Fact-checked by Grok 2 weeks ago

Inguinal lymph nodes

The inguinal lymph nodes are a group of lymph nodes located in the inguinal region of the lower abdomen and upper thigh, serving as key components of the lymphatic system by filtering lymph fluid from the lower extremities, perineum, and external genitalia to trap pathogens, cancer cells, and other foreign substances.^[1] These nodes are divided into superficial and deep subgroups, with the superficial ones positioned below the inguinal ligament and the deep ones embedded within the femoral sheath, collectively numbering around 8 to 12 per side in adults.^[1] Their primary function involves immune surveillance through the action of lymphocytes and macrophages, which process lymphatic fluid passing through the node's cortex, paracortex, and medulla before it returns to the bloodstream via the thoracic duct.^[1] Structurally, each inguinal lymph node is a small, bean-shaped organ encased in a fibrous capsule, featuring an outer cortex rich in B-cell follicles for antibody production and an inner paracortex dominated by T-cells for cell-mediated immunity, while the medulla contains plasma cells and macrophages that facilitate lymph filtration.^[1] Embryologically, they develop from mesenchymal condensations around the 11th week of gestation, with T-cell regions appearing by week 13 and B-cell areas by week 14, achieving mature architecture by approximately 20 weeks.^[1] Blood supply enters and exits via the hilum, with afferent lymphatics approaching the convex surface and efferent vessels departing through the hilum to connect with upstream nodes.^[1] The superficial inguinal nodes are further subdivided into horizontal (superior medial and superolateral) and vertical (inferior) groups, draining lymph from the skin and superficial tissues of the anterior abdominal wall below the umbilicus, buttocks, lower limbs, perineum, anal canal below the pectinate line, vulva, scrotum, and penis (except the glans).^[2] In contrast, the deep inguinal nodes, typically 1 to 3 in number and located medial to the femoral vein, receive drainage from the superficial nodes as well as deep structures like the glans penis, clitoris, and lower limb muscles, ultimately channeling filtered lymph to the external iliac nodes and onward to the common iliac and para-aortic chains.^[2] This organized drainage pattern is crucial for regional immune responses and the spread of infections or malignancies from the lower body.^[1] Clinically, enlargement of inguinal lymph nodes, known as inguinal lymphadenopathy, often signals infections such as sexually transmitted diseases (e.g., syphilis, chancroid, or lymphogranuloma venereum) or metastatic cancers from pelvic organs like the vulva, penis, or anus, making them important for diagnostic palpation and biopsy.^[1] Surgical interventions, such as sentinel lymph node biopsy using technetium-99m and isosulfan blue dye, are common in staging cancers of the lower extremities or genitalia, though procedures carry risks including lymphedema, lymphocele, and wound complications.^[1]

Overview

Definition and function

Inguinal lymph nodes are a group of small, encapsulated, bean-shaped or kidney-shaped structures situated in the inguinal (groin) region, forming an integral part of the lymphatic system where they filter lymph fluid and support immune responses.^[1] These nodes perform essential functions in the lymphatic system by filtering interstitial fluid to remove pathogens, cellular debris, and malignant cells, thereby preventing their dissemination through the bloodstream. They serve as critical sites for adaptive immunity, where B-lymphocytes proliferate in germinal centers to produce antibodies and T-lymphocytes coordinate cellular immune responses against antigens presented by dendritic cells. Additionally, resident macrophages within the nodes engage in phagocytosis, engulfing and degrading foreign particles to initiate inflammatory cascades.^[3]^[1] Histologically, the nodes feature an outer cortex with lymphoid follicles predominantly containing B-lymphocytes, a deeper paracortex enriched with T-lymphocytes and high endothelial venules for lymphocyte trafficking, and an inner medulla composed of cords and sinuses harboring plasma cells and macrophages. The structure is enclosed by a fibrous connective tissue capsule that sends trabeculae inward, creating subcapsular and medullary sinuses through which lymph percolates; afferent lymphatic vessels deliver lymph to the subcapsular sinus, while efferent vessels exit via the hilum.^[3]^[1] As the primary lymphatic drainage sites for the lower extremities, perineum, and abdominal wall below the umbilicus, inguinal lymph nodes play a vital role in containing localized infections and malignancies, averting their systemic propagation. They are subdivided into superficial and deep groups, each contributing to these overarching physiological roles.^[1]

