EDUCATION EXHIBIT - Continuing Medical Education

MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation

Published Online:Mar 1 2003https://doi.org/10.1148/rg.232025065

Abstract

Magnetic resonance (MR) imaging is useful not only for preoperative staging of gynecologic malignancies but also for prediction of the histopathologic features of a variety of intrapelvic tumors. Familiarity with the specific imaging findings that have been reported for the uterine cervix is a goal of radiologists. The typical MR imaging findings of uterine cervical lesions correspond to the histopathologic features. These lesions can be categorized as epithelial neoplasms, nonepithelial neoplasms, and nonneoplastic diseases. Cervical carcinoma accounts for most cases of malignant lesions and is staged by using the classification system established by the International Federation of Gynecology and Obstetrics. MR imaging allows differentiation between endophytic and exophytic growth and between normal and abnormal findings after hysterectomy and irradiation. Other epithelial neoplasms of the uterine cervix include adenoma malignum, which is a special type of cervical adenocarcinoma, as well as carcinoid tumor and malignant melanoma. Nonepithelial neoplasms of the uterine cervix include malignant lymphoma and leiomyoma. Nonneoplastic diseases of the uterine cervix include cervical pregnancy, cervicitis, nabothian cysts, polyps, and endometriosis.

References

1 Japan Society of Obstetrics and Gynecology. The annual report of gynecologic tumors in 1998. Acta Obstet Gynaecol Jpn 2001; 53:999-1053. [Japanese].
Google Scholar
2 Parker SL, Tong T, Bolden S, Wingo PA. Cancer statistics, 1996. CA Cancer J Clin 1996; 46:5-28.
Medline Google Scholar
3 Yamashita Y, Takahashi M, Sawada T, Miyazaki K, Okamura H. Carcinoma of the cervix: dynamic MR imaging. Radiology 1992; 182:643-648.
Google Scholar
4 Feldmann HJ, Sievers K, Fuller J, Molls M, Lohr E. Evaluation of tumor blood perfusion by dynamic MRI and CT in patients undergoing thermoradiotherapy. Eur J Radiol 1993; 16:224-229.
Medline Google Scholar
5 Hawighorst H, Knapstein PG, Weikel W, et al. Angiogenesis of uterine cervical carcinoma: characterization by pharmacokinetic magnetic resonance parameters and histological microvessel density with correlation to lymphatic involvement. Cancer Res 1997; 57:4777-4786.
Medline Google Scholar
6 Shiraiwa M, Joja I, Asakawa T, et al. Cervical carcinoma: efficacy of thin-section oblique axial T2-weighted images for evaluating parametrial invasion. Abdom Imaging 1999; 24:514-519.
Medline Google Scholar
7 Benedet JL, Bender H, Jones H, III, Ngan HYS, Pecorelli S. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. Int J Gynecol Obstet 2000; 70:209-262.
Medline Google Scholar
8 Sironi S, Belloni C, Taccagni GL, et al. Carcinoma of the cervix: value of MR imaging in detecting parametrial involvement. AJR Am J Roentgenol 1991; 156:753-756.
Medline Google Scholar
9 Togashi K, Nishimura K, Sagoh T, et al. Carcinoma of the cervix: staging with MR imaging. Radiology 1989; 171:245-251.
Google Scholar
10 Togashi K, Morikawa K, Kataoka ML, Konishi J. Cervical cancer. J Magn Reson Imaging 1998; 8:391-397.
Medline Google Scholar
11 Togashi K. Carcinoma of the cervix. MRI of the female pelvis. Tokyo, Japan: Igaku-Shoin, 1993; 123-156.
Google Scholar
12 Kaminski PF, Norris HJ. Minimal deviation carcinoma (adenoma malignum) of the cervix. Int J Gynecol Pathol 1983; 2:141-152.
Medline Google Scholar
13 Fu YS, Reagan JW, Hsiu JG, Storaalsi JP, Wentz WB. Adenocarcinoma and mixed carcinoma of the uterine cervix. Cancer 1982; 49:2560-2570.
Medline Google Scholar
14 Silverberg SG, Hurt WG. Minimal deviation adenocarcinoma (“adenoma malignum”) of the cervix: a reappraisal. Am J Obstet Gynecol 1975; 121:971-975.
Medline Google Scholar
15 Yamashita Y, Takahashi M, Katabuchi H, Fukumatsu Y, Miyazaki K, Okamura H. Adenoma malignum: MR appearances mimicking nabothian cysts. AJR Am J Roentgenol 1994; 162:649-650.
Medline Google Scholar
16 Doi T, Yamashita Y, Yasunaga T, et al. Adenoma malignum: MR imaging and pathologic study. Radiology 1997; 204:39-42.
