First case of chronic cell leukemia discovered incidentally in extra-saccular inguinal lymph node during laparoscopic bilateral inguinal hernia repair. Case report and literature review

INTRODUCTION: Chronic cell leukemia discovered incidentally in extra-saccular inguinal lymph node during laparoscopic bilateral inguinal hernia repair is extremely rare. PRESENTATION OF CASE: 62-year-old Romanian male presented at the outpatient general surgery clinic in April 2019 complaining of bilateral inguinal swelling that gradually increased in size mainly on right side and was diagnosed with bilateral inguinal hernia. During the laparoscopic repair of the hernia, a large lymph node in the left femoral canal was incidentally observed. Histopathologic, immunohistochemical, and flowcytometric evaluation of the excised specimen confirmed chronic lymphocytic leukemia/small lymphocytic lymphoma. DISCUSSION: Whole body CT showed supra and infra-diaphragmatic lymphadenopathy, and few small subsolid pulmonary nodules, possibly metastatic. Splenomegaly and pancreatomegaly were also noted, suggesting lymphomatoid infiltration. CONCLUSION: There is need for cautious inspection and meticulous palpation of the inguinal area for any lymphadenopathy during routine inguinal hernia repair.