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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.

View larger version (143K): [in a new window]   Figures 1, 2.   (1) Central pelvic recurrence in the cervix with no anterior, posterior, or lateral extension of disease in a 71-year-old woman who initially underwent radiation therapy. (a) CT scan shows enlargement and heterogeneity of the cervix (arrows), a finding indicative of recurrent carcinoma. Fluid is noted in the endocervical canal (arrowhead). (b) CT scan obtained 3 cm cephalad to a demonstrates a markedly distended and fluid-filled endometrial cavity (hydrometra) (*) that resulted from recurrent tumor obstructing the external cervical os. The superior aspect of the unenhanced urinary bladder (arrow) is seen anterior to the uterus. (2) Central pelvic recurrence with posterior extension and development of a rectovaginal fistula in a 34-year-old woman who initially underwent radical hysterectomy. (a) CT scan reveals an air-containing soft-tissue mass (arrows) arising from the left side of the vaginal cuff and extending posteriorly to involve the rectum (R). The air locules within the mass are supportive evidence of a rectovaginal fistula. (b) Lateral image from a barium enema study helps confirm the fistula (arrowheads) connecting the rectum (R) and the partially enhanced vaginal cuff (arrows).

View larger version (153K): [in a new window]   Figures 1, 2.   (1) Central pelvic recurrence in the cervix with no anterior, posterior, or lateral extension of disease in a 71-year-old woman who initially underwent radiation therapy. (a) CT scan shows enlargement and heterogeneity of the cervix (arrows), a finding indicative of recurrent carcinoma. Fluid is noted in the endocervical canal (arrowhead). (b) CT scan obtained 3 cm cephalad to a demonstrates a markedly distended and fluid-filled endometrial cavity (hydrometra) (*) that resulted from recurrent tumor obstructing the external cervical os. The superior aspect of the unenhanced urinary bladder (arrow) is seen anterior to the uterus. (2) Central pelvic recurrence with posterior extension and development of a rectovaginal fistula in a 34-year-old woman who initially underwent radical hysterectomy. (a) CT scan reveals an air-containing soft-tissue mass (arrows) arising from the left side of the vaginal cuff and extending posteriorly to involve the rectum (R). The air locules within the mass are supportive evidence of a rectovaginal fistula. (b) Lateral image from a barium enema study helps confirm the fistula (arrowheads) connecting the rectum (R) and the partially enhanced vaginal cuff (arrows).

View larger version (135K): [in a new window]   Figures 1, 2.   (1) Central pelvic recurrence in the cervix with no anterior, posterior, or lateral extension of disease in a 71-year-old woman who initially underwent radiation therapy. (a) CT scan shows enlargement and heterogeneity of the cervix (arrows), a finding indicative of recurrent carcinoma. Fluid is noted in the endocervical canal (arrowhead). (b) CT scan obtained 3 cm cephalad to a demonstrates a markedly distended and fluid-filled endometrial cavity (hydrometra) (*) that resulted from recurrent tumor obstructing the external cervical os. The superior aspect of the unenhanced urinary bladder (arrow) is seen anterior to the uterus. (2) Central pelvic recurrence with posterior extension and development of a rectovaginal fistula in a 34-year-old woman who initially underwent radical hysterectomy. (a) CT scan reveals an air-containing soft-tissue mass (arrows) arising from the left side of the vaginal cuff and extending posteriorly to involve the rectum (R). The air locules within the mass are supportive evidence of a rectovaginal fistula. (b) Lateral image from a barium enema study helps confirm the fistula (arrowheads) connecting the rectum (R) and the partially enhanced vaginal cuff (arrows).

