Abstract:
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Purpose: To report the MR Imaging findings (initial work-up, follow-up under treatment and recurrence) in rhabdomyosarcoma botryoides (RMS) of the uterine cervix in adults.
Methods and Materials: Fourteen MR examinations of 5 patients (aged 18 to 47 years, mean: 26.8 years) treated at our institution from June 2000 to March 2003 were retrospectively reviewed. We evaluated tumor signal intensity on SE T1- and FSE T2-weighted images in all patients and enhancement pattern on dynamic-acquisition contrast-enhanced SE T1-weighted images in four patients. Concomitant review by two radiologist( T.F., P.P.) and correlation with a senior pathologist (P.D.). Clinical follow-up (4 to 31 months, mean: 16.2 ) and MRI follow-up (2 to 26 months; mean 11.8) were also correlated with histologic findings.
Results: Four patients were stage I and one stage III according to the Intergroup Rhabdomyosarcoma Study (IRS)classification. In all cases initial MR imaging depicted a grape-like, polypoid mass (tumor size: 16 to 117 mm ; mean: 50.8 ) exhibiting low signal intensity mass on T1-weighted and near or equal to water high-signal intensity on T2-weighted images. Dynamic-acquisition substracted contrast-enhanced T1-weighted images showed early enhancement in all patients, homogeneous in 2 cases and heterogeneous in 2 cases. Correlation with histologic specimens showed that high signal intensity on T2-weighted images corresponds to the predominantly myxoid tumor component. All patients were treated with systemic neoadjuvant chemotherapy with good partial response and subsequent surgery in four patients (conization : 3 cases; hysterectomy : 1 case). However one patient was treated by brachytherapy for recurrence after surgery. One patient had progressive disease after initial partial response to neoadjuvant chemotherapy and died despite external radiation therapy. Good correlation was established between MR imaging and clinical findings in all cases. MR depicted all recurrences (2 cases) and residual tumor (3 cases) and allowed us to monitor the efficacy of treatment of both tumor and lymphadenopathy which was not possible through clinical examination.
Conclusion: RMS of the adult cervix uteri seems to have a distinctive high-signal intensity grape-like pattern on FSE T2-weighted images due to the predominantly myxoid component of this very rare tumor in young adults. These features may facilitate treatment monitoring and fertility-conserving treatment approaches in these young, child-bearing population with potential high long-term survival.
Taillieu MD, F,
MR Imaging Findings in Rhabdomyosarcoma Botryoides of the Uterine Cervix in Adults with Histopathologic Correlation. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3100546.html
