Presentation
Post menopausal bleeding.
Patient Data
The uterine cervix is replaced by a heterogeneous, hypervascular mass measuring 60 x 50 x 63 mm. It has markedly irregular margins, likely infiltrating into the parametrium. There is evidence of extension to the posterior bladder wall.
The endometrial cavity is distended by fluid with low-level internal echoes, in keeping with a hematometra. This measures 51 x 74 x 91 mm (206 mL). Endometrium is not clearly seen, no intracavitary mass component is evident on ultrasound.
Normal postmenopausal appearance of both ovaries. No adnexal cysts or other masses.
No pelvic free fluid.
Moderate left hydronephrosis. The right kidney appears normal.
Pelvic sidewall lymph nodes are not adequately assessed with ultrasound.
PRIMARY TUMOR:
Large infiltrative circumferential soft tissue mass replaces the uterine cervix with marked diffusion restriction.
Dimensions: 82 x 65 x 52 mm, Axials x SI, volume 140-150 cc.
There is invasion of the lower uterine segment circumferentially with complete secondary obstruction, endometrial cavity distended by simple fluid. Large volume bilateral parametrial invasion. Lower 1/3 of vagina is involved anteriorly on the left.
Marked hydronephrosis on the left, with circumferential encasement of the distal left ureter. Tumor abuts the distal right ureter with at least 90 degrees contact causing very mild right hydronephrosis.
Pelvis sidewall invasion is present on the left encasing the left internal iliac vessels, and tumor abutting but not invading the left obturator internus and left levator ani inferiorly.
Macroscopic bladder invasion from the dome of the urinary bladder superiorly posteriorly along the posterior wall to the bladder neck with urethral invasion just distal to the bladder neck between 3 o'clock and 6 o'clock. Tumor abuts but does not invade the rectum posteriorly.
REGIONAL NODES: Three suspicious pelvic nodes bilaterally. Two anterior left internal iliac nodes measuring 18 m and 19 mm in short axis with central cystic necrosis. Distal right common iliac node.
METASTASES: 28 mm osseous metastasis within the left acetabulum posteriorly.
Case Discussion
Stage 4B cervical cancer with multiple features relevant to cancer staging is demonstrated. In this case, the large invasive neoplasm was initially demonstrated on ultrasound.
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