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MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation¹

¹ From the Department of Radiology, Tsukuba University Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan (Y.O.); the Departments of Radiology (Y.O.T., Y.I.) and Obstetrics and Gynecology (H.T., H.Y.), Institute of Clinical Medicine, University of Tsukuba; and the Department of Obstetrics and Gynecology, National Kasumigaura Hospital, Tsuchiura, Japan (M.N.). Recipient of a Cum Laude award for an education exhibit at the 2001 RSNA scientific assembly. Received March 25, 2002; revision requested April 30 and received June 13; accepted June 14. Address correspondence to Y.O. (e-mail: okamotchi@muf.biglobe.ne.jp).

View larger version (51K): [in a new window]   Figure 1.  Drawing of the uterus and vagina. The cervix consists of two different types of epithelium: squamous epithelium and glandular epithelium. Squamous cells cover the epithelial surface of the portio continuing from the vagina, and columnar cells cover the glandular epithelium of the endocervical gland, which produces mucin. With age, squamous cells grow back to cover the columnar cells. This transitional area is the SCJ (arrow).

View larger version (175K): [in a new window]   Figure 2a.  Cervical carcinoma with exophytic growth in a 44-year-old woman. The pathologic stage was Ib-1. (a) Sagittal T2-weighted MR image shows a slightly hyperintense, cauliflower-like tumor in the posterior lip of the portio (arrows). The tumor markedly expands the posterior vaginal fornix. (b) Photograph of the cut surface of the resected specimen shows a white mass that expands into the fornix (arrows). (c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows that the tumor is composed of atypical squamous epithelium with cancer "pearls" (arrowheads).

View larger version (103K): [in a new window]   Figure 2b.  Cervical carcinoma with exophytic growth in a 44-year-old woman. The pathologic stage was Ib-1. (a) Sagittal T2-weighted MR image shows a slightly hyperintense, cauliflower-like tumor in the posterior lip of the portio (arrows). The tumor markedly expands the posterior vaginal fornix. (b) Photograph of the cut surface of the resected specimen shows a white mass that expands into the fornix (arrows). (c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows that the tumor is composed of atypical squamous epithelium with cancer "pearls" (arrowheads).

View larger version (156K): [in a new window]   Figure 2c.  Cervical carcinoma with exophytic growth in a 44-year-old woman. The pathologic stage was Ib-1. (a) Sagittal T2-weighted MR image shows a slightly hyperintense, cauliflower-like tumor in the posterior lip of the portio (arrows). The tumor markedly expands the posterior vaginal fornix. (b) Photograph of the cut surface of the resected specimen shows a white mass that expands into the fornix (arrows). (c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows that the tumor is composed of atypical squamous epithelium with cancer "pearls" (arrowheads).

View larger version (146K): [in a new window]   Figure 3.  Cervical carcinoma with endophytic growth in a 59-year-old woman. The preoperative imaging diagnosis was stage IIb carcinoma. Sagittal T2-weighted MR image shows a slightly hyperintense mass that replaces the cervix (white arrows). The lesion is located almost within the cervical canal. The patient also has a mature cystic teratoma of the right ovary, which is seen as a cystic mass (black arrow) behind the uterus.

View larger version (122K): [in a new window]   Figure 4a.  Stage Ib cervical carcinoma. Sagittal (a) and axial (b) T2-weighted MR images show a slightly hyperintense mass in the uterine cervix. The mass protrudes into the posterior vaginal fornix; however, the vaginal mucosa attached to the tumor is intact (arrows in a). The tumor is completely surrounded by hypointense cervical stroma on the axial image (arrowheads in b).

View larger version (148K): [in a new window]   Figure 4b.  Stage Ib cervical carcinoma. Sagittal (a) and axial (b) T2-weighted MR images show a slightly hyperintense mass in the uterine cervix. The mass protrudes into the posterior vaginal fornix; however, the vaginal mucosa attached to the tumor is intact (arrows in a). The tumor is completely surrounded by hypointense cervical stroma on the axial image (arrowheads in b).

View larger version (123K): [in a new window]   Figure 5a.  Stage IIa cervical carcinoma. Sagittal (a) and axial (b) T2-weighted MR images show a slightly hyperintense mass that protrudes into the vaginal canal (arrow in a). Most of the vaginal wall surrounding the tumor seems intact (white arrows in b), although the low signal intensity of the vaginal wall is disrupted on the right side (black arrow in b). Parametrial invasion is not seen.

