Pathways of nodal metastasis from pelvic tumors: CT demonstration

Although the normal pathways of lymphatic drainage from the pelvic organs have been well described in the anatomy literature, the pathways of nodal metastasis from individual pelvic neoplasms are not well illustrated in the imaging literature. The authors retrospectively reviewed computed tomographic scans of the abdomen and pelvis in patients with various pelvic neoplasms, including those of the ovary, testis, prostate, cervix, bladder, anorectum, and other sites, to define the pathways of nodal metastasis. In most patients, pathways of nodal metastasis correlated well with the normal lymphatic pathways described in the anatomy literature, including the superficial inguinal pathway; the anterior, lateral, hypogastric, and presacral routes of the pelvic pathway; and the paraaortic pathway. However, there also were various uncommon pathways of nodal metastasis, such as metastasis along the gonadal vessels, mesenteric and mesocolic nodes, posterior iliac crest nodes, and inferior phrenic nodes. Understanding these common and uncommon lymphatic pathways of metastasis will help radiologists detect disease spread from pelvic tumors.