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RADIOLOGY: GENITOURINARY: GU: Case# 32923: CERVICAL CANCER WITH HEMATOMETRA AND HYDROURETERO-NEPHROSIS. A 48-year-old black female presented with a two month history of vaginal bleeding. She has a prior history of uterine fibroids. The study is being done to rule out endometrial cancer. A large heterogenous soft tissue mass in direction of cervix is seen measuring approximately 7.5 x 9 x 9 cm in its transverse, anterior-posterior and craniocaudal dimensions. The mass is seen displacing the urinary bladder anteriorly and the rectum posteriorly. There are areas of speckled calcification located peripherally in the mass. The uterus is enlarged with dilated uterine cavity suggesting hydrometra secondary to obstruction by a cervical mass. Multiple right internal iliac and para-aortic retroperitoneal lymph nodes are seen. With the largest right internal iliac node measuring 2.5 x 3.5 cm. The confluent nodal mass in the para-caval region is seen obstructing the right ureter causing severe right hydrouretero-nephrosis with right renal cortical atrophy. CT is useful in staging cervical cancer, documenting response to therapy, and detecting recurrence. Most cervical cancers spread by direct extension to adjacent organs and appear as thick tissue strands or masses extending from the cervix to the parametrium, ureters, vagina, or pelvic side walls. . Lymphatic spread to the regional nodes is common. Enlargement of nodes may be evident, however, cervical cancer may involve the nodes without enlarging them. Metastasis to lung, bone, and brain is uncommon and occurs late. CT findings of the primary tumor include enlargement of the cervix, a hypodense mass within the cervix, and fluid in the endometrial cavity secondary to obstruction. Recurrences most commonly occur in the top of the vaginal vault in patients who have had hysterectomy, but may occur anywhere. Enlarged nodes in patients may indicate recurrence in a patient with a previous history of cervical cancer.

Peter Anderson