View larger version (128K): [in a new window]   Figure 5b.  Stage IIa cervical carcinoma. Sagittal (a) and axial (b) T2-weighted MR images show a slightly hyperintense mass that protrudes into the vaginal canal (arrow in a). Most of the vaginal wall surrounding the tumor seems intact (white arrows in b), although the low signal intensity of the vaginal wall is disrupted on the right side (black arrow in b). Parametrial invasion is not seen.

View larger version (165K): [in a new window]   Figure 6a.  Stage IIb cervical carcinoma. Sagittal (a) and axial (b) T2-weighted MR images show that the cervix is almost entirely replaced by a slightly hyperintense mass. The tumor protrudes into the parametrium bilaterally (arrowheads in b); however, it does not reach the pelvic wall. Hydrometra, which is caused by the obstructed internal cervical os, is also noted (arrow in a).

View larger version (170K): [in a new window]   Figure 6b.  Stage IIb cervical carcinoma. Sagittal (a) and axial (b) T2-weighted MR images show that the cervix is almost entirely replaced by a slightly hyperintense mass. The tumor protrudes into the parametrium bilaterally (arrowheads in b); however, it does not reach the pelvic wall. Hydrometra, which is caused by the obstructed internal cervical os, is also noted (arrow in a).

View larger version (157K): [in a new window]   Figure 7a.  Stage IIIa cervical carcinoma. (a) Sagittal T2-weighted MR image shows a slightly hyperintense, exophytic, solid mass that extends along the anterior vaginal wall and reaches the lower one-third of the vagina (arrow). (b) Axial T2-weighted MR image shows that the low signal intensity of the anterior vaginal wall is partly disrupted (arrowheads) and the fatty tissue between the mass and the posterior bladder wall has disappeared. However, the mass does not infiltrate the vesical mucosa.

View larger version (170K): [in a new window]   Figure 7b.  Stage IIIa cervical carcinoma. (a) Sagittal T2-weighted MR image shows a slightly hyperintense, exophytic, solid mass that extends along the anterior vaginal wall and reaches the lower one-third of the vagina (arrow). (b) Axial T2-weighted MR image shows that the low signal intensity of the anterior vaginal wall is partly disrupted (arrowheads) and the fatty tissue between the mass and the posterior bladder wall has disappeared. However, the mass does not infiltrate the vesical mucosa.

View larger version (176K): [in a new window]   Figure 8a.  Stage IIIb cervical carcinoma. (a) Sagittal T2-weighted MR image shows a slightly hyperintense, large, solid mass that extends from the uterine cervix to the lower part of the uterine body. It also extends to the lower one-third of the anterior vaginal wall (arrow). (b) Axial T2-weighted MR image shows that the tumor also reaches the left posterior wall of the bladder, although the thinned vesical muscular layer remains (arrowheads). (c) MR urogram clearly shows left hydronephrosis caused by tumor invasion.

View larger version (136K): [in a new window]   Figure 8b.  Stage IIIb cervical carcinoma. (a) Sagittal T2-weighted MR image shows a slightly hyperintense, large, solid mass that extends from the uterine cervix to the lower part of the uterine body. It also extends to the lower one-third of the anterior vaginal wall (arrow). (b) Axial T2-weighted MR image shows that the tumor also reaches the left posterior wall of the bladder, although the thinned vesical muscular layer remains (arrowheads). (c) MR urogram clearly shows left hydronephrosis caused by tumor invasion.

View larger version (83K): [in a new window]   Figure 8c.  Stage IIIb cervical carcinoma. (a) Sagittal T2-weighted MR image shows a slightly hyperintense, large, solid mass that extends from the uterine cervix to the lower part of the uterine body. It also extends to the lower one-third of the anterior vaginal wall (arrow). (b) Axial T2-weighted MR image shows that the tumor also reaches the left posterior wall of the bladder, although the thinned vesical muscular layer remains (arrowheads). (c) MR urogram clearly shows left hydronephrosis caused by tumor invasion.

View larger version (130K): [in a new window]   Figure 9.  Stage IVa cervical carcinoma. Sagittal T2-weighted MR image shows a hypointense mass that occupies the uterine cervix and invades the vaginal wall anteriorly. At the level of the vaginal extension, the tumor reaches the mucosa of the posterior vesical wall (arrows).

