PMC2666464_01
Transvaginal pelvic ultrasound images (A,B) showed a complex retrouterine mass with a homogeneous solid component (*, B) and cystic areas (arrowhead, A) intermingled with linear septa (arrow, A)
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There was no sign of ascites (Figure 1).
Pelvic MR exam. Axial GRE T1-weighted (A), axial TSE 512 T2-weighted (B), sagittal post-contrast GRE T1-weighted image and (D) sagittal TSE T2-weighted images. There is a large, expansive, well-delimited lesion with lobulated contours; the T1-weighted sequence shows homogeneous signal intensity predominately with a low signal, and T2-weighted sequences are heterogeneous with small high-intensity foci (arrow). The lesion dislocated the ovaries (arrowheads, B) anterolaterally and the uterus (*, A,C and D) anteriorly. After intravenous injection of paramagnetic contrast agent, there was a heterogeneous enhancement of the lesion that was more evident peripherally (arrowheads, C)
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T2-weighted sequences were heterogeneous with small high intensity foci (Figure 2). T1-weighted images that was more evident peripherally (Figure 2). The lesion measured 9.2 x 7.2 x 8.0 cm and was located close to the ovaries, which were dislocated anterolaterally. The contours, dimensions and signal intensity of the ovaries were normal. The uterus was normal in shape, dimensions and signal intensity, and it was also dislocated anteriorly.
Computed tomography with no intravenous contrast agent revealed that there was no calcification within the mass (arrows)
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Computed tomography of the pelvis without intravenous injection of contrast agent was performed to search for calcification and showed a low homogeneous coefficient of attenuation for the lesion, ranging from - 2 to +10 U.H, with no evidence of calcification (Figure 3).
The histopathologic section shows calretinin staining for well-differentiated mesothelial cells (*), which confirms the mesothelial origin of the tumor
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Immunohistochemistry evaluation was carried out in the histological sections with an immuno-peroxidase reaction via the avidin-biotin peroxidase method, with the primary antibodies calretinin + CEA- and BerEp4- (Figure 4).
Follow-up pelvic MR exam. Axial TSE T2-weighted (A) and post-contrast axial GRE T1-weighted (B) images show a retrouterine, large, well-delimited cystic lesion with internal post-contrast-enhanced nodules (arrows) and partial septations (arrowhead). This lesion was surgically excised and histopathologically confirmed as to be a recidivate mesothelioma (u, uterus)
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A follow-up MR exam revealed an expansive, predominantly cystic lesion with high protein content located in the posterior cul-de-sac; this lesion had shown a progressive increase in volume over 3 years and was characterized as a recurrent tumoral lesion (Figure 5).