EURORAD ESR

Case 12396

Primary Carcinoma of the Rectovaginal Septum

Author(s)
Mónica Vieira1, Teresa Margarida Cunha2, Jorge São Martinho3

1. Hospital José Joaquim Fernandes, Unidade Local de Saúde do Baixo Alentejo, Imagiologia; R. Dr. António Fernando José Covas Lima 7801-849 Beja, Portugal; Email:vieira@med.up.pt
2. Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
3. Clinica Ecorad, Vila Franca de Xira, Portugal
 
Patient
female, 61 year(s)
 
 
  • Figure 1
    Sigmoidoscopy

    Sigmoidoscopy shows (A) bulging of the sigmoid wall (asterix) about 25% of the circumference at 12 cm from anal canal, and (B) vegetative lesion with about 3cm (arrow) at 6 cm from the anal canal.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: RIS; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 2
    Axial contrast enhanced CT
     

    Heterogeneous solid spherical mass in the pouch of Douglas (asterix) with apparent invasion of parametrium (arrowhead), with no cleavage plane with rectum or cervix.There are enlarged left inguinal nodes.

     
    Area of Interest: Foetal imaging; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    There are enlarged lymph nodes in left external iliac (asterix) and pre-sacral (white arrow) lymphatic chains.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    There are enlarged lymph nodes in celiac (asterix) and retrocrural (black arrow) lymphatic chains.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Image acquisition in the excretory phase with rectal administration of contrast helps to better define the involvement of rectum wall (black arrow).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 3
    MRI
     

    Sagittal FSE T2-WI demonstrates a large mass (asterix) in the pouch of Douglas / rectovaginal septum with intermediate/high signal intensity, that extends to the uterine cervix and myometrium, compressing the sigmoid...

     
    Area of Interest: Eyes; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    The low signal of the inner layer of fibromuscular cervical stroma is preserved (circle).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    The mass was inseparable from rectum wall (arrow, see the correlation with sigmoidoscopy in Fig. 1A).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    There were multiples enlarged lymph nodes; some are shown (circles).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    On axial SE T1-WI, a mass with intermediate signal intensity is seen between the uterine cervix and rectum.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Sagittal contrast-enhanced fat-saturated T1-WI shows heterogeneous enhancement with slight area of necrosis. The invasion of the anterior rectal wall is better seen (arrow).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Coronal FSE T2-WI shows unremarkable right ovary separately identified from the mass (arrow).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Coronal FSE T2-WI shows unremarkable left ovary separately identified from the mass (arrow).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 4
    Histologic and immunohistochemical features

    (A, B) Hematoxylin and eosin stain section of biopsy showing solid tumor growth and marked cytologic atypia. Tumor showing positive staining for CAM5.2 (C) and CK7 (D). (E) Tumor showing nuclear positive stain for WT1.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Neoplasia;
     
     
Sigmoidoscopy shows (A) bulging of the sigmoid wall (asterix) about 25% of the circumference at 12 cm from anal canal, and (B) vegetative lesion with about 3cm (arrow) at 6 cm from the anal canal.
 
Heterogeneous solid spherical mass in the pouch of Douglas (asterix) with apparent invasion of parametrium (arrowhead), with no cleavage plane with rectum or cervix.There are enlarged left inguinal nodes.
 
There are enlarged lymph nodes in left external iliac (asterix) and pre-sacral (white arrow) lymphatic chains.
 
There are enlarged lymph nodes in celiac (asterix) and retrocrural (black arrow) lymphatic chains.
 
Image acquisition in the excretory phase with rectal administration of contrast helps to better define the involvement of rectum wall (black arrow).
 
Sagittal FSE T2-WI demonstrates a large mass (asterix) in the pouch of Douglas / rectovaginal septum with intermediate/high signal intensity, that extends to the uterine cervix and myometrium, compressing the sigmoid colon (arrowhead).
 
The low signal of the inner layer of fibromuscular cervical stroma is preserved (circle).
 
The mass was inseparable from rectum wall (arrow, see the correlation with sigmoidoscopy in Fig. 1A).
 
There were multiples enlarged lymph nodes; some are shown (circles).
 
On axial SE T1-WI, a mass with intermediate signal intensity is seen between the uterine cervix and rectum.
 
Sagittal contrast-enhanced fat-saturated T1-WI shows heterogeneous enhancement with slight area of necrosis. The invasion of the anterior rectal wall is better seen (arrow).
 
Coronal FSE T2-WI shows unremarkable right ovary separately identified from the mass (arrow).
 
Coronal FSE T2-WI shows unremarkable left ovary separately identified from the mass (arrow).
 
(A, B) Hematoxylin and eosin stain section of biopsy showing solid tumor growth and marked cytologic atypia. Tumor showing positive staining for CAM5.2 (C) and CK7 (D). (E) Tumor showing nuclear positive stain for WT1.
 
 
 
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