Evaluate right perianal mass and location to sphincter muscles, preoperative consideration Suboptimal study secondary to patient's body habitus.PELVIS:UTERUS, ADNEXA: Evidence of adenomyomatosis with thickened junctional stone (measuring up to 30 mm) and associated scattered cystic spaces. Multiple uterine fibroids seen with dominant fundal fibroid visualized measuring 7.8 x 5.3 cm and directed into left lower quadrant. Endometrial stripe normal in size for perimenopausal patient. Nabothian cyst formation. Normal-appearing ovaries, left ovary appears to be superiorly located on image 45 series 1401.BLADDER: Mass effect on bladder by enlarged fibroid uterus, bladder deviated rightward.LYMPH NODES: Pelvic lymphadenopathy suggested. Left pelvic sidewall nodular focus measuring 2.1 x 1.7 cm, image 38 series 501, this focus lies alongside the left uterus and alternatively may represent a subserosal fibroid, lesion mildly heterogeneously enhances, also located near left ovary. Additional left pelvic ovoid soft tissue focus measures 2.2 x 1.3 cm, image 33 series 601, abuts but appears to be separate from the uterus on image 33 series 601, minimal rim to no enhancement visualized. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Heterogeneously enhancing soft tissue mass involving internal and external sphincter with mild invasion into right ischioanal fossa fat. The base of the mass extends from the 6:00 to the 9:00 position. Lesion measures 3.2 x 2.6 cm, image 79 series 1603. Trace pelvic free fluid.
1. Heterogeneously enhancing soft tissue perianal mass demonstrating restricted diffusion, lesion involves internal and external sphincter with mild invasion into right ischioanal fossa fat, appearance worrisome for necrotic neoplasm; abscess formation another consideration but considered less likely, there is absence of a significant internal fluid component, correlation with patient's clinical history/physical exam recommended. 2. Findings suspicious for pelvic lymphadenopathy as above.3. Fibroid uterus with evidence of adenomyosis as well.