Para-aortic lymph node endometriosis: a case report

Abstract

Lymph nodes are considered a rare site for endometriosis. Its involvement in endometriosis is frequent in the pelvic lymph nodes, where it is largely associated with deep pelvic endometriosis. Herein, we report a case of para-aortic lymph node endometriosis without deep-pelvic endometriosis. A 44-year-old patient was referred to our department because of anemia due to excessive menstruation. A magnetic resonance imaging scan revealed adenomyosis and a uterine myoma of 8.7cm, with a mildly high signal on diffusion-weighted imaging and a partially low signal on the ADCmap. Therefore, malignancy could not be ruled out. Contrast-enhanced computerized tomography was performed for a systemic search, which revealed multiple pulmonary artery thrombi, left inferior vein thrombi, and a cystic right para-aortic lymph node with a size of 12×25mm. Total abdominal hysterectomy, bilateral oophorectomy, and biopsy of the right para-aortic lymph node were performed after anticoagulation therapy and inferior vena cava filter placement. Intraoperative findings revealed no pelvic or abdominal cavity endometriotic lesions. Postoperative pathology revealed uterine myoma and adenomyosis with no malignant findings. The enlarged lymph nodes have endometriotic lesions. Endometriosis can develop in isolated lymph nodes, as endometrial cells can appear in extra-pelvic organs via lymphatic and blood vessels. This case was incidentally discovered when cystic enlargement of lymph node lesions is observed, but lymph node endometriosis should be considered in addition to lymph node metastasis due to malignant disease.