On physical exam, popliteal and inguinal lymph nodes were in the same size and abdominal ultrasound showed that medial iliac lymph nodes
remained the same size as on the previous scan.
The diagnosis was solidified by the remarkable regression of the right adrenal tumor and the disappearance of paraaortic and iliac lymph nodes
in serial abdominal CT scans after complete anti-TB treatment.
Moreover, they also occur at sites outside of the pelvic cavity, such as in lumbar, mediastinal, parotid, submandibular, jugular, hepatic and iliac lymph nodes
(Maassen & Hiller).
These include the intestinal and lumbar trunks, large 'pools' of lumbar lymph nodes and common iliac lymph nodes
, the sacral nodes, external iliac lymph nodes
and inguinal nodes (4).
A transaxial PET scan of the same patient showed abnormally high uptake of the FDG isomer, and a fusion scan of the images superimposed on each other demonstrated high uptake in both internal iliac lymph nodes
, as well as in the sigmoid colon.
A study showed that when the dissection was extended to the higher external, internal, and common iliac lymph nodes
as well as the presacral lymph nodes, the metastasis rate increased from 10% to 26% (J.
Five other left iliac lymph nodes
were negative for metastatic disease.