Final Pr. ID: Poster #: CR-07 (R)
12 year old female presented with history of ureteral re-implantation and severe pelvic pain for a month. Pelvic ultrasound showed a bi-lobed hypoechoic mass in the pelvis markedly distended with internal intermediate and low level echoes and septations suggestive of hematometrocolpos thought to be secondary to imperforate hymen. Subsequent MRI evaluation of the pelvis demonstrated a complete septate uterus with longitudinal vaginal septum, atresia of the lower 1/3 of the vagina, and hematocolpos. The patient was placed on Lupron and referred for reconstructive surgery. Read More
Final Pr. ID: Poster #: CR-047
A 17-month-old female presented with a one-month history of abnormal soft tissue protruding from the vaginal introitus.
The patient’s past medical history was significant for hemi-hypertrophy of the left lower extremity. Physical examination demonstrated normal external genitalia, with pink solid tissue protruding from the vagina posterior aspect, and mild associated white fluid discharge. Laboratory analysis revelaed a normal CBC, serum HCG and AFP.
An ultrasound examination of the pelvis demonstrated a heterogeneous echogenicity soft tissue mass with scant internal vascularity centered in the vagina and cervix, measuring approximately 4.0 x 2.3 x 2.5 cm.
The patient’s clinical and imaging findings were most concerning for malignancy, namely vaginal rhabdomyosarcoma, so consultation was requested from Pediatric Surgery and Oncology. As a result of these consultations, the patient was scheduled for vaginoscopy with biopsy under general anesthesia, as well as surgical port placement due to the high suspicion for malignancy. Also to be performed under the same anesthetic was a CT examination of the chest and MR examination of the pelvis.
Vaginoscopy revealed a “pebbly appearance” of the vaginal walls, which also reportedly “felt thickened” on digital exam. Multiple surgical biopsy specimens were obtained from the visibly abnormal areas.
MR examination immediately post biopsy showed circumferential mural thickening of the cervix and vagina, with a more prominent area of soft tissue thickening at the level of the vaginal introitus. The areas of mural thickening appeared T1 and T2 signal isointense with mild post-contrast enhancement and no evidence of abnormal restricted diffusion. No focal mass was identified. CT examination of the chest was normal.
Histopathologic analysis revealed a benign lesion composed of a relatively small number of spindle cells embedded in a loose fibrous stroma. No significant numbers of mitoses or atypia were observed, including in the lining squamous epithelium. These features were most consistent with a fibroepithelial stromal polyp.
In light of the pathology findings, the port implant was removed, and the patient has since undergone surveillance vaginoscopy examinations.
This case illustrates MRI findings of a rare benign condition which may mimic vaginal rhabdomyosarcoma on the basis of clinical and ultrasound findings. MRI demonstrating an absence of aggressive features may help to suggest this rare differential consideration. Read More
Final Pr. ID: Poster #: CR-008
We report a case of a 7 year old female who presented to urology clinic due to recurrent urinary tract infections that had started 4 years ago. The patient also reported symptoms of urge incontinence and nocturnal enuresis beginning at the same time. She previously consulted an adult gynecologist, which showed no physical exam evidence of genitourinary abnormalities. An MRI of the abdomen and pelvis was also ordered at that time which reported a normal exam except for a small left renal cyst. At our institution she underwent DMSA renal scan, which was normal. She underwent a voiding cystourethrogram (VCUG), which showed no vesicoureteral reflux. However, during the VCUG, an incidental note was made of large amounts of vaginal reflux extending into the cervix, uterus, and with spillage into the peritoneal cavity presumably via the salpinges. Read More
Final Pr. ID: Poster #: CR-057
Ewing sarcoma is the second most common malignancy of bone with an incidence of approximately 200 cases per year in the United States in children under 20. Extraosseous Ewing sarcoma originating in the vagina is rare, with only 8 cases reported to date in the literature. These highly aggressive tumors require a more intensive treatment regimen compared to other vaginal masses like rhabdomyosarcoma. While the imaging findings are non-specific, awareness of this clinical entity can facilitate early diagnosis and appropriate treatment, which may improve prognosis. Read More