View larger version (146K): [in a new window]   Figures 1, 2.   (1) Central pelvic recurrence in the cervix with no anterior, posterior, or lateral extension of disease in a 71-year-old woman who initially underwent radiation therapy. (a) CT scan shows enlargement and heterogeneity of the cervix (arrows), a finding indicative of recurrent carcinoma. Fluid is noted in the endocervical canal (arrowhead). (b) CT scan obtained 3 cm cephalad to a demonstrates a markedly distended and fluid-filled endometrial cavity (hydrometra) (*) that resulted from recurrent tumor obstructing the external cervical os. The superior aspect of the unenhanced urinary bladder (arrow) is seen anterior to the uterus. (2) Central pelvic recurrence with posterior extension and development of a rectovaginal fistula in a 34-year-old woman who initially underwent radical hysterectomy. (a) CT scan reveals an air-containing soft-tissue mass (arrows) arising from the left side of the vaginal cuff and extending posteriorly to involve the rectum (R). The air locules within the mass are supportive evidence of a rectovaginal fistula. (b) Lateral image from a barium enema study helps confirm the fistula (arrowheads) connecting the rectum (R) and the partially enhanced vaginal cuff (arrows).

View larger version (154K): [in a new window]   Figures 3, 4.   (3) Central pelvic recurrence with anterior extension into the urinary bladder and left ureter in a 33-year-old woman. Excretory-phase contrast material-enhanced CT scan shows a large, centrally located pelvic mass (straight arrows) that is inseparable from the posterior wall of the urinary bladder (arrowheads) and encases the enhanced left ureter (curved arrow). (4) Central pelvic recurrence with lateral and anterior extension in a 57-year-old woman who presented with pelvic pain, a palpable anterior pelvic wall mass, and vaginal discharge. CT scan demonstrates a mass (straight arrows) arising from the vaginal cuff, infiltrating the right lateral and anterior walls of the urinary bladder (B), and invading the anterior pelvic wall (arrowheads). A vesicovaginal fistula (curved arrow) is depicted as a tract of contrast material extending from the urinary bladder into the vaginal cuff mass.

View larger version (174K): [in a new window]   Figures 3, 4.   (3) Central pelvic recurrence with anterior extension into the urinary bladder and left ureter in a 33-year-old woman. Excretory-phase contrast material-enhanced CT scan shows a large, centrally located pelvic mass (straight arrows) that is inseparable from the posterior wall of the urinary bladder (arrowheads) and encases the enhanced left ureter (curved arrow). (4) Central pelvic recurrence with lateral and anterior extension in a 57-year-old woman who presented with pelvic pain, a palpable anterior pelvic wall mass, and vaginal discharge. CT scan demonstrates a mass (straight arrows) arising from the vaginal cuff, infiltrating the right lateral and anterior walls of the urinary bladder (B), and invading the anterior pelvic wall (arrowheads). A vesicovaginal fistula (curved arrow) is depicted as a tract of contrast material extending from the urinary bladder into the vaginal cuff mass.

View larger version (150K): [in a new window]   Figure 5a.   Central pelvic recurrence with anterior extension resulting in hydronephrosis in a 53-year-old woman who presented with flank pain. (a) CT scan reveals an infiltrative soft-tissue mass located centrally in the pelvis (arrows). (b) CT scan obtained at the level of the kidneys shows high-grade, bilateral hydronephrosis (*) resulting from ureteral obstruction proximal to the pelvic mass (cf a). Bilateral nephrostomy tubes are also noted (arrows). (c) Coronal US image of the right kidney shows marked dilatation of the calyces (arrows) and renal pelvis (*).

View larger version (150K): [in a new window]   Figure 5b.   Central pelvic recurrence with anterior extension resulting in hydronephrosis in a 53-year-old woman who presented with flank pain. (a) CT scan reveals an infiltrative soft-tissue mass located centrally in the pelvis (arrows). (b) CT scan obtained at the level of the kidneys shows high-grade, bilateral hydronephrosis (*) resulting from ureteral obstruction proximal to the pelvic mass (cf a). Bilateral nephrostomy tubes are also noted (arrows). (c) Coronal US image of the right kidney shows marked dilatation of the calyces (arrows) and renal pelvis (*).

