A radiological case series of diverse vaginal cuff lesions

Abstract

This case series explores 4 unique presentations of vaginal cuff lesions, highlighting their diverse etiologies and imaging characteristics. The cases include a vaginal cuff meshoma, benign vaginal cuff cystic lesions, and metastatic endometroid adenocarcinoma. The series emphasizes the importance of a multifaceted approach utilizing patient history, clinical examination, and various imaging modalities (transvaginal ultrasound, MRI, PET-CT) for accurate diagnosis and optimal patient management.

Keywords: Gartner duct cyst; Inclusion cyst; Meshoma; Metastases; Vaginal cuff lesions.

Fig. 1

(A and B) T2-weighted MRI image showing mesh embedded in the anterior vaginal wall (white arrow). (C and D) MRI postcontrast image showing a peripheral enhancing soft tissue mass seen along the anterior vaginal cuff in the paramedian location (white arrow).

Fig. 2

Histopathology section of the attached tissue to excised vaginal mesh demonstrating squamous mucosa with submucosal hemorrhage, acute and chronic inflammation (marked with white arrow), and necrosis (H&E stain, 100x magnification).

Fig. 3

Sagittal (A) and coronal (B) transvaginal ultrasound showing a predominantly hypoechoic lesion (marked with white arrow), measuring 1.6 × 1.3 × 1.4 cm, with multiple punctate hyperechoic foci within.

Fig. 4

MRI T1 weighted noncontrast nonfat suppressed (A) and fat-suppressed (B) images showing the well-defined anterior vaginal wall inclusion cyst ( marked with white arrows). It appears hyperintense in both images and is not suppressed on fat-suppressed imaging.

Fig. 5

Transvaginal ultrasound image (A) displaying a well-defined anechoic cyst (white arrow) with peripheral vascularity within the vaginal cuff (B).

Fig. 6

T2-weighted MRI image (A) showing a hyperintense lesion (white arrow) with mild peripheral enhancement (white arrow) on T1 contrast MRI image (B).

Fig. 7

Sagittal (A) and axial (B) T2 weighted MRI images showing the new metastatic vaginal lesion (white arrows). It is a well-defined heterogenous lesion along the anterior wall of the vaginal cuff, just posterior to the urethral meatus.

Fig. 8

Axial MRI images, showing diffusion restriction with hyperintensity on DWI (A) and hypointensity on ADC image (B).

Fig. 9

Histopathological image showing infiltrating malignant glands (marked with white arrow) throughout the vaginal mucosa. The malignant glands are morphologically identical to those observed in the prior hysterectomy specimen, which showed endometrioid adenocarcinoma. The findings indicate metastatic involvement of the vagina by the patient's primary endometrial cancer. (H&E stain, 100x magnification).

Fig. 10

Histology of hysterectomy specimen showing infiltrating malignant glands (marked with white arrow) in Endometrial carcinoma, endometrioid type, FIGO Grade 3 with residual 20% myometrial invasion (H&E stain, 200× magnification).

Fig. 11

MRI Pelvis images showing intermediate signal heterogenous nodular thickening involving top of vaginal cuff on T2W sequence (A) and contrast enhancement is seen in sagittal T1 contrast image (B). Axial MRI images showing mild diffusion restriction with mild hyperintensity on DWI (C) and hypointensity on ADC sequence (D) (marked with white arrow).

Fig. 12

FDG PET Coronal (A) and Axial (B) images show intense FDG avidity in vaginal cuff lesions (marked with white arrow).