Medline Google Scholar
17 Mikami Y, Hata S, Fujiwara K, Imajo Y, Kohno I, Manabe T. Florid endocervical glandular hyperplasia with intestinal and pyloric gland metaplasia: worrisome benign mimic of “adenoma malignum”. Gynecol Oncol 1999; 74:504-511.
Medline Google Scholar
18 Itoh K, Toki T, Shiohara S, Oguchi O, Konishi I, Fujii S. A comparative analysis of cross sectional imaging techniques in minimal deviation adenocarcinoma of the uterine cervix. Br J Obstet Gynaecol 2000; 107:1158-1163.
Google Scholar
19 Li H, Sugimura K, Okizuka H, et al. Markedly high signal intensity lesions in the uterine cervix on T2-weighted imaging: differentiation between mucin-producing carcinomas and nabothian cysts. Radiat Med 1999; 17:137-143.
Medline Google Scholar
20 Yoden E, Mikami Y, Fujiwara K, Kohno I, Imajo Y. Florid endocervical glandular hyperplasia with pyloric gland metaplasia: a radiologic pitfall. J Comput Assist Tomogr 2001; 25:94-97.
Medline Google Scholar
21 Chen KTK. Female genital tract tumors in Peutz-Jeghers syndrome. Hum Pathol 1986; 17:858-861.
Medline Google Scholar
22 Tsuruchi N, Tsukamoto N, Kaku T, Kamura T, Nakano H. Adenoma malignum of the uterine cervix detected by imaging methods in a patient with Peutz-Jeghers syndrome. Gynecol Oncol 1994; 54:232-236.
Medline Google Scholar
23 Choi CG, Kim SH, Kim JS, Chi JG, Song ES, Han MC. Adenoma malignum of uterine cervix in Peutz-Jeghers syndrome: CT and US features. J Comput Assist Tomogr 1993; 17:819-821.
Medline Google Scholar
24 Kaminski PF, Norris HJ. Coexistence of ovarian neoplasms and endocervical adenocarcinoma. Obstet Gynecol 1984; 64:553-556.
Medline Google Scholar
25 Sheridan E, Lorigan PC, Goepel J, Radstone DJ, Coleman RE. Small cell carcinoma of the cervix. Clin Oncol (R Coll Radiol) 1996; 8:102-105.
Medline Google Scholar
26 Albores-Saavedra J, Larraza O, Poucell S, Rodriguez-Martinez HA. Carcinoid of the uterine cervix: additional observation on a new tumor entity. Cancer 1976; 38:2328-2342.
Medline Google Scholar
27 Ueda G, Yamasaki M. Neuroendocrine carcinoma of the uterus. Curr Top Pathol 1992; 85:309-335.
Medline Google Scholar
28 Koch CA, Azumi N, Furlong MA, et al. Carcinoid syndrome caused by an atypical carcinoid of the uterine cervix. J Clin Endocrinol Metab 1999; 84:4209-4213.
Medline Google Scholar
29 Curtin JP, Morrow CP. Melanoma of female genital tract. Coppleson M, ed. Gynecologic oncology. New York, NY: Churchill Livingstone, 1992.
Google Scholar
30 Kristiansen SB, Anderson R, Cohen DM. Primary malignant melanoma of the cervix and review of literature. Gynecol Oncol 1992; 47:398-403.
Medline Google Scholar
31 Peyman GA, Mafee MF. Uveal melanoma and similar lesions: the role of magnetic resonance imaging and computed tomography. Radiol Clin North Am 1987; 25:471-486.
Medline Google Scholar
32 Atlas SW, Grossman RJ, Gomori JN, et al. MR imaging of intracranial metastatic melanoma. J Comput Assist Tomogr 1987; 11:577-582.
Medline Google Scholar
33 Woodruff WW, Jr, Djang WT, McLendon RE, Heinz RE, Voorhees DR. Intracerebral malignant melanoma: high-field strength MR imaging. Radiology 1987; 165:209-213.
Google Scholar
34 Miyagi Y, Yamada S, Miyagi Y, et al. Malignant melanoma of uterine cervix. J Obstet Gynaecol Res 1997; 23:511-519.
Medline Google Scholar
35 Moon WK, Kim SH, Han MC. MR findings of malignant melanoma of the vagina. Clin Radiol 1993; 48:326-328.
Medline Google Scholar
36 Yamada I, Suzuki S. Primary uterine lymphoma: MR imaging. AJR Am J Roentgenol 1993; 160:662-663.
Google Scholar
37 Aozasa K, Saeli K, Ohsawa M, Horiuchi K, Mishima K, Tsujimoto M. Malignant lymphoma of the uterus: report of seven cases with immunohistochemical study. Cancer 1993; 72:1959- 1964.
Medline Google Scholar
38 Kawakami S, Togashi K, Kojima N, Morikawa K, Mori T, Konishi J. MR appearance of malignant lymphoma of the uterus. J Comput Tomogr 1995; 19:238-242.
Google Scholar
39 Kim YS, Koh BH, Cho OK, Rhim HC. MR imaging of primary uterine lymphoma. Abdom Imaging 1997; 22:441-444.
Medline Google Scholar
40 Dang HT, Terk MR, Colletti PM, Schlaerth JB, Curtin JP. Primary lymphoma of the cervix: MRI findings with gadolinium. Magn Reson Imaging 1991; 9:941-944.
