Imaging Features of Uncommon Gynecologic Cancers

Abstract

OBJECTIVE The role of imaging in patients with suspected gynecologic malignancies is to provide an accurate diagnosis to achieve the best and most tailored treatment plan. Uncommon cancers pose a distinct challenge, because current knowledge of these diseases is still limited. Our purpose is to highlight the role of cross-sectional imaging techniques, including ultrasound, CT, MRI, and PET/CT, in the diagnosis and pretreatment stratification of patients with rare gynecologic cancers. CONCLUSION This review shows the relevance of imaging findings for diagnosis, staging, and treatment planning in patients with uncommon uterine, cervical, vaginal, vulvar, and ovarian cancers.

State of the art in vulvar cancer imaging

“…The deep inguinal nodes lie medial to the femoral vein ( 7 ) . The subsequent drainage from those nodes is via the external iliac and pelvic nodes ( 5 , 8 , 9 ) .…”

“…The standard MRI protocol for the evaluation of vulvar lesions includes axial T1-weighted fast spin-echo images with a large field of view; axial and coronal high-resolution T2-weighted fast spin-echo images; and sagittal T1WI ( 7 ) . T2WI with fat suppression may show the tumor better than do images without fat suppression ( 7 , 9 , 17 ) , given that the perineal region is rich in fat, that tumors with intermediate signal intensity on T2WI (Figure 3A) are more difficult to visualize, and that the intrinsic signal intensity of the tumor is associated with necrosis (Figure 3B). Dynamic contrast-enhanced MRI can aid in the evaluation of small tumors and of involvement of the urethra, anus, and vagina ( 7 , 9 ) , as shown in Figure 3C.…”

“…T2WI with fat suppression may show the tumor better than do images without fat suppression ( 7 , 9 , 17 ) , given that the perineal region is rich in fat, that tumors with intermediate signal intensity on T2WI (Figure 3A) are more difficult to visualize, and that the intrinsic signal intensity of the tumor is associated with necrosis (Figure 3B). Dynamic contrast-enhanced MRI can aid in the evaluation of small tumors and of involvement of the urethra, anus, and vagina ( 7 , 9 ) , as shown in Figure 3C. Diffusion-weighted imaging can also be useful for delineating primary masses and lymph node metastases ( 5 , 9 ) .…”

“…Dynamic contrast-enhanced MRI can aid in the evaluation of small tumors and of involvement of the urethra, anus, and vagina ( 7 , 9 ) , as shown in Figure 3C. Diffusion-weighted imaging can also be useful for delineating primary masses and lymph node metastases ( 5 , 9 ) .…”

“…On dynamic contrast-enhanced sequences (Figure 3), there is contrast enhancement in the early arterial phase ( 7 ) . Disruption of the target appearance of the urethra on T2WI and interruption of the low signal intensity on T2WI of the vaginal wall (Figure 4A) or anal sphincter by an intermediate to high signal intensity tumor on T2WI (Figure 4B) are suggestive of invasion ( 9 ) . On CT images, a vulvar tumor appears as an area of vulvar thickening or a vulvar mass ( 7 , 9 ) .…”