Location

The inguinal lymph nodes are situated in the inguinal region of the lower abdomen and pelvis, serving as key components of the lymphatic drainage system for the lower body. They are divided into superficial and deep groups, with the superficial nodes located subcutaneously below the inguinal ligament and above the fascia lata, while the deep nodes are positioned within the femoral sheath or canal, medial to the femoral vessels.^[1] The superficial inguinal lymph nodes lie parallel to the inguinal ligament and are arranged around the saphenous opening in the fascia lata, facilitating their role in regional lymphatic filtration. In contrast, the deep inguinal lymph nodes are embedded along the course of the femoral vein, extending from the inguinal ligament inferiorly to the entrance of the adductor canal.^[4]^[1] The positioning of these nodes exhibits variability influenced by body habitus; superficial nodes are more readily palpable in individuals with low subcutaneous fat, such as thin adults, due to reduced overlying tissue. Embryologically, the inguinal lymph nodes originate from mesenchymal condensations in the developing pelvis and lower limbs, with initial formation occurring around the 11th week of gestation.^[1]

Superficial inguinal lymph nodes

Arrangement

The superficial inguinal lymph nodes are a group of approximately 8 to 10 nodes located immediately below the inguinal ligament in the groin region, positioned in the superficial fascia deep to the skin and Camper's fascia, and superficial to the fascia lata.^[1] They are subdivided into a horizontal group (superomedial and superolateral nodes, aligned parallel to the inguinal ligament along the superficial circumflex iliac vein) and a vertical group (inferior nodes, arranged along the terminal portion of the great saphenous vein).^[4]^[5] This arrangement allows them to serve as the primary collectors for superficial lymphatic drainage from the lower body.^[1]

Afferents

The superficial inguinal lymph nodes receive afferent lymphatic vessels from the superficial tissues of the lower abdomen (below the umbilicus), buttocks, perineum, and lower extremities, including the skin and subcutaneous layers of the anterior abdominal wall, anal canal below the pectinate line, and external genitalia such as the vulva, scrotum, and shaft of the penis (excluding the glans).^[1]^[4] Lymph from the lower limbs travels via superficial vessels accompanying the great saphenous vein, while perineal and genital drainage follows paths along the superficial external pudendal vessels.^[5] These afferents enter the convex surface of the nodes, facilitating filtration of lymph from these regions before further processing.^[1]

Efferents

Efferent vessels from the superficial inguinal lymph nodes primarily drain into the deep inguinal lymph nodes, located within the femoral sheath, or directly into the external iliac lymph nodes superior to the inguinal ligament.^[1]^[4] These efferents exit through the hilum of the nodes and course along the femoral vessels or pierce the inguinal ligament to join the iliac chain, ultimately connecting to the common iliac and para-aortic nodes.^[5] This pathway ensures coordinated drainage from superficial to deeper lymphatic stations.^[1]

Deep inguinal lymph nodes

Arrangement

The deep inguinal lymph nodes consist of a small group typically numbering 1 to 5, with 3 nodes being most common, arranged in a vertical chain along the medial aspect of the femoral vein.^[6]^[4] These nodes are embedded within the femoral sheath, particularly in the femoral canal, extending from just inferior to the inguinal ligament along the medial aspect of the femoral vein within the femoral sheath in the proximal thigh.^[1]^[5] In terms of size, the deep inguinal lymph nodes are generally smaller than the superficial inguinal nodes, averaging 0.3 to 1 cm in diameter, and they exhibit greater fixation due to their close embedding amid surrounding vascular and fascial structures.^[7]^[3] Their configuration reflects a compact organization influenced by the adjacent anatomy, with the nodes positioned medially and in direct proximity to the femoral vein throughout their extent.^[4] The vascular relations of these nodes are characterized by their intimate association with the femoral vein, lying adjacent to it and, in some cases, partially surrounding its medial surface, which contributes to their role in draining deep structures while maintaining structural stability.^[5]^[8]