View larger version (184K): [in a new window]   Figure 10a.  Stage IVb cervical carcinoma. (a) Sagittal T2-weighted MR image shows a large mass in the uterine cervix. (b, c) CT scans show metastases of paraaortic lymph nodes (arrows in b) and hematogenous hepatic metastases (c). These findings are classified as stage IVb disease (Table).

View larger version (118K): [in a new window]   Figure 10b.  Stage IVb cervical carcinoma. (a) Sagittal T2-weighted MR image shows a large mass in the uterine cervix. (b, c) CT scans show metastases of paraaortic lymph nodes (arrows in b) and hematogenous hepatic metastases (c). These findings are classified as stage IVb disease (Table).

View larger version (114K): [in a new window]   Figure 10c.  Stage IVb cervical carcinoma. (a) Sagittal T2-weighted MR image shows a large mass in the uterine cervix. (b, c) CT scans show metastases of paraaortic lymph nodes (arrows in b) and hematogenous hepatic metastases (c). These findings are classified as stage IVb disease (Table).

View larger version (141K): [in a new window]   Figure 11.  Morphologic changes in the uterus after conization. Sagittal T2-weighted MR image obtained after conization shows a defect in the portio (arrows).

View larger version (163K): [in a new window]   Figure 12a.  Appearance of the pelvis after radical hysterectomy. (a) Sagittal T2-weighted MR image shows that the uterus has disappeared (arrows). (b) Axial T2-weighted MR image shows a small amount of hypointense, bandlike soft tissue at the vaginal stump (arrows).

View larger version (157K): [in a new window]   Figure 12b.  Appearance of the pelvis after radical hysterectomy. (a) Sagittal T2-weighted MR image shows that the uterus has disappeared (arrows). (b) Axial T2-weighted MR image shows a small amount of hypointense, bandlike soft tissue at the vaginal stump (arrows).

View larger version (132K): [in a new window]   Figure 13a.  Local recurrence after radiation therapy. (a) Sagittal T2-weighted MR image shows a large, hypointense mass that occupies the uterine cervix and the lower part of the uterine body (arrowheads). (b) Sagittal T2-weighted MR image obtained 2 months after radiation therapy shows marked regression of the tumor (arrowheads). (c) Sagittal T2-weighted MR image obtained 14 months after radiation therapy shows a slightly hyperintense area in the uterine body (arrowheads). Histologic analysis proved that this area represented a recurrence.

View larger version (131K): [in a new window]   Figure 13b.  Local recurrence after radiation therapy. (a) Sagittal T2-weighted MR image shows a large, hypointense mass that occupies the uterine cervix and the lower part of the uterine body (arrowheads). (b) Sagittal T2-weighted MR image obtained 2 months after radiation therapy shows marked regression of the tumor (arrowheads). (c) Sagittal T2-weighted MR image obtained 14 months after radiation therapy shows a slightly hyperintense area in the uterine body (arrowheads). Histologic analysis proved that this area represented a recurrence.

View larger version (130K): [in a new window]   Figure 13c.  Local recurrence after radiation therapy. (a) Sagittal T2-weighted MR image shows a large, hypointense mass that occupies the uterine cervix and the lower part of the uterine body (arrowheads). (b) Sagittal T2-weighted MR image obtained 2 months after radiation therapy shows marked regression of the tumor (arrowheads). (c) Sagittal T2-weighted MR image obtained 14 months after radiation therapy shows a slightly hyperintense area in the uterine body (arrowheads). Histologic analysis proved that this area represented a recurrence.

View larger version (170K): [in a new window]   Figure 14a.  Local recurrence after hysterectomy. (a) Sagittal T2-weighted MR image shows a cervical carcinoma (arrow). (b, c) Sagittal (b) and axial (c) T2-weighted MR images obtained 6 months after radical hysterectomy show a hyperintense mass along the anterior vaginal wall (arrows). Biopsy demonstrated that the mass was a local recurrence.

View larger version (148K): [in a new window]   Figure 14b.  Local recurrence after hysterectomy. (a) Sagittal T2-weighted MR image shows a cervical carcinoma (arrow). (b, c) Sagittal (b) and axial (c) T2-weighted MR images obtained 6 months after radical hysterectomy show a hyperintense mass along the anterior vaginal wall (arrows). Biopsy demonstrated that the mass was a local recurrence.

View larger version (158K): [in a new window]   Figure 14c.  Local recurrence after hysterectomy. (a) Sagittal T2-weighted MR image shows a cervical carcinoma (arrow). (b, c) Sagittal (b) and axial (c) T2-weighted MR images obtained 6 months after radical hysterectomy show a hyperintense mass along the anterior vaginal wall (arrows). Biopsy demonstrated that the mass was a local recurrence.

