Vaginal discharge. Evaluate for fistula. History of recurrent urothelial cancer. High grade pT2bN0 urothelial cancer invasive to the lamina propria, s/p cystectomy/bilateral pelvic lymph node dissection, and ileal conduit (5/2014), later c/b enterovaginal fistula and recurrence in 10/2014 with vaginectomy, small bowel resection, colonic resection, and pubic symphysis excision (11/2014). ABDOMEN:LIVER, BILIARY TRACT: A subcentimeter T2 hyperintensity in the posterior right lobe is nonspecific and may represent a cyst or hemangioma (series 6, image 15). Otherwise, no significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Expected mild hydronephrosis with diversion into a right lower quadrant ileal conduit.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted in the upper abdomen.BOWEL, MESENTERY: Postsurgical findings in the small bowel and colon from partial resection. The anterior mesenteric soft tissue nodule, likely representing metastasis (series 14, image 28), is similar to prior. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical findings of total vaginectomy.BLADDER: Postsurgical findings of cystectomy and right lower quadrant ileal conduit.LYMPH NODES: Left inguinal lymphadenopathy and soft tissue nodules in the left lower abdominal wall are again seen, likely metastatic.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is an extensive enhancing amorphous necrotic mass in the central lower pelvis, with frond-like projections insinuating throughout the pelvis and into the pelvic sidewalls. The mass is difficult to measure similarly, though measures 4.2 x 4.3 cm (series 1902, image 50) centrally with a 3.0 x 2.7 cm extension in the right pelvic soft tissues. The mass overall is increased in extent compared to 3/17/15. The mass extends into the right and left superficial pelvic soft tissues and extends into the vaginal pouch, likely accounting for the clinical history of vaginal discharge. Additional enhancing soft tissue about this mass is non-specific and may represent fibrotic post-surgical changes or additional tumor. There is artifact, likely from the prior surgery, in the pelvis which slightly limits evaluation. The patient is status post pubic symphysis resection. T2 hyperintense lesions in the T11 and L1 vertebral bodies with internal fat signal are compatible with hemangiomas. OTHER: No significant abnormality noted.
Interval growth of the extensive necrotic pelvic tumor, with extension throughout the pelvic soft tissues and into the vaginal pouch, likely accounting for the patient's history of vaginal discharge.