Afferents

The deep inguinal lymph nodes receive lymphatic drainage primarily from deep structures of the perineum and pelvis, including the glans penis, prepuce, and clitoris.^[1]^[6] These nodes also collect efferents from all superficial inguinal lymph nodes, serving as a key relay point in the lymphatic pathway.^[2]^[4] Lymphatic fluid from deep genital structures travels along vessels accompanying the internal pudendal artery and vein, entering the deep inguinal nodes near their position medial to the femoral vein.^[8] Efferents from the superficial inguinal nodes connect directly to the deep group through shared lymphatic channels and interlobular pathways within the femoral sheath.^[6]^[5] Additional afferent inputs include lymph from the deep layers of the inferior abdominal wall below the umbilicus and from proximal deep tissues of the lower limb, such as those along the femoral vessels.^[8]^[2] This arrangement positions the deep inguinal nodes as a secondary filtration site, processing lymph already partially cleared by the superficial group before onward drainage.^[4]

Cloquet's node

Cloquet's node, also known as Rosenmüller's node, is the most proximal (superior) of the deep inguinal lymph nodes, situated within the femoral canal immediately inferior to the inguinal ligament.^[6] It lies at the intersection of the inguinal ligament and the femoral vein, marking the transition point between the deep inguinal and external iliac lymphatic chains.^[9] This node is embedded deep to the fascia lata and may sometimes be regarded as the most inferior node of the external iliac group due to its position.^[10] Typically oval or bean-shaped, Cloquet's node measures about 1-2 cm in length, making it often the largest among the deep inguinal nodes, and is surrounded by adipose and connective tissue within the femoral sheath.^[11] It was named after the French anatomist and surgeon Jules Germain Cloquet (1790-1883), who first described it in the early 19th century in his work on the surgical anatomy of inguinal and femoral hernias.^[12] The alternative name honors the German anatomist Johann Christian Rosenmüller (1771-1820), who also contributed to its early recognition.^[6] Positioned as the uppermost deep inguinal node, Cloquet's node receives early lymphatic drainage directly from the external genitalia and perineum, as well as from the distal lower extremity via the deep inguinal afferents.^[9] Conversely, in metastatic spread from pelvic or genital malignancies, such as penile or vulvar cancers, it is frequently the initial deep node affected, serving historically as a sentinel indicator for further pelvic involvement.^[9]

Efferents

The efferent vessels from all deep inguinal lymph nodes, including Cloquet's node, primarily drain into the external iliac lymph nodes via channels that accompany the external iliac vein and pierce the femoral septum.^[2]^[6] These vessels course superiorly alongside the iliac vessels, joining the common iliac lymph node chain without any direct connections to the superficial inguinal nodes.^[4]^[13] Anatomical variations may occur, such as occasional direct drainage from perineal lymphatic pathways to the hypogastric (internal iliac) nodes, bypassing or supplementing the standard external iliac route for certain deep perineal contributions.^[14] Ultimately, lymph from the deep inguinal nodes proceeds through the external and common iliac nodes to the para-aortic (lumbar) nodes and cisterna chyli, facilitating return to the venous system via the thoracic duct.^[2]^[5]