View larger version (133K): [in a new window]   Figure 15a.  Adenoma malignum. (a) Sagittal T2-weighted MR image shows a multicystic lesion with a solid component in the deep cervical stroma (arrowhead). (b) Sagittal MR image obtained after administration of a gadolinium-based contrast agent shows obvious enhancement of the solid component of the lesion (arrows). (c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows that the endocervical glands in the upper row have no atypia. However, those in the lower row have larger nuclei located at the center of the cells, an appearance indicative of cellular atypia.

View larger version (125K): [in a new window]   Figure 15b.  Adenoma malignum. (a) Sagittal T2-weighted MR image shows a multicystic lesion with a solid component in the deep cervical stroma (arrowhead). (b) Sagittal MR image obtained after administration of a gadolinium-based contrast agent shows obvious enhancement of the solid component of the lesion (arrows). (c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows that the endocervical glands in the upper row have no atypia. However, those in the lower row have larger nuclei located at the center of the cells, an appearance indicative of cellular atypia.

View larger version (139K): [in a new window]   Figure 15c.  Adenoma malignum. (a) Sagittal T2-weighted MR image shows a multicystic lesion with a solid component in the deep cervical stroma (arrowhead). (b) Sagittal MR image obtained after administration of a gadolinium-based contrast agent shows obvious enhancement of the solid component of the lesion (arrows). (c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows that the endocervical glands in the upper row have no atypia. However, those in the lower row have larger nuclei located at the center of the cells, an appearance indicative of cellular atypia.

View larger version (159K): [in a new window]   Figure 16a.  Endocervical hyperplasia. (a) Sagittal T2-weighted MR image shows a multicystic mass surrounding the cervical canal (arrows). An area that is hyperintense relative to the normal cervical stroma near the cysts is also noted. (b) Sagittal MR image obtained after administration of gadolinium-based contrast material shows intense enhancement of the relatively hyperintense area near the cysts on the T2-weighted image (arrows). (c) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows that the tumor is composed of normal endocervical glands without malignant features.

View larger version (126K): [in a new window]   Figure 16b.  Endocervical hyperplasia. (a) Sagittal T2-weighted MR image shows a multicystic mass surrounding the cervical canal (arrows). An area that is hyperintense relative to the normal cervical stroma near the cysts is also noted. (b) Sagittal MR image obtained after administration of gadolinium-based contrast material shows intense enhancement of the relatively hyperintense area near the cysts on the T2-weighted image (arrows). (c) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows that the tumor is composed of normal endocervical glands without malignant features.

View larger version (116K): [in a new window]   Figure 16c.  Endocervical hyperplasia. (a) Sagittal T2-weighted MR image shows a multicystic mass surrounding the cervical canal (arrows). An area that is hyperintense relative to the normal cervical stroma near the cysts is also noted. (b) Sagittal MR image obtained after administration of gadolinium-based contrast material shows intense enhancement of the relatively hyperintense area near the cysts on the T2-weighted image (arrows). (c) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows that the tumor is composed of normal endocervical glands without malignant features.

View larger version (92K): [in a new window]   Figure 17a.  Adenoma malignum in a patient with Peutz-Jeghers syndrome. (a, b) Photographs show mucocutaneous pigmentation of the lips (a) and digits (b). (c, d) Images from a double-contrast barium study show multiple polyps (arrowhead) in the colon (c) and stomach (d). (e) Sagittal T2-weighted MR image obtained during pregnancy shows a characteristic multicystic mass in the uterine cervix (arrows). (Case courtesy of Takeshi Nihei, MD, Mito Saiseikai General Hospital, Mito, Japan.)

View larger version (75K): [in a new window]   Figure 17b.  Adenoma malignum in a patient with Peutz-Jeghers syndrome. (a, b) Photographs show mucocutaneous pigmentation of the lips (a) and digits (b). (c, d) Images from a double-contrast barium study show multiple polyps (arrowhead) in the colon (c) and stomach (d). (e) Sagittal T2-weighted MR image obtained during pregnancy shows a characteristic multicystic mass in the uterine cervix (arrows). (Case courtesy of Takeshi Nihei, MD, Mito Saiseikai General Hospital, Mito, Japan.)

