PMC4064423_01
Positron emission tomography shows four positive lymph nodes, but no other positive sites.
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Positron emission tomography/computed tomography (PET/CT) revealed the involvement of two PANs (31 mm x 25 mm and 24 mm x 18 mm, respectively) and two pelvic nodes (38 mm x 45 mm and 13 mm x 16 mm, respectively), and there was no other positive site (Fig. 1).
Enhanced computed tomography (CT) images clearly shows enlarged nodes. (A) Precaval and lateroaortic nodes. (B) Bilateral suprainguinal nodes.
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Contrast-enhanced CT clearly identified these enlarged nodes, which we considered to be resectable (Fig. 2).
Images of lymph node dissection (2) corresponds to the precaval node, (3) corresponds to the lateroaortic node, and (4) corresponds to the left suprainguinal node. (1) The right suprainguinal node is not indicated here. Abbreviations: RCILA, right common iliac artery; LEILA, left external iliac artery.
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The retroperitoneal metastatic nodes were completely resected in the absence of significant adhesion to the vessels during surgery (surgical duration: 324 min, blood loss: 930 g [Fig. 3]).
Macroscopic appearance of dissected lymph nodes. Microscopically, four (1-4) out of 63 dissected lymph nodes were positive for metastatic adenocarcinoma.
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Histopathologically, we confirmed metastatic high-grade adenocarcinomas in four of 63 dissected lymph node specimens, which were identical to the nodes detected on PET/CT and CT (Fig. 4).