“Sign of groove” in Hodgkin’s lymphoma

A 56-year-old man presented with a 2-year history of an asymptomatic left inguinal swelling, along with generalized pruritus and weight loss of 10 kg over the last 6 months. Local examination showed inguinal swellings both above and below the left inguinal ligament, forming the ‘sign of groove’ [Figure 1]. Hematological investigations were unremarkable, except for anemia (Hb 10.6g/dL). A contrast-enhanced computed tomography scan revealed enlarged left inguinal, left iliac, and retroperitoneal lymph nodes. Inguinal lymph node biopsy showed large atypical Reed-Sternberg-like cells with immunopositivity for CD30 and focal positivity for CD15, with a background polymorphous infiltrate. A final diagnosis of classical Hodgkin’s lymphoma was made, and the patient was referred to medical oncology for further management.

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Figure 1:

Swellings in left inguinal region separated by a groove (sign of groove). Note the presence of lichenification and prurigo-like lesions on the thighs indicating intense pruritus.

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Though often regarded as pathognomonic of lymphogranuloma venereum, the ‘sign of groove’ or ‘groove sign of Greenblatt’ can be seen in other conditions as well, including Hodgkin’s and Non-Hodgkin’s lymphomas. The ‘groove’ is formed by the inguinal ligament separating the inguinal lymph nodes above and the femoral lymph nodes below.