View larger version (140K): [in a new window]   Figure 17c.  Adenoma malignum in a patient with Peutz-Jeghers syndrome. (a, b) Photographs show mucocutaneous pigmentation of the lips (a) and digits (b). (c, d) Images from a double-contrast barium study show multiple polyps (arrowhead) in the colon (c) and stomach (d). (e) Sagittal T2-weighted MR image obtained during pregnancy shows a characteristic multicystic mass in the uterine cervix (arrows). (Case courtesy of Takeshi Nihei, MD, Mito Saiseikai General Hospital, Mito, Japan.)

View larger version (129K): [in a new window]   Figure 17d.  Adenoma malignum in a patient with Peutz-Jeghers syndrome. (a, b) Photographs show mucocutaneous pigmentation of the lips (a) and digits (b). (c, d) Images from a double-contrast barium study show multiple polyps (arrowhead) in the colon (c) and stomach (d). (e) Sagittal T2-weighted MR image obtained during pregnancy shows a characteristic multicystic mass in the uterine cervix (arrows). (Case courtesy of Takeshi Nihei, MD, Mito Saiseikai General Hospital, Mito, Japan.)

View larger version (158K): [in a new window]   Figure 17e.  Adenoma malignum in a patient with Peutz-Jeghers syndrome. (a, b) Photographs show mucocutaneous pigmentation of the lips (a) and digits (b). (c, d) Images from a double-contrast barium study show multiple polyps (arrowhead) in the colon (c) and stomach (d). (e) Sagittal T2-weighted MR image obtained during pregnancy shows a characteristic multicystic mass in the uterine cervix (arrows). (Case courtesy of Takeshi Nihei, MD, Mito Saiseikai General Hospital, Mito, Japan.)

View larger version (145K): [in a new window]   Figure 18a.  Atypical carcinoid tumor of the uterine cervix. (a, b) Sagittal (a) and axial (b) T2-weighted MR images show a hyperintense solid mass that dilates the upper end of the vaginal tube. (c) Axial gadolinium-enhanced T1-weighted MR image shows marked homogeneous enhancement of the tumor (arrows). (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows diffuse infiltration of small tumor cells. (e) Photomicrograph (original magnification, x10; chromogranin A immunohistochemical stain) shows that the tumor is of neuroendocrine origin. The final diagnosis was atypical carcinoid tumor of the uterine cervix. (Case courtesy of Yuki Satoh, MD, Tsukuba Memorial Hospital, Tsukuba, Japan.)

View larger version (129K): [in a new window]   Figure 18b.  Atypical carcinoid tumor of the uterine cervix. (a, b) Sagittal (a) and axial (b) T2-weighted MR images show a hyperintense solid mass that dilates the upper end of the vaginal tube. (c) Axial gadolinium-enhanced T1-weighted MR image shows marked homogeneous enhancement of the tumor (arrows). (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows diffuse infiltration of small tumor cells. (e) Photomicrograph (original magnification, x10; chromogranin A immunohistochemical stain) shows that the tumor is of neuroendocrine origin. The final diagnosis was atypical carcinoid tumor of the uterine cervix. (Case courtesy of Yuki Satoh, MD, Tsukuba Memorial Hospital, Tsukuba, Japan.)

View larger version (125K): [in a new window]   Figure 18c.  Atypical carcinoid tumor of the uterine cervix. (a, b) Sagittal (a) and axial (b) T2-weighted MR images show a hyperintense solid mass that dilates the upper end of the vaginal tube. (c) Axial gadolinium-enhanced T1-weighted MR image shows marked homogeneous enhancement of the tumor (arrows). (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows diffuse infiltration of small tumor cells. (e) Photomicrograph (original magnification, x10; chromogranin A immunohistochemical stain) shows that the tumor is of neuroendocrine origin. The final diagnosis was atypical carcinoid tumor of the uterine cervix. (Case courtesy of Yuki Satoh, MD, Tsukuba Memorial Hospital, Tsukuba, Japan.)

View larger version (181K): [in a new window]   Figure 18d.  Atypical carcinoid tumor of the uterine cervix. (a, b) Sagittal (a) and axial (b) T2-weighted MR images show a hyperintense solid mass that dilates the upper end of the vaginal tube. (c) Axial gadolinium-enhanced T1-weighted MR image shows marked homogeneous enhancement of the tumor (arrows). (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows diffuse infiltration of small tumor cells. (e) Photomicrograph (original magnification, x10; chromogranin A immunohistochemical stain) shows that the tumor is of neuroendocrine origin. The final diagnosis was atypical carcinoid tumor of the uterine cervix. (Case courtesy of Yuki Satoh, MD, Tsukuba Memorial Hospital, Tsukuba, Japan.)

