Lymphatic drainage of adrenal neuroblastoma

The lymphatic drainage of adrenal neuroblastoma (NB) was investigated in 11 patients using intraoperative vital staining with carbon particle suspension. Carbon staining was most frequent in the nodes at the origin of the renal artery and next most frequent in the interaorticovenous nodes. The staining was characteristically noted in the paraaortic nodes and the nodes around the hemiazygos vein in cases of left adrenal NB, and in the paracaval nodes and the nodes around the azygos vein in cases of right adrenal NB. Histological evaluation confirmed a correlation with lymph node metastases and carbon staining. These findings suggest that the primary regional nodes of adrenal NB are the nodes at the origin of the renal artery, those around the hemiazygos vein in left adrenal NB, and those around the azygos vein in right adrenal NB. The secondary regional nodes are the interaorticovenous nodes, the paraaortic nodes in left adrenal NB, and the paracaval nodes in right adrenal NB. The topography of lymphatic drainage of adrenal NB should be considered in the management of this tumor.