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Recurrent Cervical Carcinoma: Typical and Atypical Manifestations¹

¹ From the Departments of Radiology (A.S.F., S.G.O.), Obstetrics and Gynecology (E.M.S.), and Radiation Oncology (B.D.K.), Medical College of Virginia, Virginia Commonwealth University, 12th and Marshall Sts, Richmond, VA 23298-0058. Recipient of a Certificate of Merit award for a scientific exhibit at the 1998 RSNA scientific assembly. Received February 5, 1999; revision requested March 17 and received March 31; accepted April 1. Address reprint requests to A.S.F.

After treatment of cervical carcinoma, recurrent disease may be observed in multiple sites at imaging. Both typical and atypical manifestations of recurrent disease occur. Typical manifestations of recurrent cervical carcinoma involve the pelvis and lymph nodes. Pelvic recurrences may be observed as masses involving the cervix and uterus, vagina or vaginal cuff, parametria, bladder, ureters, rectum, or ovaries and may result in fistula formation or hydronephrosis. Nodal recurrence may be identified as enlarged pelvic and retroperitoneal nodes. Atypical manifestations of recurrent cervical carcinoma are being recognized with greater frequency due to the use of intensive pelvic radiation therapy, the evolution of improved imaging techniques, and the more frequent use of imaging as a means of surveillance. These atypical manifestations may involve the solid organs of the abdomen (focal masses) as well as the peritoneum, mesentery, and omentum (implants); gastrointestinal tract (obstruction, fistula formation, ischemia); chest (metastases to the lung parenchyma, pleura, and pericardium); bones (destructive lesions); and other sites. Familiarity with the imaging features of recurrent cervical carcinoma in these anatomic locations will facilitate prompt, accurate diagnosis and treatment.

Index Terms: Abdomen, neoplasms, 70.33 • Adrenal glands, neoplasms, 86.33 • Bone neoplasms, secondary, 30.33, 40.33 • Liver neoplasms, metastases, 761.33 • Lymphatic system, neoplasms, 99.8311 • Pelvic organs, neoplasms, 80.33 • Thorax, neoplasms, 60.33 • Uterine neoplasms, 854.32