Clinical significance

Infections and inflammation

Inguinal lymph nodes play a critical role in the immune response to infections originating from their drainage territories, which include the lower extremities, perineum, and external genitalia, leading to reactive lymphadenopathy when pathogens are present.^[1] Bacterial and viral infections in these areas trigger lymph node enlargement as immune cells proliferate to combat the invading organisms.^[15] Common causes of infectious inguinal lymphadenopathy include bacterial infections of the lower limbs, such as cellulitis and foot ulcers, where pathogens like Staphylococcus or Streptococcus spread via lymphatic channels, resulting in node swelling.^[16] Sexually transmitted infections (STIs) are another major etiology; for instance, syphilis caused by Treponema pallidum often produces generalized lymphadenopathy, while chancroid due to Haemophilus ducreyi leads to painful, suppurative nodes.^[1] Lymphogranuloma venereum (LGV), resulting from specific serovars of Chlamydia trachomatis, characteristically causes tender inguinal adenopathy, and herpes simplex virus infections can induce regional node enlargement following genital outbreaks.^[15] Viral etiologies like HIV may also contribute to bilateral involvement during acute phases.^[15] In response to these infections, the nodes undergo hyperplasia and inflammation, often forming buboes—markedly enlarged, fluctuant masses particularly seen in LGV and chancroid—accompanied by pain and tenderness due to acute immune activation.^[1] This reactive process involves lymphocyte and macrophage influx, causing the nodes to become palpable and erythematous.^[15] Diagnostically, unilateral swelling typically points to a localized infection in the ipsilateral lower limb or perineum, whereas bilateral enlargement suggests systemic spread or STIs affecting both sides.^[1] For example, isolated lower extremity cellulitis often presents with ipsilateral inguinal tenderness, aiding in pinpointing the source.^[17] Complications of infectious inguinal lymphadenitis include abscess formation within the nodes, as in suppurative buboes from bacterial STIs, which may require incision and drainage to prevent further spread.^[15] Chronic or recurrent inflammation can lead to fibrosis and scarring of the nodal tissue, potentially impairing lymphatic drainage and contributing to long-term swelling.^[15]

Malignancy and surgical considerations

The inguinal lymph nodes serve as a primary site for regional metastasis in various malignancies originating from the lower body, including penile squamous cell carcinoma, vulvar cancer, anal carcinoma, and melanoma of the lower extremities.^[18]^[19]^[20] In penile cancer, for instance, inguinal involvement occurs in 20% to 50% of cases at diagnosis, often preceding distant spread and significantly influencing staging and management.^[18] Similarly, vulvar and anal cancers frequently metastasize to these nodes, with inguinal spread reported in up to 20% of early-stage vulvar cases and serving as an independent poor prognostic factor in anal carcinoma.^[19]^[20] For lower limb melanomas, the inguinal nodes are the sentinel basin for lymphatic drainage, where metastasis can occur in advanced disease.^[21] Deep inguinal nodes, including Cloquet's node (the most superior), may indicate pelvic lymph node metastasis and advanced disease in penile cancer.^[22] Diagnostic evaluation of inguinal lymph nodes in suspected malignancy typically involves imaging modalities such as ultrasound and computed tomography (CT) to assess node size, morphology, and potential involvement.^[23] Ultrasound provides high-resolution real-time imaging, enabling evaluation of features like cortical thickness and vascularity, with meta-analyses confirming its efficacy in detecting metastases in penile and vulvar cancers.^[23] CT offers complementary cross-sectional detail for staging, particularly in identifying enlarged or necrotic nodes.^[23] For more precise assessment in clinically node-negative cases, sentinel lymph node biopsy (SLNB) is employed, utilizing peritumoral injection of radiocolloid and blue dye to identify and excise the first-draining node, thereby avoiding unnecessary full dissection.^[24] This technique demonstrates high sensitivity (approximately 90%) in penile cancer per meta-analyses, guiding decisions on further therapy.^[24] Surgical management centers on inguinal lymphadenectomy, which is indicated for confirmed nodal metastasis in these cancers to achieve locoregional control and improve survival.^[19] In penile cancer, radical inguinal lymphadenectomy is standard for palpable or biopsy-proven involvement, often combined with pelvic dissection if deep nodes are affected.^[25] For vulvar and anal cancers, the procedure targets superficial and deep nodes, with video-endoscopic approaches increasingly used to minimize morbidity.^[19] However, this surgery disrupts lymphatic drainage, leading to a substantial risk of lower extremity lymphedema, reported in 16% to 50% of patients depending on the extent of dissection.^[26] Techniques like saphenous vein preservation during superficial dissection can mitigate this complication.^[21] As of 2024, ESMO guidelines recommend dynamic sentinel node biopsy for intermediate-risk penile cancer to reduce such risks.^[27] Prognostically, inguinal node involvement denotes advanced disease across these malignancies, correlating with reduced survival rates compared to node-negative cases.^[28] In penile cancer, patients with 1 to 3 positive inguinal nodes have a 5-year survival of approximately 76%, dropping to 8% with 4 or more involved nodes.^[28] For vulvar cancer, nodal metastasis lowers 5-year survival to approximately 53%, underscoring the benefit of early SLNB or prophylactic dissection in select cases.^[29] Negative nodes, conversely, are associated with excellent outcomes, with 5-year survival around 85-90% in early-stage penile and vulvar cancers.^[28]^[29]

