Lymphoma of the uterine cervix

Mild to moderate right hydronephrosis. Large heterogenous uterine cervix mass. Mild internal vascularity is seen in this mass on color Doppler ultrasound examination.

Findings: There is a large heterogeneous solid mass, containing central necrosis, measuring 12 x 10 x 9 cm, arising from the uterine cervix. It is inseparable from the posterior urinary bladder wall, extending into the parametrial area and invading/encasing the ovaries and right ureter leading to moderate hydroureteronephrosis and diffuse periureteric soft tissue thickening. Mild right perinephric fat stranding and perinephric free fluid. Partially duplex bilateral renal collecting system. A double-J stent is seen in the lower pole moiety of the right kidney. Poorly enhancing upper pole of the right kidney and a few hypo enhancing /nonenhancing focal lesions in the left kidney. A well-defined hypodense lesion showing peripheral enhancement, measuring 2.5 cm is seen in the segment 2 of the liver.  Mild splenomegaly. Enlarged bilateral external iliac and left inguinal lymph nodes. Small fat containing umbilical hernia. Two small subcutaneous nodules are seen in the anterior abdominal wall (above & below the umbilicus). 

Conclusion: 1. Large cervical mass; possible differentials include lymphoma of the uterine cervix and carcinoma of the cervix.  Possibility of leiomyoma of the uterine cervix is unlikely. Hepatic & renal lesions, pelvic & left inguinal lymphadenopathy and small subcutaneous nodules are likely metastatic deposits.

Findings: Relatively enlarged left thyroid lobe with a few nodules. Small lymph nodes along the bilateral internal mammary arteries, small lymph node in the anterior mediastinum and in left axilla. Bilateral apical pleural thickening and pleural calcifications in the lower chest. A soft tissue density lung nodule measuring 8 mm in the right lower lobe.

Findings: Large predominantly solid mass containing some cystic areas arising from uterine cervix. It is almost isointense to the muscles on both T1 & T2 images, shows diffusion restriction and heterogeneous enhancement on post-contrast study. No fat, calcification or hemorrhage is seen in it. It shows extension to the right pelvic sidewall, right parametrial & right posterior urinary bladder wall invasion and encasement of the right distal ureter. The uterus is displaced to the left side and has normal endometrial lining. Small anterior intramural fibroid. Enlarged right internal iliac & left inguinal lymph nodes.

Findings: Large intensely hypermetabolic mass arising from the uterine cervix and involving bilateral adnexa. The mass is extending superiorly along the right ureter to the renal pelvis. There is diffuse hypermetabolic peritoneal disease. Hypermetabolic lesions are seen at the lower pole of left kidney, around the kidneys, segment 2 of the liver, and left thyroid lobe. Hypermetabolic bilateral external & internal iliac, bilateral inguinal, left supraclavicular, anterior mediastinal, left internal mammary and left axillary lymph nodes. Impression: Stage IV lymphoma.

There is persistence of heterogeneously hypermetabolic mass in uterine cervix extending along the right ureter up to the renal pelvis. Multiple hypermetabolic peritoneal lesions have resolved/significantly improved; however, hypermetabolic lesions are still appreciable anterior to the spleen, inferior to the right hepatic lobe, and along the lower pole of right kidney.  The supraumbilical anterior abdominal wall nodule is smaller in size; however, with persistent hypermetabolism. An interval improvement is noted in the lymphadenopathy; however, some hypermetabolic residual lymph nodes are seen in the left inguinal, peripancreatic and retrosternal regions. Hypermetabolic left thyroid lobe nodules also show interval improvement; however, some residual persistent hypermetabolism is still appreciable. Impression: Partial interval improvement; however, with significant residual disease.