SCALENE LYMPH-NODE METASTASES WITH NEGATIVE PELVIC NODES IN INVASIVE CERVICAL-CARCINOMA

Cervical carcinoma spreads predominantly by lymphatic routes and lymph node metastases may occur even in early stages of disease. Metastases usually first appear in pelvic lymph nodes, then disseminate along th e efferent lymphatic chain to the extrapelvic lymph nodes. Cases of po sitive extrapelvic lymph node metastases with negative pelvic nodes in invasive cervical carcinoma are extremely rare. We report a 50-year-o ld woman with bulky stage IIA cervical carcinoma who had scalene lymph node metastases in the absence of pelvic lymph node metastases after radical hysterectomy and postoperative pelvic irradiation. This rare ' 'skipping'' nodal metastasis was probably via posterior trunk lymphati c drainage of the bulky cervical carcinoma which mainly invaded the po sterior vaginal cuff. Neoadjuvant or adjuvant chemotherapy is recommen ded to prolong survival of patients in such cases.