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The patient was a 50-year-old woman. Radiology Report Department: Urology Clinical Diagnosis: Hydronephrosis; lumbar pain for several days Requesting Physician: Assist in diagnosis Examination: Enhanced CT urography (CTU) Radiological Findings: Both kidneys were normal in position and morphology. The left kidney showed several small non-enhancing low-density lesions. The right renal pelvis and calyces were dilated with hydronephrosis, along with dilatation and hydroureter of the entire right ureter. There was suspected wall thickening in the pelvic segment of the right ureter (excretory phase: im57). Right kidney enhancement was reduced. The left renal pelvis and calyces showed no dilatation, and the left ureter was not significantly dilated. The bladder was well filled with no obvious abnormal density in the bladder wall, though its shape was irregular. Adjacent peritoneum showed thickening with enhancement, and there was compression of nearby liver tissue. Increased soft tissue density was noted around the abdominal aorta. The liver was normal in size on the scanned sections, with several small non-enhancing low-density lesions within the liver. Subcapsular non-enhancing low-density areas with irregular morphology were seen in the right posterior lobe and at the junction of the right and left lobes, accompanied by peritoneal thickening and enhancement with compression of adjacent liver tissue. The gallbladder appeared normal in morphology with wall thickening but no obvious abnormal density in the lumen. The spleen and pancreas showed no significant abnormalities in morphology or density. No obviously enlarged lymph nodes were seen in the abdominal cavity. Radiological Diagnosis: In view of the history, peritoneal metastasis with possible pseudomyxoma peritonei (mainly involving the liver capsule) is considered, along with retroperitoneal lymphadenopathy. An infiltrative lesion on the right pelvic wall involves the distal right ureter, causing right urinary tract dilatation and hydronephrosis with reduced right kidney function. Pelvic effusion is present; please correlate with other examinations. Small left renal cysts; liver cysts and cholecystitis; ultrasound follow-up is recommended. Review Date: January 22
* PET/CT Imaging Report Examination Date: January 24 Height: 166.0 cm Weight: 61.0 kg Clinical Diagnosis: Post-cervical cancer surgery Examination Site: Whole body Blood glucose: 5.40 mmol/L Brief History: Four years after cervical cancer surgery, with recent abdominal pain for more than 20 days; whole-body examination performed. Findings: After fasting, 18F-FDG was injected intravenously, followed by whole-body PET/CT tomography under resting conditions. Whole-body tomographic images showed: The brain was normal in morphology and structure, with no abnormal density in the brain parenchyma and no abnormal FDG metabolism. The ventricles, sulci, fissures, and cisterns were not widened. Local density and FDG uptake were normal, with no midline shift. Skull bones showed no obvious abnormalities, and FDG uptake was not increased. Both eyeballs were normal in morphology and contour, with clear retro-orbital structures. The optic nerves were symmetric, with no abnormal FDG uptake. Mucosal thickening was noted in the left maxillary sinus without abnormal FDG uptake. The remaining paranasal sinuses showed no mucosal thickening, with intact sinus walls. The nasal septum was not deviated, and nasal mucosa showed no obvious thickening or abnormal FDG uptake. The nasopharyngeal wall showed no thickening or abnormal FDG uptake. The pharyngeal recesses were symmetric, with no narrowing of the Eustachian tube openings. The infratemporal and pterygopalatine fossae were normal, with no abnormal FDG uptake. The hypopharynx was normal in morphology and structure, with clear parapharyngeal spaces. The submandibular and parotid glands were normal in size, morphology, and density bilaterally, showing physiological FDG uptake. The thyroid was normal in morphology and size with homogeneous density and no abnormal FDG uptake. Multiple small lymph nodes (long axis approximately 0.3–0.6 cm) were seen in the bilateral deep cervical spaces, submandibular, and submental regions, with no abnormal FDG uptake. The thoracic cage was symmetric bilaterally. Lung markings were clear. A few fibrotic strands were noted in the medial segment of the right middle lobe, the inferior lingular segment of the left upper lobe, and the anterior basal segment of the left lower lobe. A small calcification was present in the lateral segment of the right middle lobe. No abnormal densities were seen in the remaining lung fields, with no abnormal FDG uptake. The pleura showed no thickening, and there was no pleural effusion bilaterally, with no abnormal FDG uptake. The trachea was midline, with patent lumens in the trachea and all lobar and segmental bronchi and no obvious wall narrowing. Multiple small lymph nodes (long axis approximately 0.3–0.6 cm) were present in the pretracheal, retro-caval, aortic arch, and aortopulmonary window regions as well as both axillae, with no abnormal FDG uptake. No obviously enlarged hilar lymph nodes were seen bilaterally, with no significant increase in FDG uptake. Heart