PMC8548154_01
Ultrasound view of the uterus 1 month after childbirth. The longitudinal length of the uterus is 8.2 cm. No abnormal structures are visible in either the uterine body or the cervix.
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An obstetrical check performed one month postpartum indicated that the uterus was atrophic, and no unusual findings were detected upon pelvic ultrasound (Figure 1).
Contrast-enhanced computed tomography. (a) Numerous nodules were visible in bilateral lungs. (b) The pancreas is edematous and surrounded by effusion. (c) The uterus was enlarged, and the myometrium was irregularly stained. On the pelvic peritoneum, nodules were found (arrows).
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The uterus was enlarged and irregularly stained in contrast-enhanced CT (Figure 2).
(a) Sagittal T2-weighted MRI image of the uterus and the vagina: the myometrium signal intensity was higher than that of the intestinal stroma. Similar intensity was observed in the lower vagina, the vulva, and a nodule on Douglas' pouch. (b) Axial T2-weighted MRI image of the uterus and the pelvis. The signal intensity of the myometrium was higher than that of the coccygeus muscle. (c) Axial diffusion-weighed image of the uterine body. The entire myometrium showed high intensity. (d) Apparent diffusion coefficient (ADC) map. The mean ADC value of the whole uterus was 0.950 x 10-3 mm2/s with 0.720 x 10-3 mm2/s of it being covered by the darkest shade.
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Diffusion-weighted MRI of the uterus and the vagina suggested that the entire uterus might have been replaced by malignant tissue, which had reached deep into the lower segment of the vagina (Figure 3).
(a) FDG-PET/CT images of the whole body. Abnormal uptake of FDG was observed through the whole body, although it was strongest in the reproductive tract. (b) Axial FDG-PET/CT images of the uterine body. Urine (arrow) obscured FDG accumulation in the reproductive tract, whereas the uterus and the left ovary showed clear uptake of FDG. (c) Axial image of the ischial tuberosities and the vulva. (d) Coronal image of the uterus and the vagina. Excreted FDG into the bladder (arrow) was overlaid on the uptake in the reproductive tract.
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(a) Low-power view of the vaginal tumor. Malignant cells infiltrated into submucosal tissues, forming tumor nests. (b) High-power view. Undifferentiated cells surrounded a necrotic cluster.
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Results showed undifferentiated carcinoma (Figure 5).