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Loss of normal T2 hypointense signal of posterior cervical which is replaced by a solid T2 hyperintense lesion that shows diffusion restriction spanning little over 4cm, caudally involving posterior vaginal fornices and upper third of vagina. No parametrial extension. No pelvic lymphadenopathy. Bulky body of uterus with increased T2 hypointensity of subendometrial myometrium with prominent vascular spaces. Asymmetric bulkiness of posterior uterine wall with a slightly indistinct junctional zone. Normal ovaries.
Bleeding in between regular cycles is ominous and needs work up. This patient visited the gynecologist who examined here and felt fullness in the posterior vaginal fornices. She took a biopsy and referred the patient for a trans vaginal ultrasound, which identified a lesion in the posterior cervix. In the meantime histopathology turned out to be poorly differntiating carcinoma probably non keratinizing squamous cell carcinoma. Adenomyotic changes are seen in the uterine body.
Staging of cervical neoplasm is done using MRI. Non contrast three plane T2 weighted imaging is sufficient to assess local extent. Parametrial extension is assessed. Ideally 50-100 ml of ultrasound gel injected into the vagina allows better depiction of vaginal extent (not done in this case). Gadolinium use is not mandatory.