Diagnostic ultrasound ( PDFDrive )

CHAPTER 54 Pediatric Pelvic Sonography 1883
A
B
C
D E F
FIG. 54.21 Rhabdomyosarcoma of Vagina. Sagittal (A) scan through the uterus shows a heterogeneous solid mass in the upper vagina
inseparable from the cervix. Normal fundus and endometrial echo are visible superior to the mass, with signiicant vascularity on color Doppler
imaging (B). Transverse scan (C) shows a heterogeneous mass that expands the upper vagina and cervix. Magnetic resonance image shows
intermediate signal mass with a frondlike coniguration on sagittal (D) and transverse (E) T2-weighted imaging with high signal in the surrounding
vagina as a result of luid and blood. The mass avidly enhances after gadolinium administration (F) with extension along the anterior vaginal wall
(arrow).
duct remnants (müllerian cyst and dilated prostatic utricle) with
unilateral renal agenesis.
Neoplasm
Tumors of the uterus and vagina are uncommon in the pediatric
patient. Malignant tumors are more common than are benign
tumors, and the vagina is a more common site than is the uterus.
Rhabdomyosarcoma is the most common primary malignant
neoplasm (Fig. 54.21). 67 It can arise from the uterus or vagina,
although uterine involvement is more frequent by direct extension
from a vaginal tumor. Presentation is usually at 6 to 18 months
of age with vaginal bleeding or protrusion of a polypoid cluster
of masses (sarcoma botryoides) through the introitus. Rhabdomyosarcoma
most oten arises from the anterior wall of the
vagina near the cervix. It may also arise in the distal vagina or
labia. Direct extension of the tumor into the bladder neck is
common, but posterior invasion of the rectum is infrequent.
Lymphadenopathy and distant metastases are uncommon at
presentation. On sonographic examination, these tumors are
solid, homogeneous masses that ill the vaginal cavity or cause
enlargement of the uterus with an irregular contour.
Endodermal sinus tumor, a less common genital neoplasm,
is a highly malignant germ cell tumor that can arise in the vagina.
It has clinical and sonographic presentations similar to those of
rhabdomyosarcoma Other malignant tumors of the uterus and
vagina are rare. Adenocarcinoma of the cervix in adults arises
from the endocervix, whereas in children it is a polypoid lesion
that originates from the ectocervix and upper vagina. Carcinoma
of the vagina (usually clear cell adenocarcinoma) usually occurs
in teenagers with a history of in utero DES exposure. Leukemic
iniltration of the uterus can occur secondary to contiguous
extension from an ovarian relapse. Sonography shows a
large, homogeneous, hypoechoic, pelvic mass incorporating the
uterus and ovaries, which cannot be separately identiied. here
may be associated hydronephrosis caused by distal ureteral
obstruction.
Benign, solid neoplasms of the uterus and vagina are rare in
children. However, benign cystic vaginal masses can occur. he
most common cystic lesion of the vagina is Gartner cyst. A
remnant of the distal wolian (mesonephric) duct, Gartner cysts
may be single or multiple and typically arise from the anterolateral
vaginal wall. hey appear as luid-illed cysts within the vagina