View larger version (148K): [in a new window]   Figure 5c.   Central pelvic recurrence with anterior extension resulting in hydronephrosis in a 53-year-old woman who presented with flank pain. (a) CT scan reveals an infiltrative soft-tissue mass located centrally in the pelvis (arrows). (b) CT scan obtained at the level of the kidneys shows high-grade, bilateral hydronephrosis (*) resulting from ureteral obstruction proximal to the pelvic mass (cf a). Bilateral nephrostomy tubes are also noted (arrows). (c) Coronal US image of the right kidney shows marked dilatation of the calyces (arrows) and renal pelvis (*).

View larger version (164K): [in a new window]   Figures 6, 7.   (6) Pelvic side wall recurrence without evidence of a centrally located pelvic recurrence in a 50-year-old woman who presented with pelvic and left lower extremity pain. CT scan demonstrates an enhancing mass (arrows) that is inseparable from the left pyriform muscle (P), presacral tissues, and the region of the left sciatic nerve. Its proximity to the sciatic nerve probably accounted for the patient's left lower extremity pain. Recurrent squamous cell carcinoma was confirmed at percutaneous biopsy. (7) Pelvic recurrence involving the ovaries in a 55-year-old woman who initially underwent radiation therapy. Contrast-enhanced CT scan of the pelvis shows large, low-attenuation masses bilaterally in the pelvis (M). Ovarian metastases from cervical carcinoma were confirmed at surgery.

View larger version (158K): [in a new window]   Figures 6, 7.   (6) Pelvic side wall recurrence without evidence of a centrally located pelvic recurrence in a 50-year-old woman who presented with pelvic and left lower extremity pain. CT scan demonstrates an enhancing mass (arrows) that is inseparable from the left pyriform muscle (P), presacral tissues, and the region of the left sciatic nerve. Its proximity to the sciatic nerve probably accounted for the patient's left lower extremity pain. Recurrent squamous cell carcinoma was confirmed at percutaneous biopsy. (7) Pelvic recurrence involving the ovaries in a 55-year-old woman who initially underwent radiation therapy. Contrast-enhanced CT scan of the pelvis shows large, low-attenuation masses bilaterally in the pelvis (M). Ovarian metastases from cervical carcinoma were confirmed at surgery.

View larger version (164K): [in a new window]   Figure 8a.   Extensive pelvic and retroperitoneal nodal recurrence in a 57-year-old woman in whom adenocarcinoma of the cervix had been diagnosed 2 years earlier. (a) CT scan of the pelvis demonstrates enlarged left external iliac lymph nodes (N) that are similar in attenuation to the enhanced urinary bladder (B). An enlarged right obturator lymph node is also seen (arrow). (b) CT scan obtained 3 cm cephalad to a shows an enlarged, low-attenuating lymph node (N) in the left common iliac chain that is inseparable from the left psoas muscle (arrowhead). An enlarged right common iliac lymph node (arrow) similar in attenuation to the right obturator node (cf a) is also noted. (c) CT scan obtained 3 cm cephalad to b reveals enlarged, heterogeneously enhancing paraaortic (straight arrow) and interaortocaval (arrowhead) lymph nodes. The inferior vena cava (curved arrow) is compressed by the lymphadenopathy.

View larger version (146K): [in a new window]   Figure 8b.   Extensive pelvic and retroperitoneal nodal recurrence in a 57-year-old woman in whom adenocarcinoma of the cervix had been diagnosed 2 years earlier. (a) CT scan of the pelvis demonstrates enlarged left external iliac lymph nodes (N) that are similar in attenuation to the enhanced urinary bladder (B). An enlarged right obturator lymph node is also seen (arrow). (b) CT scan obtained 3 cm cephalad to a shows an enlarged, low-attenuating lymph node (N) in the left common iliac chain that is inseparable from the left psoas muscle (arrowhead). An enlarged right common iliac lymph node (arrow) similar in attenuation to the right obturator node (cf a) is also noted. (c) CT scan obtained 3 cm cephalad to b reveals enlarged, heterogeneously enhancing paraaortic (straight arrow) and interaortocaval (arrowhead) lymph nodes. The inferior vena cava (curved arrow) is compressed by the lymphadenopathy.

