Abstract: Endometrial and cervical cancers are common gynecological malignancies that often present similarly and have considerable overlap, yet they require different treatment strategies. When tumors grow large enough to involve both the endometrium and the cervix, determining their origin can be challenging. We report the case of a 51-year-old female who presented with complaints of vaginal bleeding for the past 5 months and had a hemoglobin level of 4 g/dL. During a per speculum examination, a fragile mass was found occupying the entire vagina. A per vaginal examination could not assess the cervix or the size of the uterus. A magnetic resonance imaging (MRI) revealed a well-defined heterogeneous lesion of intermediate T2 signal in the vagina and fornices, causing distension. The lesion extended into the endometrial cavity without invading the myometrium or cervical stroma. It showed enhancement and diffusion restriction on imaging. A biopsy of the lesion suggested endometrioid carcinoma, and the patient was started on chemotherapy, resulting in near-complete resolution of the lesion. Certain imaging features can help differentiate between cervical and endometrial origins, such as the epicenter of the tumor and the pattern of enhancement on dynamic contrast MRI. Another differential diagnosis to consider is adenoma malignum of the cervix.
Adke et al. (Wed,) studied this question.
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