accepted: 2021-09-14
Published online: 2021-09-28

Abstract

Background: Sentinel node biopsy in vulvar cancer is associated with much less morbidity than inguinofemoral node dissection. Our study focused on describing the morphology of superficial lymphatic drainage of the vulva and its relationship to regional nodes, which may facilitate orientation during surgery.
Materials and methods: In 24 female cadavers, injections of patent blue (at various localisations medially, unilaterally and bilaterally) were used to visualise the lymphatic drainage of the vulva. After dissection of lymphatic vessels and nodes, their course was documented by photograph and then analysed. Subsequently, a map of vulvar superficial lymphatics was created.
Results: The cutaneous and subcutaneous tissue of the vulva primarily drained to superficial inguinal nodes. There was no evidence of a solitary lymph node that drained the unilateral vulva. Each area of the vulva drained to its own lymph node, which was variably localised in the subcutaneous groin around the great saphenous vein. Anastomoses between individual inguinal superficial lymph nodes are likely. Right-left symmetry in the course of lymphatic collectors was not detected. Natural drainage of the medial and paramedial areas to contralateral inguinal nodes was also not detected. The drainage pattern to ipsilateral inguinal nodes was consistent in cadavers without evidence of vulvar disease and may be applicable in the early stages of vulvar cancer.
Conclusions: There was no evidence of a solitary node that drained the unilateral vulva. Each part of the vulva may drain to a corresponding lymph node in a different localisation of the groin. The surgeon should take this variability into account.

Abstract

Background: Sentinel node biopsy in vulvar cancer is associated with much less morbidity than inguinofemoral node dissection. Our study focused on describing the morphology of superficial lymphatic drainage of the vulva and its relationship to regional nodes, which may facilitate orientation during surgery.
Materials and methods: In 24 female cadavers, injections of patent blue (at various localisations medially, unilaterally and bilaterally) were used to visualise the lymphatic drainage of the vulva. After dissection of lymphatic vessels and nodes, their course was documented by photograph and then analysed. Subsequently, a map of vulvar superficial lymphatics was created.
Results: The cutaneous and subcutaneous tissue of the vulva primarily drained to superficial inguinal nodes. There was no evidence of a solitary lymph node that drained the unilateral vulva. Each area of the vulva drained to its own lymph node, which was variably localised in the subcutaneous groin around the great saphenous vein. Anastomoses between individual inguinal superficial lymph nodes are likely. Right-left symmetry in the course of lymphatic collectors was not detected. Natural drainage of the medial and paramedial areas to contralateral inguinal nodes was also not detected. The drainage pattern to ipsilateral inguinal nodes was consistent in cadavers without evidence of vulvar disease and may be applicable in the early stages of vulvar cancer.
Conclusions: There was no evidence of a solitary node that drained the unilateral vulva. Each part of the vulva may drain to a corresponding lymph node in a different localisation of the groin. The surgeon should take this variability into account.

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Keywords

vulva, cancer, sentinel node, lymphatic mapping, anatomy

About this article
Title

Superficial lymphatic drainage of the vulva and its relation to the regional nodes: an experimental study

Journal

Folia Morphologica

Issue

Vol 81, No 4 (2022)

Article type

Original article

Pages

917-922

Published online

2021-09-28

Page views

4099

Article views/downloads

2821

DOI

10.5603/FM.a2021.0096

Pubmed

34590298

Bibliographic record

Folia Morphol 2022;81(4):917-922.