References

[1]
Anatomy, Abdomen and Pelvis: Inguinal Lymph Node - NCBI - NIH
The lymph node's primary function is to filter for harmful substances as lymphatic fluids travel through its cortex, paracortex, and medulla. Clinical signs of ...Introduction · Structure and Function · Surgical Considerations · Clinical Significance
[2]
Anatomy, Abdomen and Pelvis: Lymphatic Drainage - NCBI - NIH
The upper medial group of the superficial inguinal lymph nodes drains the anterior abdominal wall below the umbilicus, up to the perineum, external genitalia, ...
[3]
Anatomy, Lymph Nodes - StatPearls - NCBI Bookshelf - NIH
Jul 25, 2023 · The primary function of lymph nodes is filtering interstitial fluid collected from soft tissues and eventually returning it to the vascular ...
[4]
Inguinal lymph nodes: Anatomy and function - Kenhub
The deep inguinal lymph nodes lie within the femoral sheath, medial to the femoral vein and range from approximately 1-3 nodes. They are similarly divided into ...
[5]
Deep inguinal lymph nodes | Radiology Reference Article
Mar 28, 2023 · The most proximal or highest node is known as the node of Cloquet, named after Jules Germain Cloquet (1790-1883), a French surgeon with an ...<|separator|>
[6]
Lymphatic Drainage of the Lower Limb - Vessels - Nodes - TeachMeAnatomy
### Summary of Deep Inguinal Lymph Nodes
[7]
Inguinal lymph nodes: size, number, and other characteristics in ...
Results: The mean short-axis inguinal lymph node size was 5.4 mm (range 2.1-13.6 mm), measured at 8.8 mm two standard deviations above the mean. The mean number ...
[8]
Deep Inguinal Lymph Nodes - an overview | ScienceDirect Topics
This system receives afferent drainage from the deep lymphatic network of the lower limb coursing with the femoral vessels, the superficial inguinal lymph nodes ...
[9]
Lymphatic Drainage of The Lower Limb - Earth's Lab
Their efferent vessels from the deep inguinal lymph nodes drain into the external iliac nodes after piercing the femoral septum, which shuts the femoral ring.
[10]
Anatomy of pelvic lymph nodes and vessels - Kenhub
Deep inguinal lymph nodes lie within the femoral sheath just medial to the femoral vein. These lymph nodes drain the glans penis or clitoris while also ...
[11]
Inguinal Region Anatomy - Medscape Reference
Apr 21, 2025 · Superficial inguinal lymph nodes - These nodes receive lymph from the anal canal (below the pectinate line), the skin below the umbilicus, lower ...
[12]
Deep inguinal nodes - e-Anatomy - IMAIOS
The deep inguinal lymph nodes drain superiorly to the external iliac lymph nodes, then to the pelvic lymph nodes and on to the paraaortic lymph nodes.<|control11|><|separator|>
[13]
Lymph nodes: Definition, anatomy and locations | Kenhub
Those nodes deep to the fascia are the deep inguinal nodes. The largest and most superior of the deep nodes is the deep inguinal node of Cloquet. It is ...
[14]
Jules Germain Cloquet (1790-1883)--drawing master and anatomist
Jules Germain Cloquet, the famed French anatomist, surgeon, and professor, may not be remembered as one of the pioneers of hernia surgery.
[15]
Lymphadenopathy - StatPearls - NCBI Bookshelf
Infectious disease can be viral, bacterial, mycobacterial, fungal, or parasitic etiology: Viral etiologies of lymphadenopathy include HIV, mononucleosis caused ...
