PMC8723868_01
(a) Pretreatment biopsy containing sheets of malignant glandular cells. (b) Higher power magnification where the vast majority of tumor is composed of signet-ring adenocarcinoma cells (arrow). (c) Postsurgical biopsy demonstrating a mixture of conventional mucinous adenocarcinoma (arrow). (d) Postsurgical biopsy demonstrating residual signet cell adenocarcinoma (arrow).
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The pretreatment biopsy (Figure 1(a)) contained sheets of malignant glandular cells. At higher power, the majority of tumor is composed of signet-ring adenocarcinoma cells (Figure 1(b), arrow), so named because the mucin-filled cytoplasm displaces the nucleus to the periphery of the cell giving the appearance of a signet ring. Sections through this tumor demonstrated a mixture of conventional mucinous adenocarcinoma (Figure 1(c)) along with residual signet-cell adenocarcinoma (Figure 1(d), arrow).
Magnetic resonance image sagittal scan with gross tumor volume (GTV) contours. (a) Fraction 1 with bulky tumor postexternal beam radiotherapy, where GTV was 20.5 cm3. (b) By fraction 4, there was a significant tumor response to brachytherapy with a GTV of 4.7 cm3.
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The use of real-time MRI guidance on 2 fractions, and combined intracavitary/interstitial techniques, resulted in significant tumor shrinkage during brachytherapy that was evident between fractions 1 and 4 (Figure 2).
PET CT sagittal scan postradiation and presurgery with demonstration of a metabolically active mass within the cervix, consistent with the patient's known malignancy.
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A PET/CT revealed a standardized uptake value (SUV) of 13.97 in the cervix consistent with residual tumor, as seen in Figure 3.