Figure 714 T4 N1 Vaginal carcinoma with rectovaginal fistula

Transaxial T2W1 showing upper vaginal tumour which presented with rectovaginal fistula. Low signal tumour (T) extends from the right lateral vagina (V) along the right utero-sacral ligament (short arrows) and is tethered to the sacrum posteriorly (arrow). Tumour extends through the right perirectal space to invade the rectum (R). Fluid and locules of gas are seen within the fistula tract (asterisk). There are bilateral enlarged external iliac lymph nodes (N).

Sagittal T2W1 showing high signal in the cervix (C) and posterior vaginal fornix (*) following biopsy of a small vaginal primary. The abnormalities are well defined and of high signal intensity suggestive of locules of fluid, rather than tumour which is typically less well defined and of intermediate to high signal intensity. In this patient there was residual tumour, which was not visible on MRI.

Figure 7.16.Vagina following radiotherapy for cervical carcinoma.

Transaxial T2W1 showing high signal thickening (arrows) of the lower vagina, principally involving the muscular component, in a patient treated with radiotherapy for cervical carcinoma 20 years previously. High signal in the vaginal wall typically resolves within 12 to 18 months after radiotherapy, but may persist long term.

Figure 7.17. T4N0 Vaginal carcinoma showing response to radiotherapy.

(a) Sagittal T2W1 before and (b) 3 years following radiotherapy. Before radiotherapy, tumour (T) is seen involving the posterior vaginal fornix and extending through the posterior vaginal wall to involve the rectal wall (arrow). Following radiotherapy, the tumour is no longer visible.The vaginal wall shows very low signal, the posterior vaginal wall appears adherent to the posterior lip of the cervix with obliteration of the posterior vaginal fornix (arrows), (c) Transaxial T2W1 at the level of the mid vagina 3 years following radiotherapy. The vaginal wall is thickened, irregular and of low signal following radiotherapy (arrows).There is a small low signal nodule (arrowhead) between the posterior vaginal wall and the rectum representing fibrosis at the site of previous tumour invasion.

Figure 7.18. Vesico-vaginal fistula and recurrent tumour following radiotherapy forT4 vaginal carcinoma.

(a) Sagittal T2W1 showing vesico-vaginal fistula (black arrows). The bladder wall (B) is thickened and irregular.There is air (crossed arrows) in the anterior bladder and urine in the upper vagina (V). There is also a defect in the anterior bladder wall and urine (asterisks) tracks around the pubis (P) into the anterior abdominal wall. High signal is seen in the rectal submucosa (R) due to radiotherapy. Uterus (U). (b) TransaxialT2W1 showing vesico-vaginal fistula on the right (arrow) with urine in the upper vagina (V).There is air (crossed arrows) and debris in the bladder lumen (B). There is high signal in the pelvic fat (F) due to previous radiotherapy. High signal in the obturator externus muscles (OE) may either be radiotherapy related or due to inflammation induced by the anterior urine leak, (c) Transaxial T2W1 in the same patient showing recurrent tumour (T) at the right vesico-ureteric junction obstructing the right ureter (arrowheads). A collection containing urine and air due to bladder rupture is seen anteriorly within the rectus abdominis muscle (asterisk).The rectum (R) shows high signal in the submucosa and perirectal fat due to previous radiotherapy. Cervix (C); bladder (B). Differentiation ofrecurrent tumour from post treatment fibrosis or inflammatory tissue may be difficult. Tumour is typically ofintermediate to high signal and has a solid appearance with mass effect. Fibrosis is typically of low signal with tethering and retraction of adjacent structures. Inflammatory masses are less common but may be indistinguishable from recurrent tumour

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