PMC6159299_01
T1 weighted axial section of the pelvis. The well-circumscribed rounded mass in the region of the upper vagina demonstrates intermediate T1 signal.
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fig1
On the T1 weighted images, the signal intensity of the abnormality was intermediate, similar to that of the skeletal muscle (Figure 1).
T2 weighted axial section of the pelvis with a small field of view. The well-circumscribed rounded mass in the region of the upper vagina demonstrates heterogeneous T2 signal. Loss of left posterolateral outer vaginal margin and signal change in the left paravaginal fat was noted.
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fig2
T2 signal with no enhancement, whereas the posterosuperior aspect was of low T2 signal with avid enhancement (Figures 2-4). There was no restricted diffusion. The posterior wall of the retroverted uterus was demonstrated to abut the superior surface of the lesion and the vaginal lumen was deviated anteriorly.
T2 weighted sagittal section of the pelvis. Discrete zones of low and high signal are demonstrated within the lesion. The mass appears to be arising within the posterior vaginal wall with displacement of the vaginal lumen anteriorly.
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fig3
T2 signal with no enhancement, whereas the posterosuperior aspect was of low T2 signal with avid enhancement (Figures 2-4). There was no restricted diffusion. The posterior wall of the retroverted uterus was demonstrated to abut the superior surface of the lesion and the vaginal lumen was deviated anteriorly.
Sagittal T1  weighted image with fat saturation and gadolinium contrast enhancement. The area of low T2 signal noted within the lesion in figure 3 demonstrates avid contrast enhancement and corresponds histologically to a hypercellular area with high collagen content. The high T2 signal area does not enhance and corresponds to paucicellular myxoid tissue.
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fig4
T2 signal with no enhancement, whereas the posterosuperior aspect was of low T2 signal with avid enhancement (Figures 2-4). There was no restricted diffusion. The posterior wall of the retroverted uterus was demonstrated to abut the superior surface of the lesion and the vaginal lumen was deviated anteriorly.
Axial portal venous phase contrast-enhanced CT image of the upper vagina demonstrating a mixed attenuation mass with patchy avid contrast enhancement.
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fig5
Again, the vaginal lesion demonstrated fluid and soft tissue attenuation areas with regions of enhancement (Figure 5).
Haematoxylin and eosin preparation of the vaginal mass on a large block mount with x2 magnification. The deep pink hypercellular area contains spindle cells set in dense collagen, whereas the paler area reflects an area of myxoid change with few cells. This correlates precisely with the appearances in Figures 3 and 4.
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fig6
Microscopic examination (Figure 6) revealed an unencapsulated lesion with a spindle cell morphology arranged occasionally in fascicles.