Presentation
Vaginal bleeding in a postmenopausal woman. Gynecological examination revealed a 3 cm mass in the cervix - biopsy performed.
Patient Data
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Technique: Axial images were obtained through the abdomen (not shown) and pelvis after oral contrast administration and after intravenous contrast (portal venous and renal excretory phases). Multiplanar reconstructions were also done.
Findings: There is a heterogeneously enhancing mass involving the cervix, measuring 6.8 x 3.5 x 4.5 cm (Long x AP x T), apparently limited to the upper 2/3rd of vagina, with indistinct CT limits to the posterior aspect of the bladder wall. A thin layer of fat tissue seems to separate the mass from the anterior wall of the rectum. The body of the uterus shows a distended/obstructed endometrium cavity surrounded by a thin myometrium wall. Enlarged left external iliac lymph node. No free fluid in the pelvis. The remainder exam is unremarkable.
Conclusion: Mass involving the cervix as described - MRI study is required to assess parametrial invasion. Left external iliac enlarged lymph node -likely N1 disease.
Case Discussion
Unfortunately, in many places in the world, access to MRI exams is still difficult. As a way to not delay treatment, oncologists request CT of the pelvis for local staging in some gynecological malignancies.
This case was histologically confirmed as a squamous cell carcinoma of the cervix.
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