a 59 y/o woman with pelvic pain

Images

Doctor's Information

Name : Morteza
Family : Sanei taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : rahebe jafarinia

Case Section

Genital Female Imaging

Patient's Information

Gender : Female
Age : 59

Clinical Summary

a 59 y/o woman with pelvic pain and vaginal bleeding.no past medical history is present.

Imaging Findings

a huge mass is seen in cervix that is high signal in T1,low signal in T2.a similar lesion is seen in urethra.after IV contrast,heterogenous enhancement is seen.an enhancing lymph node is seen in LT inguinal region.

Differential Diagnosis

cervical SCC,cervical adenocarcinoma

Final Diagnosis

Primary Uterine Cervical Melanoma

Discussion (Related Text)

Melanoma of the cervix is a rare and aggressive neoplasm associated with short survival rate. About 60% of the cases already have clinical evidence of tumor beyond the cervix at the time of diagnosis Cervical melanoma is highly aggressive as both local recurrence and widespread metastases usually occur within a short span of a few months to two years of the diagnosis. The most widely used imaging modalities for cancer staging and re-staging are CT, MRI, and PET/CT. MRI may assist in distinguishing cervical melanoma from other tumors, based on a distinct signal pattern on T1- and T2-weighted images. Malignant melanoma with rich melanocytes is expected to appear hyperintense on T1-weighted images (7). However, mucosal melanomas may be amelanotic, and a definite diagnosis must be confirmed by immunohistochemical staining for S-100 protein, HMB-45, and vimentin and by excluding any other primary melanoma site. Because the clinical presentation and spread pattern of uterine melanoma resemble that of cervical carcinoma, the FIGO staging system has been generally accepted (1). Sentinel lymph nodes sampling is a reliable method to predict the metastatic status of the regional lymphatic basin in patients with cutaneous melanoma and cervical cancers (8, 9). Prior research has investigated the diagnostic accuracy of MRI, CT and PET for identifying lymph node status in primary cervical cancer. The results demonstrated that PET was superior to MRI and CT for sensitivity, specificity, and accuracy in detecting pelvic nodal metastasis (10, 11). The role of PET for staging and re-staging cutaneous malignant melanoma has been reported to have high sensitivity and accuracy, and was most valuable for patients in clinical stage IIC and higher). However, no reports have been published about the role of PET or PET/CT in the clinical management of malignant melanomas arising from female reproductive organs. One of the proposed criteria to diagnose primary melanomas of the uterine cervix is absence of primary lesion elsewhere, especially in the skin, ocular, or other mucosal sites. In conclusion, PET/CT is a sensitive method for detecting early spread of this aggressive disease.

References

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