Background. Lymphatic and hematologic metastases are rare in microinvasive cervical cancers (FIGO stage IA1), supporting a role for conservative treatment. Cervical conization followed by prolonged surveillance is an accepted treatment in patients with low- risk features and negative surgical margins. This option is particularly appealing for younger or nulliparous patients, in whom fertility may be highly desired. Case. We report a case of a 22- year- old, HIV- negative female with stage IA1 squamous cell cervical carcinoma who was found to have bilateral lymph node metastases in both pelvic and para- aortic distributions after electing to undergo hysterectomy. Conclusion. Clinicians treating patients with microinvasive cervical cancer conservatively must be aware of the possibility of lymph node involvement and should consider radiological imaging to look for metastatic disease. Background. Lymphatic and hematologic metastases are rare in microinvasive cervical cancers (FIGO stage IA1), supporting a role for conservative treatment. Cervical conization followed by prolonged surveillance is an accepted treatment in patients with low- risk features and negative surgical margins. This option is particularly appealing for younger or nulliparous patients, in whom fertility may be highly desirable. Case report, case of a 22-year-old, HIV-negative female with stage IA1 squamous cell cervical carcinoma who was found to have bilateral lymph node metastases in both pelvic and para-aortic distributions after electing to undergo hysterectomy. Conclusion. Clinicians treating patients with microinvasive cervical cancer conservatively must be be aware of the possibility of lymph node involvement and should consider radiological imaging to look for metastatic disease.