21st June 2023

A 65-year-old gentleman with a history of testicular cancer 40 years ago, treated with a left orchidectomy and no further adjuvant treatment, presents with a left groin lump

A 65-year-old gentleman with a history of testicular cancer 40 years ago, treated with a left orchidectomy and no further adjuvant treatment, presents with a left groin lump. The mass is firm, fixed and has been growing in size over the past 4 weeks. He has no other significant history and takes no regular medication. Biopsy of the site confirms a malignant groin nodal mass. Which of the following is the most likely to cause a malignant inguinal lymph node?