35-year-old female with cervical cancer, status post treatment now with changes on exam concerning for recurrence versus scar tissue. Back pain and increased vaginal discharge. PELVIS:UTERUS, ADNEXA: The cervical tumor measures 6.8 cm in transverse and 5.1 cm in AP diameter with central necrosis (series 1204 image 304). The tumor also demonstrates restricted diffusion (series 705 image 324). There is new enhancing inferior extension of the cervical mass into the vagina and periurethral region (series 1203 image 158). Associated outward fingerlike extensions and stranding are suspicious for parametrial invasion. BLADDER: There is wall thickening and T2 hyperintense signal intensity of the posterior urinary bladder wall (sagittal series 801 image 21) suggestive of submucosal edema.LYMPH NODES: Mildly enlarged enhancing lymph nodes in the bilateral pelvic sidewall regions (series 1204 image 354) are noted as well as a centrally necrotic lymph node in the right external iliac chain (series 1205 image 395).BOWEL, MESENTERY: Mild ascites.BONES, SOFT TISSUES: Small enhancing foci of the right posterior iliac bone (series 1202 image 537), right lower sacrum (series 1202 image 352), and bilateral inferior pubic rami (series 1202 images 142, 202) correlate with increased FDG activity on the same day PET/CT exam consistent with osseous metastases. These osseous lesions also demonstrate restricted effusion. Adjacent to the right inferior pubic rami osseous lesions, there are small enhancing foci (axial series 1204 image 134), and soft tissue metastatic disease cannot be excluded.OTHER: No significant abnormality noted.
1.Large cervical tumor with evidence of parametrial extension and new inferior extension of the enhancing tumor into the vagina and periurethral region. 2.There is nodal and osseous metastatic disease as described above. 