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Abstract
Introduction/Background Endometrial cancer(EC) is the most common gynecologic cancer and the fourth-most common cancer among women in the United States.1 EC are generally regarded as having favorable prognosis, with a 5-year overall survival reaching 80%.2 Lymph node metastasis is the most important prognostic factor which helps in deciding adjuvant treatment. Incidence of isolated paraaortic lymph node metastasis is approximately 1–3%.3 Duplication of the inferior vena cava (IVC) is a congenital anomaly with an incidence of 0.1% to 3.5%.4 The correct diagnosis is important for retroperitoneal surgery and venous interventions.5
Methodology We present an unusual case of isolated paraortic lymph node(PaLN) from uterin adenocancer FIGO stage IIIC2 patient with vena cava duplication. To the best of our knowledge, this is the first report of vena cava duplication with isolated paraortic lypmh node metastasis of endometrium cancer successful surgical treatment, according to a Medline search of English publications.
Results A 61-year old woman presented with post-menopausal bleeding. On preoperative evulation, endometrial biopsy revealed FIGO grade 1 endometrioid adenocarcinoma and MR demonstrated less than %50 myometrial invasion. Computed tomography(CT) showed duplication vena cava inferior above suprarenal area. She underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection and omentectomy due to frozen section result tumor diameter 4 cm and myometrial invasion >50%.
Conclusion IVC duplication is especially important in retroperitoneal surgery. IVC duplication and its association with a large number of renal vessels and abnormal arms complicates dissection and increases the risk of bleeding. Therefore, identification of the type of duplication IVC in the preoperative period may be possible with full analysis of CT scan or angiography.6
We reported a first case of isolated paraortic lymph node metastasis from endometrioid type uterin adenocancer patient with vena cava duplication. This case highlights the importance of preoperative screening.
References
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Surgery photo and abdominal CT scan of the patient in (coronal view) showing vena cava duplication
Abdominal CT scan of the patient in axial view showing 8.24 mm lymph node metastasis and histopatological examination showing lymph node metastasis