Testis and ovary

Source region and uptake · Para-aortic L2

The gonads develop on the posterior abdominal wall and drag their lymphatics with them, so testicular and ovarian lymph runs alongside the gonadal vessels straight to the para-aortic nodes at L2, skipping the inguinal nodes entirely.

Detail

Drains to
Para-aortic (lumbar) nodes at L2
Follows
Gonadal vessels back to the embryonic level of origin
Scrotal skin, by contrast
Superficial inguinal nodes
Surgical rule
Inguinal orchidectomy with high cord ligation, never a scrotal incision
Uterus exception
Fundus drains to para-aortic nodes along the ovarian vessels; cervix to iliac and obturator nodes

When it goes wrong

Trans-scrotal biopsy of a testicular tumour

Seeds the inguinal nodes and changes the staging and radiotherapy field

Metastatic germ cell tumour

Bulky para-aortic mass, sometimes reaching the left supraclavicular node with a normal-feeling abdomen

Practise this structure

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