[16]
Cellulitis - StatPearls - NCBI Bookshelf - NIH
If cellulitis is affecting the patient's lower extremities, careful evaluation should be made to look between the patient's toes for fissuring or tinea pedis.Missing: inguinal | Show results with:inguinal
[17]
Cellulitis | Better Health Channel
The lymph nodes may swell and be noticed as a tender lump in the groin and armpit. You may also have fevers, sweats and vomiting.Missing: inguinal | Show results with:inguinal
[18]
Inguinal Lymph Nodes in Carcinoma Penis-Observation or Surgery?
Jan 1, 2016 · The inguinal lymph nodes are the most common site of metastases. Thirty to sixty percent of patients with penile cancer have palpable groin ...
[19]
Surgical management of metastatic inguinal lymphadenopathy - PMC
Inguinal lymphadenectomy, or groin dissection, has a key role in the management of patients with penile, vulval, anal, and cutaneous malignancy.
[20]
Saphenous Vein Sparing Superficial Inguinal Dissection in Lower ...
The reported studies on sparing the saphenous vein in inguinal node dissection suggest a reduced rate of lymphedema and other postoperative complications [6, 7] ...
[21]
Anal cancer – a review - PMC - NIH
Inguinal lymph node metastasis is an independent poor prognostic factor for local treatment failure and long term survival. Synchronous inguinal metastasis are ...
[22]
Deep Inguinal Lymph Node Metastases Can Predict Pelvic Lymph ...
Sep 15, 2021 · Lymph node metastasis (LNM) is the major prognostic factor for survival of penile squamous cell carcinoma (PSCC) (1). Regional lymph nodes (LNs) ...Table 1 · Survival Analysis · Discussion
[23]
The Role of Ultrasound in the Evaluation of Inguinal Lymph Nodes ...
Jun 23, 2022 · The aim of this systematic review and meta-analysis is to determine the efficacy of ultrasound to assess the inguinal lymph nodes in patients ...
[24]
Radioisotope-Guided Sentinel Lymph Node Biopsy in Penile Cancer
Apr 14, 2022 · In conclusion, the results of this study suggest that radioisotope-guided DSNB may reduce the morbidity of inguinal lymphadenectomy in patients ...
[25]
Accuracy of sentinel lymph node biopsy for inguinal ... - NCBI - NIH
This review found that sentinel lymph node mapping in penile squamous cell carcinoma was associated with high sensitivity and detection rates.
[26]
Penile cancer: current therapy and future directions - PMC - NIH
Radical inguinal lymphadenectomy was recommended for patients with histologically proven LN metastasis. In addition, pelvic LN dissection was recommended in ...
[27]
Risk factors for lower extremity lymphedema after inguinal ... - NIH
Feb 16, 2022 · Our study found that number of inguinal lymph nodes removed ≥ 10 was associated with a significantly higher incidence of lower extremity lymphedema.
[28]
Lymph Node Metastases and Prognosis in Penile Cancer - PMC - NIH
Penile squamous cell carcinoma is commonly characterized by regional lymph node spread in a stepwise pattern before distant metastases.Missing: anal | Show results with:anal
[29]
Vulvar Cancer - StatPearls - NCBI Bookshelf - NIH
... prognostic factor for overall survival in patients with vulvar cancer. Survival rates are significantly lower for patients with lymph node metastasis: 65 ...Missing: penile | Show results with:penile