23-year-old female with 10-cm pelvic mass on outside CT. Interpretation of outside exam requested. ABDOMEN:LUNG BASES: Single right lower lobe micronodular on image one of 89. No other abnormalities in the lung bases. Small hiatal hernia is noted.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Unremarkable.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild prominence of the left renal collecting system. No evidence of stone.RETROPERITONEUM, LYMPH NODES: Please see below.BOWEL, MESENTERY: Thickening of the lateral gastric wall extending towards the GE junction. Ill-defined soft tissue density between the greater curvature of the stomach and spleen measuring 3.5 x 1.3 cm. Etiology of this soft tissue mass is unknown and may be related to gastric wall thickening. No abnormality of the small bowel. Colon is unremarkable except for mass-effect as is mentioned below.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Uterus and adnexa are displaced by and abut the 10-cm mass that will be described further below.BLADDER: Bladder is distended and displaced by the pelvic mass.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mass effect on the rectum, displacing it to the right of the pelvic mass. No evidence of bowel obstruction. No evidence of invasion into bowel, as the fat planes between the mass and bowel are preserved.BONES, SOFT TISSUES: No significant abnormality noted. Specifically, no involvement of the pelvic bones or sacrum by the pelvic mass.OTHER: 10-cm pelvic mass which has centrally low density likely due to necrosis. It is most likely that the mass arises from the posterior wall of the vagina (better appreciated on the companion MRI study) as the adjacent pelvic bones as well as the uterus and adnexa are not clearly contiguous with the mass (this is also better seen on the outside MR images).
1. 10-cm pelvic mass which has mass-effect on the rectum, bladder and adnexa. We favor a sarcoma with origin of this lesion likely the posterior wall of the vagina (this is better appreciated on the companion MRI). 2. Soft tissue density adjacent to the splenic hilum and gastric wall thickening as described above . Upper endoscopy is recommended for further evaluation.