EURORAD ESR

Case 13121

Giant fibroepithelial polyp of the uterine cervix

Author(s)
Tonolini Massimo, M.D.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 87 year(s)
 
 
  • Figure 1
    Transvaginal ultrasound at admission
     

    Transverse (a) and longitudinal (b) scans showed post-hysterectomy status, enlarged uterine cervix stump (calipers) due to egg-shaped echogenic mass, absence of adnexal masses and free fluid.

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

    Transverse (a) and longitudinal (b) scans showed post-hysterectomy status, enlarged uterine cervix stump (calipers) due to egg-shaped echogenic mass, absence of adnexal masses and free fluid. (o Foley catheter balloon).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 2
    Urgent unenhanced and post-contrast multidetector CT
     

    Multiplanar unenhanced images (a-c) confirmed enlarged uterine cervix stump (arrowheads), with increased attenuation (55 Hounsfield units) in the dorsal portion (*) interpreted as intravaginal fresh blood. Foley...

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

    Multiplanar unenhanced images (a-c) confirmed enlarged uterine cervix stump (arrowheads), with increased attenuation (55 Hounsfield units) in the dorsal portion (*) interpreted as intravaginal fresh blood. Absent free...

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

    Multiplanar unenhanced images (a-c) confirmed enlarged uterine cervix stump (arrowheads), with increased attenuation (55 Hounsfield units) in the dorsal portion (*) interpreted as intravaginal fresh blood. Foley...

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

    After intravenous contrast the dorsal hyperattenuating portion (*) did not enhance. Arterial-phase early enhancement was noted in the anterior solid portion of the enlarged cervix (arrowheads), without contrast...

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

    After intravenous contrast the dorsal hyperattenuating portion (*) did not enhance. Arterial-phase early enhancement was noted in the anterior solid portion of the enlarged cervix (arrowheads), without contrast...

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

    Portal venous (f,g) and excretory (h,i) phase acquisitions showed persistent progressive enhancement in the anterior solid portion of the enlarged cervix (arrowheads), absent enhancement in the dorsal hyperattenuating...

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

    Portal venous (f,g) and excretory (h,i) phase acquisitions showed persistent progressive enhancement in the anterior solid portion of the enlarged cervix (arrowheads), absent enhancement in the dorsal hyperattenuating...

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

    Portal venous (f,g) and excretory (h,i) phase acquisitions showed persistent progressive enhancement in the anterior solid portion of the enlarged cervix (arrowheads), absent enhancement in the dorsal hyperattenuating...

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

    Portal venous (f,g) and excretory (h,i) phase acquisitions showed persistent progressive enhancement in the anterior solid portion of the enlarged cervix (arrowheads), absent enhancement in the dorsal hyperattenuating...

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

    Midline sagittal T2-weighted image confirmed heterogeneous intermediate-to-high signal mass (arrowheads) at the cervical stump. Note normal fluid-filled vagina (thin arrows).

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

    Coronal (b) and axial (c) T2-weighted images showed heterogeneous intermediate-to-high signal mass (arrowheads) at the cervical stump, with a central protruding portion (arrow).

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

    Coronal (b) and axial (c) T2-weighted images showed heterogeneous intermediate-to-high signal mass (arrowheads) at the cervical stump, with a central protruding portion (arrow).

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

    Note normal fluid-filled vagina (thin arrows) and urinary bladder.

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

    Heavily T2-weighted fat-suppressed image showed heterogeneous intermediate-to-high signal mass (arrowheads) at the cervical stump, with a central protruding portion (arrow). Surrounding planes (+) without adenopathies...

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

    The cervical stump mass (arrowheads) showed solid-type intermediate signal intensity on unenhanced T1-weighted acquisition.

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

    High b-value (600 sec/mm2) diffusion-weighted image (g) and corresponding apparent diffusion coefficient (ADC) map (g) showed mild hypointensity of the cervical stump mass (arrowheads).

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

    Corresponding apparent diffusion coefficient (ADC) map showed unrestricted diffusion of the cervical stump mass (arrowheads) with mean ADC value 1.62x10-3 mm2/sec.

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

    Sagittal (i) and fat-suppressed coronal (j) T1-weighted images after intravenous gadolinium showed heterogeneously enhancing cervical mass (arrowheads), normal mucosal enhancement at the vagina (thin arrows).

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

    Sagittal (i) and fat-suppressed coronal (j) T1-weighted images after intravenous gadolinium showed heterogeneously enhancing cervical mass (arrowheads), normal mucosal enhancement at the vagina (thin arrows).

