Short Communication
Aortic Sentinel Node Transperitoneal Detection in Endometrial Cancer and Horseshoe Kidney
Ane Bombin, Mikel Gorostidi Pulgar*, Olaia Aristegui, Arantxa Lekuona and Irene Diez
Department of Obstetrics and Gynecology, University Hospital Donostia, Spain
*Corresponding author: Mikel Gorostidi, Department of Obstetrics and Gynecology, University Hospital Donostia, Spain
Published: 13 Mar, 2018
Cite this article as: Bombin A, Pulgar MG, Aristegui O,
Lekuona A, Diez I. Aortic Sentinel
Node Transperitoneal Detection in
Endometrial Cancer and Horseshoe
Kidney. Clin Oncol. 2018; 3: 1433.
Short Comunaction
A 57-year-old woman referred to our department with suprapubic pain and post menopause
bleeding, diagnosed on endometrial biopsy with a G1 Endometrial Carcinoma (EC). MRI shows
less than 50% myometrial infiltration, and no infiltration of cervical stroma, but a horseshoe kidney
is incidentally diagnosed.
The most common fusion anomaly is the horseshoe kidney. The reported incidence based upon
data from birth defect registries varies from 0.4 to 1.6 in 10,000 live births. But it is difficult to
determine accurately since many patients with these abnormalities are undiagnosed, especially if
they are asymptomatic.
A total laparoscopic hysterectomy with double salpingo-oophorectomy was planned. Sentinel
node dissection was performed as part of our institutional research protocol, approved by local IRB
and consent inform signed. In our research protocol a double injection technique in the uterine
fundus (transcervical) and in the cervix (superficial and deep, 3 and 9h) is performed with Green
IndoCyanine (ICG). Cervical injection is performed due to its best detection rate, but also a fundal
injection is performed to detect aortic pathways as we have already described.
Low risk EC have excellent outcomes, with high disease free survival and overall survival. But
nodal and distant relapses have por prognosis. It´s under research that not detected metastasis or
micrometastasis could be the answer for relapses in this population. Aortic metastases are probably
very low in this setting, although its value could be more important in high risk EC [1]. The research
of our institution is designed to answer this question [2].
A Full HD Image 1S with ICG camera system from Karl Storz (Karl Storz Endoscopy,
Mittelstrasse, Tuttlingen, Germany) was used for ICG detection with Near Infra Red (NIR) system.
A horseshoe kidney above the aorta greatly complicates lymph
node dissection at this level and it´s a challenging situation, especially
if a complete lymph node dissection is necessary. Several abnormalities
in the position, rotation, and vascular supply of the kidney have been
described [3]. It´s not possible to follow infundibulopelvic lymphatic
pathway due to horseshoe kidney in this patient, but a clear ICG
stained infundibulopelvic drainage [4] system and a clear aortic
sentinel node (SN) is detected. Finally 4 SN are detected, with positive
bilateral pelvic detection (1 left external iliac SN, 1 right obturator SN
and 1 right external iliaca SN) and aortic detection (1 supramesenteric
mesenteric aortic SN).
Definitive histology was an IB G1 EC and all sentinel nodes
negative.
Aortic SN mapping is feasible even in a horseshoe kidney EC
patient.
Figure 1
Figure 1
Right infundíbulo-pelvic ligament with HD Chroma vision (SPIES- Storz Professional Image
Enhancement System, STORZ).
Figure 2
Figure 2
Right Infundibulo-pelvic lymphatic pathway under Near Infra Red (NIR) vision with SPIES system.
Figure 3
Figure 4
Figure 5
Figure 5
Horshoe kidney above great vessels, aberrant right renal vein
coming from “right” horseshoe kidney and aorta. Note that the peritoneal tent
is lifted up and the excised site of the aortic SN is easily viewed above the
aorta.
References
- Gorostidi M, Ruiz R. Sentinel-lymph-node mapping in endometrial cancer. Lancet Oncol. 2017;18(5):e235.
- Ruiz R, Gorostidi M, Jaunarena I, Goiri C, Aguerre J, Lekuona A. Sentinel node biopsy in endometrial cancer with dual cervical and fundal ICG injection. Int J Gynecol Cancer. 2018;28(1):139-44.
- Natsis K, Piagkou M, Skotsimara A, Protogerou V, Tsitouridis I, Skandalakis P. Horseshoe kidney: A review of anatomy and pathology. Surg Radiol Anat. 2014;36(6):517-26.
- Geppert B, Lonnerfors C, Bollino M, Arechvo A, Persson J. A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer. Gynecol Oncol. 2017;145(2):256-61.