View larger version (163K): [in a new window]   Figure 18e.  Atypical carcinoid tumor of the uterine cervix. (a, b) Sagittal (a) and axial (b) T2-weighted MR images show a hyperintense solid mass that dilates the upper end of the vaginal tube. (c) Axial gadolinium-enhanced T1-weighted MR image shows marked homogeneous enhancement of the tumor (arrows). (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows diffuse infiltration of small tumor cells. (e) Photomicrograph (original magnification, x10; chromogranin A immunohistochemical stain) shows that the tumor is of neuroendocrine origin. The final diagnosis was atypical carcinoid tumor of the uterine cervix. (Case courtesy of Yuki Satoh, MD, Tsukuba Memorial Hospital, Tsukuba, Japan.)

View larger version (173K): [in a new window]   Figure 19a.  Malignant melanoma of the vagina with direct invasion of the cervix. (a) Sagittal T2-weighted MR image shows a hypointense tumor that involves the uterine cervix and vagina. (b) Sagittal T1-weighted MR image shows characteristic high signal intensity of the tumor (arrowheads). (c) Photograph shows that the tumor is black and occupies the vagina and cervix. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows that the tumor is composed of melanocytes with rich melanin granules.

View larger version (152K): [in a new window]   Figure 19b.  Malignant melanoma of the vagina with direct invasion of the cervix. (a) Sagittal T2-weighted MR image shows a hypointense tumor that involves the uterine cervix and vagina. (b) Sagittal T1-weighted MR image shows characteristic high signal intensity of the tumor (arrowheads). (c) Photograph shows that the tumor is black and occupies the vagina and cervix. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows that the tumor is composed of melanocytes with rich melanin granules.

View larger version (125K): [in a new window]   Figure 19c.  Malignant melanoma of the vagina with direct invasion of the cervix. (a) Sagittal T2-weighted MR image shows a hypointense tumor that involves the uterine cervix and vagina. (b) Sagittal T1-weighted MR image shows characteristic high signal intensity of the tumor (arrowheads). (c) Photograph shows that the tumor is black and occupies the vagina and cervix. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows that the tumor is composed of melanocytes with rich melanin granules.

View larger version (162K): [in a new window]   Figure 19d.  Malignant melanoma of the vagina with direct invasion of the cervix. (a) Sagittal T2-weighted MR image shows a hypointense tumor that involves the uterine cervix and vagina. (b) Sagittal T1-weighted MR image shows characteristic high signal intensity of the tumor (arrowheads). (c) Photograph shows that the tumor is black and occupies the vagina and cervix. (d) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows that the tumor is composed of melanocytes with rich melanin granules.

View larger version (159K): [in a new window]   Figure 20a.  Malignant lymphoma of the uterine cervix. (a) Sagittal T2-weighted MR image shows a hyperintense lobulated tumor that involves the anterior wall of the uterine cervix (arrows). Although the mass is very large, the cervical epithelium remains as a hyperintense band behind the tumor (arrowheads). (b) Sagittal T1-weighted MR image shows that the tumor has low signal intensity (arrows). (c) Sagittal contrast-enhanced MR image shows that the tumor enhances heterogeneously (arrows). (d) Photograph of the surgical specimen shows a preserved cervical canal (arrowheads). (e) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows small tumor cells with large nuclei that proliferate diffusely.

View larger version (139K): [in a new window]   Figure 20b.  Malignant lymphoma of the uterine cervix. (a) Sagittal T2-weighted MR image shows a hyperintense lobulated tumor that involves the anterior wall of the uterine cervix (arrows). Although the mass is very large, the cervical epithelium remains as a hyperintense band behind the tumor (arrowheads). (b) Sagittal T1-weighted MR image shows that the tumor has low signal intensity (arrows). (c) Sagittal contrast-enhanced MR image shows that the tumor enhances heterogeneously (arrows). (d) Photograph of the surgical specimen shows a preserved cervical canal (arrowheads). (e) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows small tumor cells with large nuclei that proliferate diffusely.