Keywords

vulva
cancer
sentinel node
lymphatic mapping
anatomy

Authors

D. Pavlista
O. Eliska

References (25)
  1. Adib T, Barton DPJ. The sentinel lymph node: relevance in gynaecological cancers. Eur J Surg Oncol. 2006; 32(8): 866–874.
  2. Ansink AC, Sie-Go DM, van der Velden J, et al. Identification of sentinel lymph nodes in vulvar carcinoma patients with the aid of a patent blue V injection: a multicenter study. Cancer. 1999; 86(4): 652–656, doi: 10.1002/(sici)1097-0142(19990815)86:4<652::aid-cncr14>3.0.co;2-r.
  3. Bartels P. Das Lymfgefasssystem. In Handbuch der Anatomie des Menschen. K. von Bardeleben (ed.). 3 Band. Semper Bonis Artibus, Jena 1909.
  4. Bruhns C. Ueber die Lymphgefäse der weiblichen Genitalien, nebst einigen Bemerkungen über die Topographie der Leistendrüsen. Arch f Anat U Phys Anat Abt. 1898: 57–80.
  5. Eliska O, Eliskova M. Morphology of lymphatics in human venous crural ulcers with lipodermatosclerosis. Lymphology. 2001; 34(3): 111–123.
  6. Fons G, ter Rahe B, Sloof G, et al. Failure in the detection of the sentinel lymph node with a combined technique of radioactive tracer and blue dye in a patient with cancer of the vulva and a single positive lymph node. Gynecol Oncol. 2004; 92(3): 981–984.
  7. Gerota D. Zur Technik der Lymphgefassinjektion – Eine neue Injektionsmasse fuer Lymphgefasse-Polychrome Injektion. Anat Anz. 1896; 12: 216–224.
  8. Gordinier ME, Malpica A, Burke TW, et al. Groin recurrence in patients with vulvar cancer with negative nodes on superficial inguinal lymphadenectomy. Gynecol Oncol. 2003; 90(3): 625–628.
  9. Hassanzade M, Attaran M, Treglia G, et al. Lymphatic mapping and sentinel node biopsy in squamous cell carcinoma of the vulva: systematic review and meta-analysis of the literature. Gynecol Oncol. 2013; 130(1): 237–245.
  10. Judson PL, Habermann EB, Baxter NN, et al. Trends in the incidence of invasive and in situ vulvar carcinoma. Obstet Gynecol. 2006; 107(5): 1018–1022.
  11. Kubik S, Manestar M. Topographic relationship of the ventromedial lymphatic bundle and the superficial inguinal nodes to the subcutaneous veins. Clin Anat. 1995; 8(1): 25–28.
  12. Levenback C, Burke TW, Morris M, et al. Potential applications of intraoperative lymphatic mapping in vulvar cancer. Gynecol Oncol. 1995; 59(2): 216–220.
  13. Levenback C, Coleman RL, Burke TW, et al. Intraoperative lymphatic mapping and sentinel node identification with blue dye in patients with vulvar cancer. Gynecol Oncol. 2001; 83(2): 276–281.
  14. Levenback CF, Ali S, Coleman RL, et al. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study. J Clin Oncol. 2012; 30(31): 3786–3791.
  15. Oonk MHM, Planchamp F, Baldwin P, et al. European Society of Gynaecological Oncology Guidelines for the Management of Patients With Vulvar Cancer. Int J Gynecol Cancer. 2017; 27(4): 832–837.
  16. Parry-Jones E. Lymphatics of the vulva. J Obstet Gynaecol Br Common. 1963; 70(5): 751–765.
  17. Poirer P, Cuneo B. Etude speciale des lymphatiques des differentes parties du corps. In: Charpy A. Traite d´anatomie humaine Tom II, Les lymphatiques, . Masson et Cie Ed, Paris 1909.
  18. Puig-Tintoré LM, Ordi J, Vidal-Sicart S, et al. Further data on the usefulness of sentinel lymph node identification and ultrastaging in vulvar squamous cell carcinoma. Gynecol Oncol. 2003; 88(1): 29–34.
  19. Xu Q, Moore Jr JE. Ex vivo perfusion of human lymph nodes. J Pathol. 2020; 251: 225–227.
  20. Ramirez PT, Levenback C. Sentinel nodes in gynecologic malignancies. Curr Opin Oncol. 2001; 13(5): 403–407.
  21. Reiffenstuhl G. Das Lymphsystem des weiblichen Genitale. Urban & Schwarzenberg, Munchen Berlin Wien 1957.
  22. Rob L, Robova H, Pluta M, et al. Further data on sentinel lymph node mapping in vulvar cancer by blue dye and radiocolloid Tc99. Int J Gynecol Cancer. 2007; 17(1): 147–153.
  23. Rouviere H. Anatomie des lymphatiques de l´homme. Masson, Paris 1932.
  24. Sappey PhC. Traite de, anatomie descriptive Tome II Myologie Angiologie. Adrien Delaheaye et Cie Libraire Editeurs, Paris 1876.
  25. Suami H, Shinaoka A. The methodology of lymphatic anatomy studies in a cadaver model: an overview. Plast Aesthet Res. 2019; 6(33).

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