PMC9020987_01
Histopathology and immunohistochemistry of the cervical lesion (a) Tumor cells stain positive for desmin (black arrow). (b) Small, spindled, and round cells interspersed with strap cells against a background of myxoid stroma suggestive of rhabdomyoblastic differentiation. (c) Cambium layer (white arrow) demonstrating foci of subepithelial condensation of undifferentiated cells.
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Histopathology (Figure 1) revealed primitive mesenchymal elements arranged in both hypo and hypercellular areas with loose myxoid stroma and perivascular condensation.
(a, b) MRI of the pelvis (axial and sagittal views) before neoadjuvant chemoradiotherapy demonstrating a heterogeneously enhanced well-circumscribed lesion measuring 3.2 cm(ap) x 6.1 cm(tr) confined within the middle compartment of the pelvis. There is association with distention of the forniceal and transitional compartments of the vagina with caudal displacement of the introitus. (c, d) MRI of the pelvis after neoadjuvant chemoradiotherapy demonstrated a significant decrease in the volume of the lesion which measured 1.3 cm(ap) x 1.2 cm(tr) remaining confined within the middle compartment of the pelvis. The residual disease is epicentred in the upper third of the vagina with cranial extension into the cervical and lower endometrial canal.
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Considering these findings, a magnetic resonance imaging (MRI) scan of the abdomen and pelvis was requested to delineate the extent of the disease (Figure 2). An MRI scan was repeated after the completion of neoadjuvant treatment (Figure 2).
Prolapsed, exophytic cervical mass measuring 8 cm x 8 cm which redeveloped after initial excisional biopsy.
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Clinical assessment one month after initial excisional biopsy revealed regrowth of the fungating cervical mass with extension beyond the introitus (Figure 3).