Pelvic mass. Evaluate proximity to nerves, vessels, and ureter. PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted. No hydroureter.LYMPH NODES: 6.1 x 3.2 x 5.0 cm heterogeneously enhancing left obturator soft tissue lesion, suspicious for metastatic nodal mass, similar to prior. Lesion is situated between the left external and internal iliac veins, and it compresses without occluding the left external iliac vein. Lesion abuts the adjacent sigmoid colon, without invasion. The visualized left obturator nerve passes just posterior to the aforementioned lesion, no secondary signs of nerve impingement such as muscle atrophy seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: The visualized musculature is symmetric bilaterally.There is nonenhancing soft tissue prominence about the left vaginal cuff (series 601, image 23), likely postsurgical. The punctate focus of hypermetabolic activity in the pelvis posterior to the lesion alluded to above seen on the prior PET, corresponds to a nonenhancing nonspecific thin linear focus of low T2 signal, may reflect scarring.OTHER: Subcentimeter Tarlov cysts noted.
Left obturator lesion suspicious for metastatic nodal disease or implant unchanged, associated compression of left external iliac vein seen, left obturator nerve passes just posteriorly, no evidence of neurovascular involvement otherwise.