Tattoo pigment migrates to regional lymph nodes, often causing acute or chronic lymphadenopathy. Past reports on tattoo lymphadenopathy are almost exclusively from Western countries. However, systemic distribution of tattoo pigment in lymph nodes has not been assessed in detail. In this article, we report a Japanese case of cervical adenocarcinoma, in which we successfully assessed the distribution of tattoo pigment deposition in pelvic and para-aortic lymph nodes. A 61-year-old woman with Japanese-style tattoos on both arms and her left thigh visited another clinic with postcoital bleeding. She was diagnosed with clinical stage 1B1 (cervical adenocarcinoma) and underwent radical hysterectomy and pelvic/para-aortic lymph node dissection. Histopathological examination revealed deposition of a black pigment in multiple lymph nodes. The pigment was more abundant in the left pelvic lymph nodes than in the para-aortic lymph nodes, a finding suggestive of pigment drainage from the tattoo on the left thigh. She remains free of disease more than 1 year after surgery. The diagnosis of tattoo lymphadenopathy is not easy when clinical information is lacking. The differential diagnoses include metastatic melanoma. Clinicians and pathologists should better recognize this phenomenon.