Ectopic pregnancy in a paraaortic lymph node
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A 39-year-old woman, gravida 3, para 1, conceived via IVF-ET. She had undergone bilateral salpingectomy due to an ectopic pregnancy with hydrosalpinx previously. At 5 5/7 weeks of gestation, a gestational sac (GS) was not seen in the uterine cavity. At 6 1/7 weeks, she underwent a laparoscopic examination that showed no evidence of ectopic pregnancy in her pelvic cavity. By 6 4/7 weeks, her hCG level rose to 9429 mIU/ml, and she was transferred to hospital. The doctor could not detect an ectopic pregnancy by pelvic MRI, but a 1 cm cystic lesion at the cesarean section scar was observed. They performed a total hysterectomy at 6 5/7 weeks with her informed consent.

However, gestational tissue was not seen in the uterus on histopathological examination. Postoperatively, the hCG increased to 13105 mIU/ml and a CT scan was performed to localize the ectopic pregnancy. Computed tomography images show a retroperitoneal ectopic pregnancy in the left paraaortic lymph node. Intraoperatively, the gestational sac is located in the left paraaortic region, without bleeding, and is contiguous to the lymphatic vessels. Arrows indicate the gestational sac. IMA, the inferior mesenteric artery. Histologically, chorionic villi are seen in the lymph node tissues.

A 2-cm-enhancing cystic mass on the left side of the aorta was detected and a retroperitoneal ectopic pregnancy (REP) on the left paraaortic region was diagnosed. At 7 2/7 weeks, they performed an open laparotomy and observed that the surface of the peritoneum covering the paraaortic region was smooth and free of scars. The intact gestational sac was located in the left paraaortic region and was contiguous to the lymphatic vessels. The mass was completely resected and histopathological evaluation showed trophoblastic tissue along with lymph node tissue, confirming the ectopic pregnancy in the paraaortic lymph node. Postoperatively the hCG level decreased steadily. She was discharged from hospital 14 days postoperatively.

Source: https://www.ejog.org/article/S0301-2115(20)30568-6/fulltext?rss=yes
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