57-year-old woman with history of vaginal adenocarcinoma and bleeding. Additional history as per chart: Patient status post hysterectomy and bilateral salpingo-oophorectomy in 2011 for benign disease. 2 x 1 cm midline lower one third vaginal mass biopsy and path consistent with poorly differentiated adenocarcinoma. PELVIS:UTERUS, ADNEXA: Patient status post hysterectomy and bilateral salpingo-oophorectomy. There is thickening with irregular intermediate T2 signal seen in the anterolateral left vaginal wall (6/37). Additional masslike intermediate T2 signal seen in the posterior urethra and described below.BLADDER: There is a large saddle urethral diverticulum (5/39). Within this diverticulum, there is a 25 x 17 mm intermediate T2 mass (5/39) extending from the posterior lateral left urethral wall into the anterolateral vaginal wall. This mass is seen extending over a length of approximately 2.4 cm superiorly into the bladder base. Additionally, there is local infiltration into the pelvic floor and surrounding fat along with significant enhancement.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The rectosigmoid colon appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Soft tissue mass extending from the posterior lateral left urethra to the anterolateral left vaginal wall. The differential for this mass includes an adenocarcinoma within a urethral diverticulum, Mullerian duct remnant adenocarcinoma, or vaginal adenocarcinoma of the anterior wall (considered less likely given location).2.This mass is locally infiltrative involving the base of the bladder and the pelvic floor. No lymphadenopathy noted.3.Large saddle urethral diverticulum.