Vaginal bleeding after receiving three sessions of chemoradiotherapy.
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Irregular circumferential thickening of the cervical wall extends downward to involve the upper half vagina and infiltration of the parametrium more obviously in the left side is seen.
Invasion of the mass to the left posterolateral wall of the urinary bladder and dilatation of the left ureter and hydroureteronephrosis is evident.
Involving the mesorectal fascia with tumor approaching the anterior middle third rectum in the left side is noted.
Invasion of the mass to the left pelvic sidewall muscles including the piriformis and coccygeus muscles also is noted.
There is no regional metastasis.
Post-treatment edematous changes are seen at the intrinsic and extrinsic pelvic muscles and surrounding soft tissues.
In the recent case with cervical mass with regarding the imaging findings, locally advanced cervical cancer (stage IVa) is considered according to FIGO system staging.
Histopathology report after biopsy of cervical mass:
Innumerable irregular nests consist of malignant squamous cells invading the stroma. Laminated keratin pearls are seen within the center of the nests. Individual cells have abundant eosinophilic keratinized cytoplasm.
Diagnosis: Keratinizing type of the cervix squamous cell carcinoma.