View larger version (132K): [in a new window]   Figure 8c.   Extensive pelvic and retroperitoneal nodal recurrence in a 57-year-old woman in whom adenocarcinoma of the cervix had been diagnosed 2 years earlier. (a) CT scan of the pelvis demonstrates enlarged left external iliac lymph nodes (N) that are similar in attenuation to the enhanced urinary bladder (B). An enlarged right obturator lymph node is also seen (arrow). (b) CT scan obtained 3 cm cephalad to a shows an enlarged, low-attenuating lymph node (N) in the left common iliac chain that is inseparable from the left psoas muscle (arrowhead). An enlarged right common iliac lymph node (arrow) similar in attenuation to the right obturator node (cf a) is also noted. (c) CT scan obtained 3 cm cephalad to b reveals enlarged, heterogeneously enhancing paraaortic (straight arrow) and interaortocaval (arrowhead) lymph nodes. The inferior vena cava (curved arrow) is compressed by the lymphadenopathy.

View larger version (142K): [in a new window]   Figures 9, 10.   (9) Liver metastases in a 44-year-old woman with a history of cervical carcinoma who had undergone radiation therapy. Contrast-enhanced CT scan shows multiple low-attenuation lesions in the right and left hepatic lobes (arrows), findings that are indicative of liver metastases. Enlarged, high-attenuation retrocrural lymph nodes are also seen (arrowheads); the cause of the high attenuation within the nodes is unknown. Results of liver biopsy confirmed recurrent cervical carcinoma. (10) Adrenal metastases in a 53-year-old woman with a history of cervical carcinoma. Contrast-enhanced CT scan demonstrates bilateral low-attenuation adrenal masses (arrows), findings that are indicative of metastases.

View larger version (155K): [in a new window]   Figures 9, 10.   (9) Liver metastases in a 44-year-old woman with a history of cervical carcinoma who had undergone radiation therapy. Contrast-enhanced CT scan shows multiple low-attenuation lesions in the right and left hepatic lobes (arrows), findings that are indicative of liver metastases. Enlarged, high-attenuation retrocrural lymph nodes are also seen (arrowheads); the cause of the high attenuation within the nodes is unknown. Results of liver biopsy confirmed recurrent cervical carcinoma. (10) Adrenal metastases in a 53-year-old woman with a history of cervical carcinoma. Contrast-enhanced CT scan demonstrates bilateral low-attenuation adrenal masses (arrows), findings that are indicative of metastases.

View larger version (144K): [in a new window]   Figure 11a.   Renal metastases in a 45-year-old woman with cervical carcinoma who had undergone radiation therapy. Contrast-enhanced CT scans obtained at the level of the kidneys (b obtained at a slightly lower level than a) reveal bilateral low-attenuation renal masses (arrows). A CT scan obtained 1 year earlier demonstrated normal kidneys.

View larger version (146K): [in a new window]   Figure 11b.   Renal metastases in a 45-year-old woman with cervical carcinoma who had undergone radiation therapy. Contrast-enhanced CT scans obtained at the level of the kidneys (b obtained at a slightly lower level than a) reveal bilateral low-attenuation renal masses (arrows). A CT scan obtained 1 year earlier demonstrated normal kidneys.

View larger version (147K): [in a new window]   Figure 12.   Multiple peritoneal implants on the surface of the liver in a 48-year-old woman with cervical carcinoma. Contrast-enhanced CT scan of the abdomen demonstrates multiple low-attenuation peritoneal implants (arrows) with resulting scalloping of the liver surface.

