2019 Volume 35 Issue 2 Pages 304-310
CASE: A 68-year-old gravida 1, para 1 underwent computed tomography (CT) for the evaluation of ischemic enteritis. CT revealed enlarged right-sided pelvic lymph nodes measuring 25 mm and 12 mm. A malignant tumor was suspected based on positron emission tomography-CT and transvaginal cytology testing. Examination of the uterus did not reveal any findings suggestive of malignancy. Laparoscopic lymphadenectomy was performed to establish a conclusive diagnosis. The uterus and adnexa showed no abnormalities. Laparoscopic ultrasonography was useful for the evaluation of blood flow to the lymph nodes. The lymph node measuring 25 mm was located on the dorsal aspect of the right obturator nerve and showed adhesions with surrounding tissues. This lymph node (25 mm in size) was removed; however, the lymph node measuring 12 mm could not be identified and was not removed. Histopathological diagnosis of the resected lymph node showed squamous cell carcinoma (SCC). Postoperative review did not reveal any primary tumor. Histopathological examination of the resected lymph node confirmed metastatic SCC from an unknown primary carcinoma. The patient was treated with total pelvic radiation.
Conclusion: Laparoscopic lymphadenectomy is useful for histopathological diagnosis and postoperative decision-making regarding optimal treatment for deep-seated lesions such as pelvic lymph nodes. Notably, laparoscopic ultrasonography enables evaluation of blood flow, which is useful.
