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RADIOLOGY: ABDOMEN: Case# 32935: CERVICAL CA WITH RENAL & RETROPERITONEAL METS. 46 year old woman with cervical cancer. Check for metastatic disease. Patient states that she has pain in the hips and kidney region. There is a low attenuation soft tissue mass in the right retroperitoneum, invading the upper pole of the right kidney and the posterior segment of the right lobe of the liver. This mass measures 6.5cm transverse x 6.0cm AP and another region measures 6.5cm transverse x 4.2cm AP (image 1). There is bilateral hydronephrosis, moderate. The uterus is markedly enlarged. The left portion of the uterus is quite heterogeneous. This may represent fluid trapped within the uterine cavity, versus direct invasion by the previous cervical carcinoma, versus degenerating leiomyomas. There is also a focal well-circumscribed low attenuation lesion in the right portion of the uterus that may also represent tumor versus degenerating leiomyoma. Overall, this large uterine mass measures 11.5cm transverse x 8.2cm AP (image 2). The cervix does not appear enlarged, however, there are strandy infiltrative changes in the adjacent fat. There are also mild diffuse infiltrative changes in the remainder of the pelvic fat, consistent with radiation therapy. The bladder wall is also thickened, consistent with radiation. There are degenerative changes in the spine. There is a low attenuation mass in the right gluteal muscle, with dense peripheral rim. This is consistent with either necrotic tumor mass or abscess. Overall, it measures 3.2cm transverse x 3.2cm AP. 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