View larger version (143K): [in a new window]   Figure 13a.   Mesenteric and peritoneal recurrence of cervical carcinoma in a 37-year-old woman who initially underwent radiation therapy. (a) Contrast-enhanced CT scan obtained at the level of the renal hila shows a mesenteric mass (arrows) encasing the superior mesenteric artery (arrowhead). (b) Contrast-enhanced CT scan obtained 5 cm caudad to a reveals ascites (A) and irregular thickening of the peritoneum (arrows), findings that are indicative of implants. (c) Contrast-enhanced CT scan obtained 8 cm caudad to b shows a low-attenuation, heterogeneously enhancing tumor implant in the right paracolic gutter (arrow) with resulting medial displacement of the ascending colon (C). (d) Contrast-enhanced CT scan obtained at the level of the false pelvis demonstrates multiple serosal implants (arrows) distorting the lumen of the sigmoid colon (C).

View larger version (133K): [in a new window]   Figure 13b.   Mesenteric and peritoneal recurrence of cervical carcinoma in a 37-year-old woman who initially underwent radiation therapy. (a) Contrast-enhanced CT scan obtained at the level of the renal hila shows a mesenteric mass (arrows) encasing the superior mesenteric artery (arrowhead). (b) Contrast-enhanced CT scan obtained 5 cm caudad to a reveals ascites (A) and irregular thickening of the peritoneum (arrows), findings that are indicative of implants. (c) Contrast-enhanced CT scan obtained 8 cm caudad to b shows a low-attenuation, heterogeneously enhancing tumor implant in the right paracolic gutter (arrow) with resulting medial displacement of the ascending colon (C). (d) Contrast-enhanced CT scan obtained at the level of the false pelvis demonstrates multiple serosal implants (arrows) distorting the lumen of the sigmoid colon (C).

View larger version (137K): [in a new window]   Figure 13c.   Mesenteric and peritoneal recurrence of cervical carcinoma in a 37-year-old woman who initially underwent radiation therapy. (a) Contrast-enhanced CT scan obtained at the level of the renal hila shows a mesenteric mass (arrows) encasing the superior mesenteric artery (arrowhead). (b) Contrast-enhanced CT scan obtained 5 cm caudad to a reveals ascites (A) and irregular thickening of the peritoneum (arrows), findings that are indicative of implants. (c) Contrast-enhanced CT scan obtained 8 cm caudad to b shows a low-attenuation, heterogeneously enhancing tumor implant in the right paracolic gutter (arrow) with resulting medial displacement of the ascending colon (C). (d) Contrast-enhanced CT scan obtained at the level of the false pelvis demonstrates multiple serosal implants (arrows) distorting the lumen of the sigmoid colon (C).

View larger version (143K): [in a new window]   Figure 13d.   Mesenteric and peritoneal recurrence of cervical carcinoma in a 37-year-old woman who initially underwent radiation therapy. (a) Contrast-enhanced CT scan obtained at the level of the renal hila shows a mesenteric mass (arrows) encasing the superior mesenteric artery (arrowhead). (b) Contrast-enhanced CT scan obtained 5 cm caudad to a reveals ascites (A) and irregular thickening of the peritoneum (arrows), findings that are indicative of implants. (c) Contrast-enhanced CT scan obtained 8 cm caudad to b shows a low-attenuation, heterogeneously enhancing tumor implant in the right paracolic gutter (arrow) with resulting medial displacement of the ascending colon (C). (d) Contrast-enhanced CT scan obtained at the level of the false pelvis demonstrates multiple serosal implants (arrows) distorting the lumen of the sigmoid colon (C).

