History of rectal cancer status post chemoradiation therapy. PELVIS:UTERUS, ADNEXA: The uterus is lobular in contour and enlarged secondary to numerous well-defined hypointense masses compatible with numerous fibroids. The endometrium is not significantly thickened. The adnexa are unremarkable.BLADDER: The bladder is normally distended without a focal abnormality.There is abnormal marked circumferential T2 weighted mildly hyperintense thickening of the urethra extending from the bladder base for 2.4 cm with the ureter measuring up to 1.8 x 1.6 cm (series 401/16), suspicious for malignancy. LYMPH NODES: Interval near complete resolution of the mesorectal lymphadenopathy with small lymph nodes measuring less than 1 to 2 mm in short axis. (Series 401/27).BOWEL, MESENTERY: There is asymmetric wall thickening of the lower anterior rectum measuring up to 2.6 x 0.9 x 2.9 cm (series 401/15 and series 501/33), significantly decreased in size from the prior study. The asymmetric thickening is intermediate and markedly low signal intensity on T2-weighted imaging compatible with residual tumor and/or postradiation therapeutic changes. There is no restricted diffusion associated with the mass or definite postcontrast enhancement. There is mild irregularity of the adjacent serosal surface but no definite invasion into the adjacent vaginal wall, similar to prior.BONES, SOFT TISSUES: Note is made of grade 1/2 anterolisthesis of L5 relative to S1.OTHER: No significant abnormality noted.
1.Interval marked decrease in size of the low rectal tumor with persistent asymmetric wall thickening of the anterior lower rectal wall demonstrating intermediate and markedly low T2-weighted signal intensity compatible with a combination of residual and/or postradiation therapeutic changes. Marked interval decrease in the mesorectal lymphadenopathy.2.Abnormal marked circumferential thickening of the urethra is suspicious for malignancy until proven otherwise. Tissue sampling is recommended. This was relayed to Dr. David Caba (surgery) at 1345 on 12/14/2015.3.Numerous uterine fibroids. 