EURORAD ESR

Case 12446

Neuroendocrine cervical carcinoma – a rare tumour with agressive behaviour

Author(s)
Cristina Maciel1, 2, Óran Roche2, Giovanni Coniglio2, Anju Sahdev2

(1) Hospital São João,
Serviço de Radiologia;
Alameda Prof. Hernâni Monteiro
4200-319 Porto, Portugal;
Email:tina_maciel@yahoo.com
(2) St Bartholomew's Hospital,
Department of Radiology;
West Smithfield
London EC1A 7BE, UK
 
Patient
female, 47 year(s)
 
 
  • Figure 1
    Pelvic MRI
     

    Sagittal T2W. Large tumour extending from the cervical stroma (T), distending the endocervical canal (blue arrow), involving the vaginal fornices (red arrows) and the uterine body/fundus, with deep myometrial...

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

    Coronal oblique T2W. Breach of the low-signal-intensity ring of cervical stroma (red arrows), with tumour extension within vaginal fornices (blue arrows). There is parametrial irregularity bilaterally (short arrows),...

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

    Sagittal T1W contrast-enhanced image shows poor enhancement of the tumour, with necrotic areas (blue arrow).

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

    (a) DWI and ADC map show marked restriction in the cervix. (b) DWI and ADC map at the level of the uterine body show marked restriction, in keeping with myometrial invasion.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 2
    [18F]FDG-PET
     

    [18F]FDG-PET MIP image demonstrates intense metabolic activity within a large pelvic mass corresponding to the primary cervical tumour. Widely disseminated metabolically active metastatic disease is revealed, in...

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

    Spot image from three-dimensional MIP demonstrates multiple foci of intense FDG uptake in the supra and infratentorial brain parenchyma in keeping with brain metastasis.

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: PET; Procedure: Diagnostic procedure; Special Focus: Metastases;
     
     
  • Figure 3
    [18F]-FDG-PET/CT
     

    Axial low dose CT image shows cannonball metastases. Fused [18F]-FDG-PET/CT demonstrates corresponding avid FDG uptake within the pulmonary nodules in keeping with lung metastasis.

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

    Axial CT and fused [18F]-FDG-PET/CT. Nodular soft tissue lesion just inferior to the falciform ligament, with intense FDG uptake consistent with neoplastic deposit (blue arrows). Large paraaortic nodal disease (red...

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

    Axial CT and fused [18F]-FDG-PET/CT. Nodular left adrenal lesion with intense FDG uptake, consistent with metastases (blue arrows). Right retrocural nodal disease is depicted (red arrows). Physiological [18F]-FDG...

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

    Axial low dose CT and fused [18F]-FDG-PET/CT. Nodular lesion in right paracolic gutter, with intense FDG uptake, in keeping with a peritoneal deposit (blue arrows). Aortocaval (red arrows) and paraaortic (short...

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: PET-CT; Procedure: Diagnostic procedure; Special Focus: Metastases;
     
     
Sagittal T2W. Large tumour extending from the cervical stroma (T), distending the endocervical canal (blue arrow), involving the vaginal fornices (red arrows) and the uterine body/fundus, with deep myometrial invasion (short arrow).
 
Coronal oblique T2W. Breach of the low-signal-intensity ring of cervical stroma (red arrows), with tumour extension within vaginal fornices (blue arrows). There is parametrial irregularity bilaterally (short arrows), in keeping with parametrial invasion. T-tumour.
 
Sagittal T1W contrast-enhanced image shows poor enhancement of the tumour, with necrotic areas (blue arrow).
 
(a) DWI and ADC map show marked restriction in the cervix. (b) DWI and ADC map at the level of the uterine body show marked restriction, in keeping with myometrial invasion.
 
[18F]FDG-PET MIP image demonstrates intense metabolic activity within a large pelvic mass corresponding to the primary cervical tumour. Widely disseminated metabolically active metastatic disease is revealed, in keeping with a very aggressive tumour.
 
Spot image from three-dimensional MIP demonstrates multiple foci of intense FDG uptake in the supra and infratentorial brain parenchyma in keeping with brain metastasis.
 
Axial low dose CT image shows cannonball metastases. Fused [18F]-FDG-PET/CT demonstrates corresponding avid FDG uptake within the pulmonary nodules in keeping with lung metastasis.
 
Axial CT and fused [18F]-FDG-PET/CT. Nodular soft tissue lesion just inferior to the falciform ligament, with intense FDG uptake consistent with neoplastic deposit (blue arrows). Large paraaortic nodal disease (red arrows).
 
Axial CT and fused [18F]-FDG-PET/CT. Nodular left adrenal lesion with intense FDG uptake, consistent with metastases (blue arrows). Right retrocural nodal disease is depicted (red arrows). Physiological [18F]-FDG renal excretion.
 
Axial low dose CT and fused [18F]-FDG-PET/CT. Nodular lesion in right paracolic gutter, with intense FDG uptake, in keeping with a peritoneal deposit (blue arrows). Aortocaval (red arrows) and paraaortic (short arrows). lymphadenopathy.
 
 
 
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