View larger version (127K): [in a new window]   Figures 14, 15.   (14) Extensive ascites and peritoneal implants in a 48-year-old woman with cervical carcinoma who initially underwent radical hysterectomy. T2-weighted fat-suppressed MR image (repetition time msec/effective echo time msec = 3,500/138) demonstrates extensive ascites (A) and a peritoneal implant protruding into the ascites (arrow). (15) Omental implant and Sister Joseph nodule in a 62-year-old woman with recurrent cervical carcinoma. Contrast-enhanced abdominal CT scan shows a low-attenuation omental implant (arrow). An umbilical soft-tissue mass (arrowhead) lies immediately anterior to the omental implant; this finding is indicative of an umbilical metastasis (Sister Joseph nodule). A low-attenuation mesenteric implant is also seen (M).

View larger version (126K): [in a new window]   Figures 14, 15.   (14) Extensive ascites and peritoneal implants in a 48-year-old woman with cervical carcinoma who initially underwent radical hysterectomy. T2-weighted fat-suppressed MR image (repetition time msec/effective echo time msec = 3,500/138) demonstrates extensive ascites (A) and a peritoneal implant protruding into the ascites (arrow). (15) Omental implant and Sister Joseph nodule in a 62-year-old woman with recurrent cervical carcinoma. Contrast-enhanced abdominal CT scan shows a low-attenuation omental implant (arrow). An umbilical soft-tissue mass (arrowhead) lies immediately anterior to the omental implant; this finding is indicative of an umbilical metastasis (Sister Joseph nodule). A low-attenuation mesenteric implant is also seen (M).

View larger version (128K): [in a new window]   Figure 16a.   Rectal involvement by recurrent cervical carcinoma in a 34-year-old woman who presented with vaginal bleeding. (a) Lateral view from a barium enema study demonstrates spiculation and mass effect on the anterior wall of the rectosigmoid colon (arrows) as well as luminal narrowing. (b) Contrast-enhanced CT scan of the pelvis shows a recurrent mass in the preserved cervix (arrows) that is inseparable from the anterior wall of the rectum (R) and accounts for the extrinsic mass effect on the rectosigmoid colon noted in a. Packing material is seen in the cervix.

View larger version (153K): [in a new window]   Figure 16b.   Rectal involvement by recurrent cervical carcinoma in a 34-year-old woman who presented with vaginal bleeding. (a) Lateral view from a barium enema study demonstrates spiculation and mass effect on the anterior wall of the rectosigmoid colon (arrows) as well as luminal narrowing. (b) Contrast-enhanced CT scan of the pelvis shows a recurrent mass in the preserved cervix (arrows) that is inseparable from the anterior wall of the rectum (R) and accounts for the extrinsic mass effect on the rectosigmoid colon noted in a. Packing material is seen in the cervix.

View larger version (113K): [in a new window]   Figure 17.   Small bowel obstruction in a 64-year-old woman who presented with nausea, vomiting, and abdominal pain. Anteroposterior view from a small bowel follow-through study demonstrates marked dilatation of the duodenum (D) and proximal jejunum (J) with an abrupt transition (arrow), findings that are indicative of a high-grade small bowel obstruction. Bilateral percutaneous nephrostomy tubes and inferior vena cava filters are also seen. Contiguous spread of an extensive pelvic recurrence was detected at surgery.

View larger version (167K): [in a new window]   Figure 18a.   Small bowel obstruction in a 56-year-old woman with recurrent cervical carcinoma. (a) Contrast-enhanced CT scan shows multiple dilated loops of small bowel (B), a finding that is indicative of a small bowel obstruction. Air-fluid levels are also identified (arrows). (b) Contrast-enhanced CT scan obtained 5 cm cephalad to a elucidates the cause of the small bowel obstruction, a tumor implant (arrow) that is inseparable from a dilated loop of ileum (B). A collapsed descending colon is also noted (arrowhead).

View larger version (162K): [in a new window]   Figure 18b.   Small bowel obstruction in a 56-year-old woman with recurrent cervical carcinoma. (a) Contrast-enhanced CT scan shows multiple dilated loops of small bowel (B), a finding that is indicative of a small bowel obstruction. Air-fluid levels are also identified (arrows). (b) Contrast-enhanced CT scan obtained 5 cm cephalad to a elucidates the cause of the small bowel obstruction, a tumor implant (arrow) that is inseparable from a dilated loop of ileum (B). A collapsed descending colon is also noted (arrowhead).

