Radical hysterectomy with at least excision of about 4 cm of the vaginal wall, with bilateral oophorectomy (due to her menopausal status), complete pelvic lymph node dissection, and Para-aortic
lymph node sampling were done for her.
Below the diaphragm upper abdominal para-aortic
soft tissue appears contiguous with the mediastinal mass.Chest radiograph (D) after7 days of induction chemotherapy shows significant improvement in right lung aeration, mild effusion, and partial lung collapse.
Contrast abdominal MRI revealed a left para-aortic
nodule, 36/30/32 mm in size, neighboring the caudal end of the renal arteries, probably of mesenteric origin (Figure 2).
Surgical staging included total hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and para-aortic
lymphadenectomy, if necessary.
All had cervical lymph nodes, 16 had axillary nodes, 3 had para-aortic
nodes, 3 had inguinal lymphadenopathy and 3 had epitrochlear involvement.
(16) In our cohort of patients on surveillance, only two relapses (2%) were to supradiaphragmatic sites, and both were associated with either para-aortic
or inguinal nodal metastases.
The two para-aortic
LNs, which later expanded, remained within the normal size range (6.4 [+ or -] 0.3 and 7.1 [+ or -] 0.8 mm, resp., Figures 1(g)-1(h)).
In addition, conglomerated lymph nodes with 4 cm in size were detected in the para-aortic
The next hypothesis was that the metastasis to the right pulmonary node was via the para-aortic
lymphatic system, originating from small peritumour lymphatics associated with the primary adenocarcinoma.
For patients with large tumors (> 2 cm), para-aortic
lymph node sampling was performed.
Ruptured SOV aneurysms can predispose to formation of para-aortic
abscess and endocarditis (15).
Abdominal computed tomography showed a low-density para-aortic
mass surrounding the renal artery, as well as an endovascular metal stent attached to the left renal artery and abdominal aorta [Figure 2].