MR Imaging Findings and Patterns of Spread in Secondary Tumor Involvement of the Uterine Body and Cervix
Ur Metser1,
Masoom A. Haider1,
Korosh Khalili1 and
Scott Boerner2
1 Department of Medical Imaging, University Health Network—Mount Sinai
Hospitals, Princess Margaret Hospital, University of Toronto, 610 University
Ave., Toronto, Ontario M5G 2M9, Canada.
2 Department of Pathology, University Health Network—Mount Sinai Hospital,
Princess Margaret Hospital, University of Toronto, Toronto, Ontario M5G 2M9,
Canada.
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Fig. 1A. —39-year-old woman who underwent subtotal gastrectomy for
signet-ring cell adenocarcinoma of stomach. Transverse sonogram of pelvis
shows large cauliflowerlike mass (arrows) protruding into bladder
lumen. Biopsy revealed mass to be metastatic gastric adenocarcinoma.
Contrast-enhanced CT scan (not shown) showed left ovarian mass and seeding
along peritoneal reflections between bladder and uterus.
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Fig. 1B. —39-year-old woman who underwent subtotal gastrectomy for
signet-ring cell adenocarcinoma of stomach. Axial T2-weighted MR image shows
complex, partially cystic left adnexal mass (M) consistent with Krukenberg's
tumor invading myometrium (arrowheads).
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Fig. 2. —80-year-old woman with moderately differentiated
adenocarcinoma of colon situated 20 cm from anal verge. Sagittal
contrast-enhanced T1-weighted MR image obtained for staging reveals 4.6-cm
mass (M) in sigmoid colon invading posterior body (arrowheads) of
uterus (asterisk).
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Fig. 3A. —85-year-old woman with 1-month history of postmenopausal
bleeding. Biopsy of friable growth on cervix showed adenocarcinoma of
indeterminate origin. MR imaging shows two separate abnormalities. Axial
T2-weighted MR image shows complex, partially cystic mass in left adnexa
(arrows) and polypoid mass of intermediate signal intensity
encompassing both anterior and posterior lips of cervix
(arrowheads).
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Fig. 3B. —85-year-old woman with 1-month history of postmenopausal
bleeding. Biopsy of friable growth on cervix showed adenocarcinoma of
indeterminate origin. MR imaging shows two separate abnormalities. Coronal
T2-weighted MR image more clearly delineates cervical mass
(arrowheads). Note inflated balloon of Foley catheter (B) and fluid
in vagina. Pathologic examination found well-differentiated papillary serous
adenocarcinoma of left ovary involving left fallopian tube. Cervical mass
represented metastatic deposit.
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Fig. 4A. —64-year-old woman who presented with hematuria. She had
undergone transurethral resection of high-grade transitional cell carcinoma of
bladder 12 months earlier, and findings at cystoscopy performed 6 months after
surgery had been normal. Recent cystoscopic findings suggested presence of
mass thought to be invading bladder from external source. Sagittal T2-weighted
image shows mass in uterine body and cervix with loss of definition of
junctional zone (arrows) and extension into upper vagina
(arrowhead). Both ovaries were also involved (not shown).
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Fig. 4B. —64-year-old woman who presented with hematuria. She had
undergone transurethral resection of high-grade transitional cell carcinoma of
bladder 12 months earlier, and findings at cystoscopy performed 6 months after
surgery had been normal. Recent cystoscopic findings suggested presence of
mass thought to be invading bladder from external source. Sagittal T1-weighted
contrast-enhanced MR image shows enlarged, heterogeneously enhancing uterine
body, cervix, and bladder wall consistent with tumor infiltration
(arrows). Endometrial involvement (arrowheads) is also seen.
Initial radiologic diagnosis was primary cervical or endometrial tumor. At
biopsy, tumor was found to be high-grade papillary urothelial carcinoma with
capillarylike space involvement by tumor.
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Fig. 5A. —47-year-old woman who presented with intermittent vaginal
bleeding. Pap smear showed malignant cells compatible with adenocarcinoma.
Contrast-enhanced CT scan of pelvis shows enlarged uterus (arrows).
Retroperitoneal lymphadenopathy and bone metastases (not shown) were also
found.
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Fig. 5B. —47-year-old woman who presented with intermittent vaginal
bleeding. Pap smear showed malignant cells compatible with adenocarcinoma.
Sagittal T2-weighted MR image shows enlarged uterus with preserved shape as
well as diffuse heterogeneous low signal of myometrium and loss of junctional
zone (arrows). Diffuse bone marrow infiltration (arrowheads)
consistent with metastases is visible.
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Fig. 5C. —47-year-old woman who presented with intermittent vaginal
bleeding. Pap smear showed malignant cells compatible with adenocarcinoma.
Axial delayed (120 sec) contrast-enhanced fat-suppressed T1-weighted MR image
of lower uterine segment and cervix shows persistent hypointense foci in
myometrium (arrowheads). Abnormal signal (arrows) in
endometrial and endocervical canals shown in B can also be seen on both
images.
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Fig. 5D. —47-year-old woman who presented with intermittent vaginal
bleeding. Pap smear showed malignant cells compatible with adenocarcinoma.
T2-weighted MR image of lower uterine segment and cervix (corresponding to
C) shows thickening of myometrium with loss of junctional zone
(arrows). Abnormal signal (arrowheads) within endometrial
and endocervical canal can also be seen.
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Fig. 5E. —47-year-old woman who presented with intermittent vaginal
bleeding. Pap smear showed malignant cells compatible with adenocarcinoma.
Photomicrograph of histopathologic specimen shows abnormal increase in
cellularity of cervical stroma and linear infiltrates of abnormal small cells
with scattered signet-ring morphology (arrow). Morphology of
malignant cells and pattern of infiltration are classic signs of metastatic
lobular carcinoma of breast. On subsequently obtained mammogram (not shown),
2-cm spiculated mass was seen adjacent to inverted nipple, consistent with
primary carcinoma of the breast. (H and E, x200)
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Copyright © 2003 by the American Roentgen Ray Society.
