Objective

To present a rare case of retroperitoneal ectopic pregnancy with lymphatic migration after in vitro fertilization–embryo transfer (IVF-ET) and propose the possible explanation for embryonic migration.

Design

Illustrative video presentation. Images, videos (educational videos), and title slides were used to introduce the case of a patient with retroperitoneal ectopic pregnancy with lymphatic migration after IVF-ET and provide a potential explanation for embryo distant migration in the patient. This work was approved by the institutional review board.

Setting

University hospital.

Patient(s)

A 32-year-old woman (gravida 2, para 0) with a history of right salpingectomy was admitted to the hospital 40 days after IVF-ET because of ectopic pregnancy for 1 day; the patient had secondary infertility for 6 years. Gynecologic examination indicated anterior 40-day uterus with no tenderness. A preoperative B-mode ultrasound scan showed that the endometrium was 23 mm, and there was no acoustic image of the pregnant sac in the uterine cavity. Magnetic resonance imaging showed that 1 oval signal measuring approximately 30 × 28 × 35 mm was detected at the gap between the aorta anterior to the third lumbar vertebra and inferior vena cava. The inferior vena cava could be seen on the rear right of the gestational sac, and the abdominal aorta could be seen on the rear left.

Intervention(s)

Retroperitoneal ectopic pregnancy with lymphatic migration after IVF-ET was diagnosed using B-mode ultrasound, MRI, and pathology analysis and was removed laparoscopically.

Main Outcome Measure(s)

Mechanism analysis of distant ectopic migration in a patient receiving IVF-ET with a history of tubal surgery.

Result(s)

The patient was diagnosed using B-mode ultrasound and MRI and underwent laparoscopic surgery to diagnose and remove the retroperitoneal ectopic pregnancy tissue. Further, the pregnancy lesion was completely removed using an ultrasonic knife. The pathological examination showed that the pregnancy tissue was located inside an enlarged lymph node surrounded by lymphoid tissue, and lymphocyte infiltration was also seen in the endometrial tissue, suggesting that the implanted embryo migrated to the retroperitoneum through the lymphatic channels. The patient successfully conceived through IVF-ET 1 year after the operation, and a full-term neonate was delivered by cesarean section.

Conclusion(s)

This case reinforces that in patients with a history of tubal surgery, whether unilateral or bilateral, clinicians should pay more attention to the possibility of retroperitoneal pregnancy after IVF-ET and to the follow-up of such patients. The pathological examination report provided evidence that lymphatic migration may be the possible mechanism of retroperitoneal ectopic pregnancy or embryonic migration after intrauterine placement.

中文翻译：

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体外受精-胚胎移植后腹膜后异位妊娠伴淋巴结转移一例报告：对胚胎远距离迁移的解释

客观的

介绍一例罕见的体外受精-胚胎移植 (IVF-ET) 后腹膜后异位妊娠伴淋巴迁移的病例，并提出胚胎迁移的可能解释。

设计

说明性视频演示。图像、视频（教育视频）和标题幻灯片介绍了 IVF-ET 后腹膜后异位妊娠伴淋巴移行的患者病例，并为患者的胚胎远距离移行提供了可能的解释。这项工作得到了机构审查委员会的批准。

环境

大学医院。

病人）

32岁女性（妊娠2，产妇0）有右侧输卵管切除史，IVF-ET后40天因异位妊娠1天入院；患者继发不孕6年。妇科检查显示前 40 天子宫无压痛。术前B超显示子宫内膜23mm，宫腔内未见孕囊声像。磁共振成像显示在第三腰椎前主动脉与下腔静脉之间的间隙处检测到1个约30×28×35mm的椭圆形信号。孕囊右后方可见下腔静脉，左后方可见腹主动脉。

干预措施

使用 B 型超声、MRI 和病理分析诊断 IVF-ET 后腹膜后异位妊娠伴淋巴管迁移，并通过腹腔镜切除。

主要观察指标）

输卵管手术史患者接受IVF-ET远距离异位移行的机制分析

结果）

患者经B超和MRI确诊，行腹腔镜手术确诊并切除腹膜后异位妊娠组织。此外，使用超声波刀完全去除妊娠病变。病理检查显示妊娠组织位于淋巴组织包围的肿大淋巴结内，子宫内膜组织也可见淋巴细胞浸润，提示着床胚胎经淋巴管迁移至腹膜后腔。患者术后1年通过IVF-ET成功受孕，剖宫产产下足月新生儿。

结论

该病例进一步表明，对于有输卵管手术史的患者，无论是单侧还是双侧，临床医生都应更加关注 IVF-ET 后腹膜后妊娠的可能性以及对此类患者的随访。病理检查报告提供的证据表明，淋巴管迁移可能是腹膜后异位妊娠或宫内植入后胚胎迁移的可能机制。