Reason: New pelvic mass, presumed vaginal carcinoma. Need further evaluation with MRI prior to chemoradiation. History: As above PELVIS:UTERUS, ADNEXA:Patient is status post hysterectomy.There is a circumferential mass centered at the vaginal cuff involving the mid and upper vagina, extending cranially 6.8 cm and measuring approximately 8.3 x 5.2 cm in transverse dimension (501/44, 81/25). There are multiple parametrial soft tissue nodules in the pelvis. Nodules on the left extend to within 1 to 2 mm of the adjacent sidewall (601/41). There are multiple perirectal and retrorectal soft tissue implants within the mesorectal fascia with a large mass measuring 4.5 x 3.7 cm. Perirectal soft tissue implants abut and and are intermittently associated with the rectosigmoid colon (801/34) without definite invasion. A portion of the dominant mass abuts the left aspect of the posterior bladder wall. BLADDER: No significant abnormality noted.LYMPH NODES: Multiple enlarged pelvic lymph nodes with a left external iliac iliac node measuring up to 3.3 x 3.6 cm which compresses the left external iliac vein. Para-aortic lymphadenopathy is seen on coronal views and demonstrated on recent CT (701/18).BOWEL, MESENTERY: Multiple perirectal implants abutting the rectosigmoid as above. No mass is seen within the colon to indicate a colon cancer.BONES, SOFT TISSUES: Multiple enhancing osseous lesions likely represent metastases including the bilateral sacrum, bilateral inferior pubic rami and proximal left femoral diaphysis.OTHER: Partially thrombosed aneurysmal and normal in all all dilatation of the right common iliac artery measuring 3.2 cm
1.Vaginal cuff mass involving the upper vagina and extending into the parametrial tissues with multiple soft tissue nodules within the pelvis. A gynecological malignancy is favored including endometrial or upward extension of a vaginal or possibly cervical cancer. Correlate with history, as this also could represent a recurrent tumor.2.Retroperitoneal and pelvic lymphadenopathy.3.Multiple enhancing osseous lesions, likely metastases.