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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