Presentation
Abnormal uterine bleeding.
Patient Data
The uterus is mildly enlarged measuring about 55*70*105 mm.
A 55*65*70 mm large mass originating from the lower segment endometrium with extension to the cervix and upper two-third endometrial cavity.
Invasion of the mass into the deep myometrium and reaches cervix, parametrium, vagina upper a third, and mesorectal fascia (with an implant measuring about 10*20mm ) are noted.
Bilateral complex adnexal masses with cystic necrotic changes measuring about 55*90 mm in the right side and 57*75 mm on the left side in the background of adnexal invasion by endometrial carcinoma.
The free fluid within the col-du-sac space with septations and metastatic implants up to 8 mm is seen.
Metastatic implants also are seen at the serosal layer of descending and sigmoid colons.
Metastatic adenopathies are seen next to the right common iliac and internal iliac chains up to 10*22 mm.
The endometrial mass and its metastatic implants at adnexal, peritoneal, and colonic loops serosal surfaces show heterogeneous signals with marked water restriction and heterogeneous enhancements.
An intramural myoma measuring about 14 mm is seen at the left posterior wall of the uterus body.
Case Discussion
The mass was biopsied and histopathologic examinations are consistent with endometrioid adenocarcinoma with papillary patterns in some foci.
Regarding the imaging findings, endometrioid adenocarcinoma with adjacent adnexal, parametrial invasion as well as lymph nodes and peritoneal implants are compatible with FIGO stage IVa.
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