View larger version (154K): [in a new window]   Figure 20c.  Malignant lymphoma of the uterine cervix. (a) Sagittal T2-weighted MR image shows a hyperintense lobulated tumor that involves the anterior wall of the uterine cervix (arrows). Although the mass is very large, the cervical epithelium remains as a hyperintense band behind the tumor (arrowheads). (b) Sagittal T1-weighted MR image shows that the tumor has low signal intensity (arrows). (c) Sagittal contrast-enhanced MR image shows that the tumor enhances heterogeneously (arrows). (d) Photograph of the surgical specimen shows a preserved cervical canal (arrowheads). (e) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows small tumor cells with large nuclei that proliferate diffusely.

View larger version (104K): [in a new window]   Figure 20d.  Malignant lymphoma of the uterine cervix. (a) Sagittal T2-weighted MR image shows a hyperintense lobulated tumor that involves the anterior wall of the uterine cervix (arrows). Although the mass is very large, the cervical epithelium remains as a hyperintense band behind the tumor (arrowheads). (b) Sagittal T1-weighted MR image shows that the tumor has low signal intensity (arrows). (c) Sagittal contrast-enhanced MR image shows that the tumor enhances heterogeneously (arrows). (d) Photograph of the surgical specimen shows a preserved cervical canal (arrowheads). (e) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows small tumor cells with large nuclei that proliferate diffusely.

View larger version (146K): [in a new window]   Figure 20e.  Malignant lymphoma of the uterine cervix. (a) Sagittal T2-weighted MR image shows a hyperintense lobulated tumor that involves the anterior wall of the uterine cervix (arrows). Although the mass is very large, the cervical epithelium remains as a hyperintense band behind the tumor (arrowheads). (b) Sagittal T1-weighted MR image shows that the tumor has low signal intensity (arrows). (c) Sagittal contrast-enhanced MR image shows that the tumor enhances heterogeneously (arrows). (d) Photograph of the surgical specimen shows a preserved cervical canal (arrowheads). (e) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows small tumor cells with large nuclei that proliferate diffusely.

View larger version (173K): [in a new window]   Figure 21a.  Cervical leiomyoma. (a) Sagittal T2-weighted MR image shows a hypointense solid mass that arises from the posterior wall of the uterine cervix (arrows). Hyperintense areas suggestive of degeneration or hypercellularity are also noted. (b) Sagittal T1-weighted MR image shows tumoral flow voids (arrowheads). (c) Photograph shows the tumor (arrows), which was resected separately from the uterus. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows spindle-shaped tumor cells proliferating with some direction. The presence of mitotic figures resulted in the diagnosis of cellular leiomyoma.

View larger version (157K): [in a new window]   Figure 21b.  Cervical leiomyoma. (a) Sagittal T2-weighted MR image shows a hypointense solid mass that arises from the posterior wall of the uterine cervix (arrows). Hyperintense areas suggestive of degeneration or hypercellularity are also noted. (b) Sagittal T1-weighted MR image shows tumoral flow voids (arrowheads). (c) Photograph shows the tumor (arrows), which was resected separately from the uterus. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows spindle-shaped tumor cells proliferating with some direction. The presence of mitotic figures resulted in the diagnosis of cellular leiomyoma.

View larger version (112K): [in a new window]   Figure 21c.  Cervical leiomyoma. (a) Sagittal T2-weighted MR image shows a hypointense solid mass that arises from the posterior wall of the uterine cervix (arrows). Hyperintense areas suggestive of degeneration or hypercellularity are also noted. (b) Sagittal T1-weighted MR image shows tumoral flow voids (arrowheads). (c) Photograph shows the tumor (arrows), which was resected separately from the uterus. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows spindle-shaped tumor cells proliferating with some direction. The presence of mitotic figures resulted in the diagnosis of cellular leiomyoma.

View larger version (153K): [in a new window]   Figure 21d.  Cervical leiomyoma. (a) Sagittal T2-weighted MR image shows a hypointense solid mass that arises from the posterior wall of the uterine cervix (arrows). Hyperintense areas suggestive of degeneration or hypercellularity are also noted. (b) Sagittal T1-weighted MR image shows tumoral flow voids (arrowheads). (c) Photograph shows the tumor (arrows), which was resected separately from the uterus. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) shows spindle-shaped tumor cells proliferating with some direction. The presence of mitotic figures resulted in the diagnosis of cellular leiomyoma.

View larger version (167K): [in a new window]   Figure 22a.  Cervical pregnancy. (a) Sagittal T2-weighted MR image shows a hypointense large mass that occupies the enlarged uterine cervix (arrows). (b) Sagittal T1-weighted MR image shows that the mass is partially hyperintense (arrowhead). (c) Sagittal contrast-enhanced MR image shows that the mass does not enhance. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) of a specimen obtained with dilation and curettage shows chorionic villi. Thus, the clinical diagnosis was cervical pregnancy.