Medline Google Scholar
41 Mehta M, Thurston WA. Magnetic resonance imaging appearance of primary cervical non-Hodgkin’s lymphoma: 3 case reports. Can Assoc Radiol J 1998; 49:250-252.
Medline Google Scholar
42 Clark DP, Ostler P, Watkinson A, Collis C, Berger L. Magnetic resonance imaging in primary cervical lymphoma: the role in diagnosis and follow-up. Clin Radiol 1998; 53:383-385.
Medline Google Scholar
43 Gompel C, Silverberg SG. The cervix: benign tumors and tumor-like lesions. Pathology in gynecology and obstetrics. 4th ed. Philadelphia, Pa: Lippincott, 1994.
Google Scholar
44 Hricak H, Tscholakoff D, Heinrichs L, et al. Uterine leiomyomas: correlation of MR, histopathologic findings, and symptoms. Radiology 1986; 158:385-391.
Google Scholar
45 Ueda H, Togashi K, Konishi I, et al. Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. RadioGraphics 1999; 19:S131-S145.
Google Scholar
46 Oguchi O, Mori A, Kobayashi Y, Horiuchi A, Nikaido T, Fujii S. Prediction of histopathologic features and proliferative activity of uterine leiomyoma by magnetic resonance imaging prior to GnRH analogue therapy: correlation between T2-weighted images and effect of GnRH analogue. J Obstet Gynaecol 1995; 21:107-117.
Medline Google Scholar
47 Okizuka H, Sugimura K, Takemori M, Obayashi C, Kitao M, Ishida T. MR detection of degenerating uterine leiomyomas. J Comput Assist Tomogr 1993; 17:760-766.
Medline Google Scholar
48 Kawakami S, Togashi K, Konishi I, et al. Red degeneration of uterine leiomyoma: MR appearance. J Comput Assist Tomogr 1994; 18:925-928.
Medline Google Scholar
49 Tsushima Y, Kita T, Yamamoto K. Uterine lipoleiomyoma: MRI, CT, and ultrasonographic findings. Br J Radiol 1997; 70:1068-1070.
Medline Google Scholar
50 Yamashita Y, Torashima M, Takahashi M, et al. Hyperintense uterine leiomyoma at T2-weighted MR imaging: differentiation with dynamic enhanced MR imaging and clinical implications. Radiology 1993; 189:721-725.
Google Scholar
51 Werber J, Prasadarao PR, Harris VJ. Cervical pregnancy diagnosed by ultrasound. Radiology 1983; 149:279-280.
Google Scholar
52 Parente JT, Ou C, Levy J, Legatt E. Cervical pregnancy analysis: a review and report of five cases. Obstet Gynecol 1983; 62:79-82.
Medline Google Scholar
53 Rothe DJ, Birnbaum SJ. Cervical pregnancy: diagnosis and management. Obstet Gynecol 1973; 42:675-680.
Medline Google Scholar
54 Jung SE, Byun JY, Lee JM, et al. Characteristic MR findings of cervical pregnancy. J Magn Reson Imaging 2001; 13:918-922.
Medline Google Scholar
55 Berek JS, Adashi EY, Hillard PA. Genitourinary infections and sexually transmitted diseases. Novak’s gynecology. 12th ed. Baltimore, Md: Williams & Wilkins, 1996; 429-445.
Google Scholar
56 Danforth DN, Scott JR. Obstetrics and gynecology Philadelphia, Pa: Lippincott, 1986.
Google Scholar
57 Novak ER, Woodruff JD. Novak’s gynecologic and obstetric pathology with clinical and endocrine relations 8th ed. Philadelphia, Pa: Saunders, 1979.
Google Scholar
58 Fogel SR, Slasky BS. Sonography of nabothian cysts. AJR Am J Roentgenol 1982; 138:927-930.
Medline Google Scholar
59 Kurman RJ, Norris HJ, Wilkinson E. Tumors of the cervix. Atlas of tumor pathology: tumors of the cervix, vagina, and vulva. Washington, DC: Armed Forces Institute of Pathology, 1992.
Google Scholar
60 Togashi K, Noma S, Ozasa H. CT and MR demonstration of nabothian cysts mimicking a cystic adnexal mass. J Comput Assist Tomogr 1987; 11:1091-1092.
Medline Google Scholar
61 Golan A, Ber A, Wolman I, David MP. Cervical polyp: evaluation of current treatment. Gynecol Obstet Invest 1994; 37:56-58.
Medline Google Scholar
62 Togashi K. Miscellaneous lesions of the uterus. MRI of the female pelvis. Tokyo, Japan: Igaku-Shoin, 1993; 179-202.
Google Scholar
63 Fukunaga M. Uterus-like mass in the uterine cervix: superficial cervical endometriosis with florid smooth muscle metaplasia? Virchows Arch 2001; 438:302-305.
Medline Google Scholar

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Published in print: Mar 2003

Vol. 23, No. 2

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