View larger version (112K): [in a new window]   Figure 19.   Enterocutaneous fistula resulting from recurrent cervical carcinoma in a 51-year-old woman who initially underwent radical hysterectomy. Lateral view from a small bowel follow-through study demonstrates a tract of contrast material extending from the ileum to the skin (arrows).

View larger version (168K): [in a new window]   Figure 20.   Focal wall thickening and tethering of the small intestine secondary to a mesenteric implant in a 55-year-old woman who presented with abdominal pain. Contrast-enhanced CT scan demonstrates a mesenteric tumor implant (arrow) that results in minor wall thickening and tethering of a small bowel loop (B).

View larger version (131K): [in a new window]   Figure 21.   Multiple pulmonary metastases in a 53-year-old woman with a history of cervical carcinoma who presented for surveillance CT. Contrast-enhanced CT scan of the lower chest shows multiple bilateral pulmonary nodules 3-15 mm in diameter (arrows).

View larger version (92K): [in a new window]   Figure 22.   Pleural and pericardial recurrence of cervical carcinoma in a 35-year-old woman who presented with left-sided chest pain. Contrast-enhanced CT scan of the chest demonstrates minor bilateral pleural thickening (arrows), small bilateral pleural fluid collections, thickening and nodularity of the pericardium (arrowheads), and atelectasis in the lung bases. Thoracoscopy helped confirm pleural recurrence of cervical carcinoma.

View larger version (147K): [in a new window]   Figures 23, 24.   (23) Vertebral metastasis in a 69-year-old woman with a history of cervical carcinoma who presented for evaluation of back pain. Contrast-enhanced CT scan reveals confluent lymphadenopathy (*) adjacent to the aorta (A) and esophagus (E). The lymphadenopathy has extended posteriorly and caused destruction of the T10 vertebral body (arrow). Review of previous CT scans demonstrated that the lymphadenopathy predated the development of the vertebral metastasis. (24) Bone metastases in a 38-year-old woman with known pelvic recurrence of cervical carcinoma. Contrast-enhanced fat-suppressed T1-weighted (200/4.4; 70° flip angle) MR image of the pelvis shows enhancing, infiltrative soft tissue in the pelvis (*), a finding that is indicative of pelvic recurrence. Enhancing foci in the left ilium (arrowhead) and sacrum (arrow) are also seen, findings that are consistent with osseous metastases.

View larger version (137K): [in a new window]   Figures 23, 24.   (23) Vertebral metastasis in a 69-year-old woman with a history of cervical carcinoma who presented for evaluation of back pain. Contrast-enhanced CT scan reveals confluent lymphadenopathy (*) adjacent to the aorta (A) and esophagus (E). The lymphadenopathy has extended posteriorly and caused destruction of the T10 vertebral body (arrow). Review of previous CT scans demonstrated that the lymphadenopathy predated the development of the vertebral metastasis. (24) Bone metastases in a 38-year-old woman with known pelvic recurrence of cervical carcinoma. Contrast-enhanced fat-suppressed T1-weighted (200/4.4; 70° flip angle) MR image of the pelvis shows enhancing, infiltrative soft tissue in the pelvis (*), a finding that is indicative of pelvic recurrence. Enhancing foci in the left ilium (arrowhead) and sacrum (arrow) are also seen, findings that are consistent with osseous metastases.

View larger version (81K): [in a new window]   Figure 25.   Subcutaneous metastasis in a 47-year-old woman with cervical carcinoma. Contrast-enhanced CT scan of the pelvis shows a rounded soft-tissue focus (arrow) in the subcutaneous fat of the right buttock. This focus was not present on a CT scan obtained 6 months earlier. Percutaneous biopsy revealed squamous cell carcinoma, a finding consistent with metastatic disease.