Infrarenal Metastases from Endometrial Cancer - A Case Report

Introduction Patients diagnosed with endometrial cancer report a high risk of developing pelvic and even para-aortic lymph node metastases, the most frequently incriminated para-aortic lymph node stations including the infra-mesenteric area. However, in certain cases para-aortic metastases above the inferior mesenteric artery might be encountered. Material and methods We present the case of a 63-year-old patient diagnosed with a moderately differentiated endometroid adenocarcinoma who was diagnosed with para-aortic lymph node metastases in the infra-renal area. Results The 63-year-old patient presented for postmenopausal uterine bleeding and was diagnosed with a moderately differentiated endometroid adenocarcinoma in association with pelvic and paraaortic adenopathies. Surprisingly, the preoperative computed tomography described the presence of large adenopathic masses above the inferior mesenteric artery so we decided to extend the area of lymph node dissection. The patient was submitted to total hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection, the para-aortic resected lymph nodes including both the inframesenteric and the infra-renal group. The histopathological studies confirmed the presence of metastases in the infra-renal lymph node station. Conclusions In patients with endometrial cancer infra-renal para-aortic lymph node stations might present metastatic cells; therefore, a close evaluation of these groups during preoperative workup as well as intraoperatively is mandatory.