     
    Area of Interest: Genital / Reproductive system female; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
Transverse (a) and longitudinal (b) scans showed post-hysterectomy status, enlarged uterine cervix stump (calipers) due to egg-shaped echogenic mass, absence of adnexal masses and free fluid.
 
Transverse (a) and longitudinal (b) scans showed post-hysterectomy status, enlarged uterine cervix stump (calipers) due to egg-shaped echogenic mass, absence of adnexal masses and free fluid. (o Foley catheter balloon).
 
Multiplanar unenhanced images (a-c) confirmed enlarged uterine cervix stump (arrowheads), with increased attenuation (55 Hounsfield units) in the dorsal portion (*) interpreted as intravaginal fresh blood. Foley catheter (short Arrow).
 
Multiplanar unenhanced images (a-c) confirmed enlarged uterine cervix stump (arrowheads), with increased attenuation (55 Hounsfield units) in the dorsal portion (*) interpreted as intravaginal fresh blood. Absent free fluid.
 
Multiplanar unenhanced images (a-c) confirmed enlarged uterine cervix stump (arrowheads), with increased attenuation (55 Hounsfield units) in the dorsal portion (*) interpreted as intravaginal fresh blood. Foley catheter (short Arrow).
 
After intravenous contrast the dorsal hyperattenuating portion (*) did not enhance. Arterial-phase early enhancement was noted in the anterior solid portion of the enlarged cervix (arrowheads), without contrast extravasation suggesting active bleeding.
 
After intravenous contrast the dorsal hyperattenuating portion (*) did not enhance. Arterial-phase early enhancement was noted in the anterior solid portion of the enlarged cervix (arrowheads), without contrast extravasation suggesting active bleeding.
 
Portal venous (f,g) and excretory (h,i) phase acquisitions showed persistent progressive enhancement in the anterior solid portion of the enlarged cervix (arrowheads), absent enhancement in the dorsal hyperattenuating portion(*).
 
Portal venous (f,g) and excretory (h,i) phase acquisitions showed persistent progressive enhancement in the anterior solid portion of the enlarged cervix (arrowheads), absent enhancement in the dorsal hyperattenuating portion (*).
 
Portal venous (f,g) and excretory (h,i) phase acquisitions showed persistent progressive enhancement in the anterior solid portion of the enlarged cervix (arrowheads), absent enhancement in the dorsal hyperattenuating portion (*).
 
Portal venous (f,g) and excretory (h,i) phase acquisitions showed persistent progressive enhancement in the anterior solid portion of the enlarged cervix (arrowheads), absent enhancement in the dorsal hyperattenuating portion(*).
 
Midline sagittal T2-weighted image confirmed heterogeneous intermediate-to-high signal mass (arrowheads) at the cervical stump. Note normal fluid-filled vagina (thin arrows).
 
Coronal (b) and axial (c) T2-weighted images showed heterogeneous intermediate-to-high signal mass (arrowheads) at the cervical stump, with a central protruding portion (arrow).
 
Coronal (b) and axial (c) T2-weighted images showed heterogeneous intermediate-to-high signal mass (arrowheads) at the cervical stump, with a central protruding portion (arrow).
 
Note normal fluid-filled vagina (thin arrows) and urinary bladder.
 
Heavily T2-weighted fat-suppressed image showed heterogeneous intermediate-to-high signal mass (arrowheads) at the cervical stump, with a central protruding portion (arrow). Surrounding planes (+) without adenopathies and inflammatory changes.
 
The cervical stump mass (arrowheads) showed solid-type intermediate signal intensity on unenhanced T1-weighted acquisition.
 
High b-value (600 sec/mm2) diffusion-weighted image (g) and corresponding apparent diffusion coefficient (ADC) map (g) showed mild hypointensity of the cervical stump mass (arrowheads).
 
Corresponding apparent diffusion coefficient (ADC) map showed unrestricted diffusion of the cervical stump mass (arrowheads) with mean ADC value 1.62x10-3 mm2/sec.
 
Sagittal (i) and fat-suppressed coronal (j) T1-weighted images after intravenous gadolinium showed heterogeneously enhancing cervical mass (arrowheads), normal mucosal enhancement at the vagina (thin arrows).
 
Sagittal (i) and fat-suppressed coronal (j) T1-weighted images after intravenous gadolinium showed heterogeneously enhancing cervical mass (arrowheads), normal mucosal enhancement at the vagina (thin arrows).
 
 
 
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