Male 57 years old Reason: Patient with known history of multi recurrent sigmoid cancer pet scan showing hot suv spot in right posterior pelvic sidewall and midline pelvic mass. Evaluate extent of disease with attention to important landmarks and structures history: Recurrent sigmoid cancer PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes in the sigmoid colon. There is a subtle soft tissue abnormality involving the sigmoid colon about the level of the anastomosis which is suboptimally evaluated but may represent residual disease near the anastomotic site.There is a spiculated soft tissue mass in the presacral soft tissues anterior to the S2 vertebral body measuring 1.6 x 1.2 cm that corresponds to the abnormality on PET/CT. Laterally in the right pelvic sidewall adjacent to the S1 foramina there is a second soft tissue mass measuring 1.5 x 1.3 cm. This lesion is slightly more infiltrative in nature and abuts the pelvic sidewall.Morphologic features of the lesion suggest disease near the resection margin.BONES, SOFT TISSUES: In the right sacrum there is a T2 hyperintense mildly T1 hypointense enhancing lesion measuring 2.0 x 1.7 cm.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/20/2016 13:40:54)MIDLINE PELVIC SOFT TISSUE: 1.6 x 1.2 cm (Image 55, Series 12).RIGHT LATERAL PELVIC SOFT TISSUE: 1.5 x 1.3 cm (Image 58, Series 12).
1.Two soft tissue masses within the pelvis correlating to the abnormality on PET/CT one at midline and one along the right pelvic sidewall near the right S1 foramina .2.Right sacral lesion differential considerations include metastatic disease (although the lesion does not show FDG activity) or an atypical hemangioma. Correlation with prior MRI if available would be helpful as there is no correlate on the CT portion of the PET/CT.