Female 74 years old with urethral cancer receiving CRT. Evaluate for extent of disease for radiation planing. PELVIS:UTERUS, ADNEXA: Atrophic or surgically absent uterus.BLADDER: A Foley catheter is in place and the urinary bladder is nondistended. Mild trabeculation of the bladder wall is again seen which may reflect chronic bladder outlet obstruction. There is a stable T1 isointense, nonenhancing nodular intraluminal focus along the right lateral aspect of the Foley catheter (series 902, image 306) which is nonspecific and unchanged, this may be related to hemorrhagic material.LYMPH NODES: The reference right inguinal lymph node has decreased in size and is no longer enhancing. Reference measurement is provided below.BOWEL, MESENTERY: Severe sigmoid and descending colonic diverticulosis with thickening of the wall suggesting chronic inflammation. No evidence of acute diverticulitis.BONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine.OTHER: Comparison of the reference enhancing urethral mass is difficult due to changes in areas of intralesional enhancement, with areas of internal nonenhancement likely from treatment-related necrosis. There was previously confluent enhancement but on the current exam the enhancement pattern is more that of concentric circles. The maximal thickness anteriorly measures 7 mm (series 904, image 233), previously the region of maximal thickness was posteriorly and measured 11 mm. Amorphus enhancement extending towards the vaginal cuff has improved. The amount of diffusion restriction associated with the mass has improved.A moderate degree of perineal enhancement is new and nonspecific. Mild cellulitis cannot be excluded and correlation with physical exam is suggested.INDEX LESION MEASUREMENTS (Current exam date/time: 12/8/2016 06:30:00)URETHRAL MASS: 2.8 x 2.6 cm (Image 238, Series 904); 2.8 x 2.6 cm on prior (10/7/2016) (Image 140, Series 9).RIGHT INGUINAL LYMPH NODE: 1.4 x 1.3 cm (Image 238, Series 904); 2.1 x 1.9 cm on prior (10/7/2016) (Image 145, Series 9).
1.The urethral mass consistent with the patient's known urethral squamous cell carcinoma is stable in size but the enhancement pattern and diffusion restriction have improved indicating treatment response.2.Interval decrease in size and enhancement of metastatic right inguinal lymph node. 3.No new sites of disease.4.A moderate degree of perineal enhancement is new but nonspecific. Mild cellulitis is not excluded and correlation with physical exam is suggested.