View larger version (138K): [in a new window]   Figure 22b.  Cervical pregnancy. (a) Sagittal T2-weighted MR image shows a hypointense large mass that occupies the enlarged uterine cervix (arrows). (b) Sagittal T1-weighted MR image shows that the mass is partially hyperintense (arrowhead). (c) Sagittal contrast-enhanced MR image shows that the mass does not enhance. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) of a specimen obtained with dilation and curettage shows chorionic villi. Thus, the clinical diagnosis was cervical pregnancy.

View larger version (147K): [in a new window]   Figure 22c.  Cervical pregnancy. (a) Sagittal T2-weighted MR image shows a hypointense large mass that occupies the enlarged uterine cervix (arrows). (b) Sagittal T1-weighted MR image shows that the mass is partially hyperintense (arrowhead). (c) Sagittal contrast-enhanced MR image shows that the mass does not enhance. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) of a specimen obtained with dilation and curettage shows chorionic villi. Thus, the clinical diagnosis was cervical pregnancy.

View larger version (119K): [in a new window]   Figure 22d.  Cervical pregnancy. (a) Sagittal T2-weighted MR image shows a hypointense large mass that occupies the enlarged uterine cervix (arrows). (b) Sagittal T1-weighted MR image shows that the mass is partially hyperintense (arrowhead). (c) Sagittal contrast-enhanced MR image shows that the mass does not enhance. (d) Photomicrograph (original magnification, x4; hematoxylin-eosin stain) of a specimen obtained with dilation and curettage shows chorionic villi. Thus, the clinical diagnosis was cervical pregnancy.

View larger version (190K): [in a new window]   Figure 23a.  Uterine cervicitis. (a) Sagittal T2-weighted MR image shows some cystic lesions along the cervical canal (arrowheads). In addition, multiple leiomyomas are seen in the uterine body (arrows). (b) Sagittal contrast-enhanced MR image shows no enhancement within or around the cysts. (c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows many small round cells infiltrating the cervical glands and ductal dilatation.

View larger version (167K): [in a new window]   Figure 23b.  Uterine cervicitis. (a) Sagittal T2-weighted MR image shows some cystic lesions along the cervical canal (arrowheads). In addition, multiple leiomyomas are seen in the uterine body (arrows). (b) Sagittal contrast-enhanced MR image shows no enhancement within or around the cysts. (c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows many small round cells infiltrating the cervical glands and ductal dilatation.

View larger version (152K): [in a new window]   Figure 23c.  Uterine cervicitis. (a) Sagittal T2-weighted MR image shows some cystic lesions along the cervical canal (arrowheads). In addition, multiple leiomyomas are seen in the uterine body (arrows). (b) Sagittal contrast-enhanced MR image shows no enhancement within or around the cysts. (c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) shows many small round cells infiltrating the cervical glands and ductal dilatation.

View larger version (158K): [in a new window]   Figure 24a.  Nabothian cysts. (a) Sagittal T2-weighted MR image shows multiple small cysts in the deep stroma of the anterior cervix (arrows). (b) Sagittal T1-weighted MR image shows that the lesions have slightly high signal intensity (arrows).

View larger version (133K): [in a new window]   Figure 24b.  Nabothian cysts. (a) Sagittal T2-weighted MR image shows multiple small cysts in the deep stroma of the anterior cervix (arrows). (b) Sagittal T1-weighted MR image shows that the lesions have slightly high signal intensity (arrows).

View larger version (152K): [in a new window]   Figure 25a.  Cervical polyp. (a) Sagittal T2-weighted MR image shows a large multicystic mass filling the endocervical canal (arrows). (b) Sagittal T1-weighted MR image shows hypointense fluid filling the cysts (arrows). At histologic analysis, the lesion was proved to represent cystically dilated endometrial glands and was diagnosed as a cystic polyp.

View larger version (138K): [in a new window]   Figure 25b.  Cervical polyp. (a) Sagittal T2-weighted MR image shows a large multicystic mass filling the endocervical canal (arrows). (b) Sagittal T1-weighted MR image shows hypointense fluid filling the cysts (arrows). At histologic analysis, the lesion was proved to represent cystically dilated endometrial glands and was diagnosed as a cystic polyp.