size was within normal limits, with minimal myocardial FDG uptake. The pericardium showed no thickening and no pericardial effusion. Bilateral breast tissue was relatively loose, with multiple small slightly dense nodules showing no abnormal FDG uptake. A punctate calcification was noted in the upper inner quadrant of the right breast. The liver was somewhat irregular in morphology but not significantly abnormal in size. The liver edge was not smooth, with no widening of the fissures. Multiple flat soft-tissue thickenings were seen along the liver capsule, with small amounts of subcapsular fluid in corresponding areas showing increased FDG uptake (SUVmax = 5.6). A small cystic low-density lesion was present under the capsule of the right posterior lobe with no abnormal FDG uptake. No obvious abnormal densities were seen in the liver parenchyma on plain CT, and FDG metabolism was normal. The porta hepatis was clear. Intra- and extrahepatic bile ducts were not dilated. The gallbladder was normal in morphology and size, with mild wall thickening, no positive stones or obvious masses, and clear gallbladder fossa. Local FDG uptake was not abnormal. The pancreas had clear contours, normal morphology and size, no obvious abnormal densities, clear surrounding spaces, and no dilated pancreatic duct or abnormal FDG uptake. The spleen was basically normal in morphology and size, with normal density and FDG uptake. The right kidney was enlarged with reduced cortical density, dilated renal pelvis and hydronephrosis, and dilatation with hydroureter of the upper and middle segments of the right ureter. The left kidney showed duplex renal pelvis and ureter anomalies, with no focal bulges at the renal margin. Plain CT showed no obvious abnormal densities in the parenchyma and no significant abnormal FDG uptake. The bilateral renal pelvis, calyces, and ureters were not dilated, with no positive stones and no obvious abnormal FDG uptake. The perirenal spaces were clear. Both adrenal glands were normal in morphology, size, and density, with no abnormal local FDG uptake. The esophagus was not dilated, with no increased FDG uptake in the wall. The stomach was adequately filled, with mild wall thickening in the antrum and mildly increased FDG uptake (SUVmax = 2.4). Bowel filling was suboptimal, with no masses and no obvious abnormal FDG uptake. Post-cervical cancer surgery changes were present, with slightly disorganized anatomy in the surgical area but no abnormal density at the stump and no abnormal FDG uptake. Multiple irregular flocculent soft-tissue shadows and nodules were seen involving the pelvic peritoneum, right pelvic wall, right iliac fossa, perivascular retroperitoneal areas, right paracolic gutter, greater omentum, and diaphragmatic peritoneum. These had coalesced into masses, with involvement of the lower right ureter and increased FDG uptake (SUVmax = 8.5). Lymph nodes around the abdominal aorta in the retroperitoneum showed blurred, irregular contours with increased FDG uptake (SUVmax = 3.8). The bladder was not filled, with no positive stones or obvious masses. Small amounts of pelvic fluid were present. Spinal alignment was normal. Degenerative osteophytes were seen at some vertebral margins and facet joints, with disc bulging at L3/4, L4/5, and L5/S1 and no abnormal FDG uptake. Imaging Diagnosis: 1. Post-cervical cancer surgery with multiple peritoneal seeding metastases involving the pelvic peritoneum, right pelvic wall, right iliac fossa, perivascular retroperitoneal areas, right paracolic gutter, mid-to-lower abdominal greater omentum, and diaphragmatic peritoneum. Retroperitoneal lymph node metastases, subcapsular liver fluid, involvement of the lower right ureter, and dilatation with hydronephrosis of the right renal pelvis and upper-to-middle right ureter. 2. Small subcapsular cyst in the right posterior lobe of the liver. Chronic cholecystitis. Duplex renal pelvis and ureter anomaly on the left. Mild gastric antral wall thickening with mildly increased FDG uptake, suggestive of gastritis; gastroscopy follow-up recommended. 3. Chronic inflammation in the medial segment of the right middle lobe, inferior lingular segment of the left upper lobe, and anterior basal segment of the left lower lobe. Small calcification in the lateral segment of the right middle lobe. Chronic inflammatory mediastinal lymph nodes. 4. Multiple small fibroadenomas likely in both breasts; breast specialist follow-up recommended. Small calcification in the upper inner quadrant of the right breast. Chronic inflammatory lymph nodes in both axillae. 5. Degenerative changes in the cervical, thoracic, and lumbar spine with disc bulging at L3/4, L4/5, and L5/S1. 6. Chronic inflammation in the left maxillary sinus. Chronic inflammatory lymph nodes in the bilateral deep cervical spaces, submandibular, and submental regions. Normal brain FDG metabolism. Report Time: January 24 Review Time: January 25
cobas HPV High-Risk Human Papillomavirus Test Report Referring Hospital: This hospital Sampling Time: (not provided) Received Date: January 15 Test Date: January 15 13:48 Test Result: Cervix/Vagina Results: Subtype \ Result \ Reference HPV16 Negative (Negative) HPV18 Negative (Negative) Other 12 high-risk HPV types Positive (Negative) Notes: 1. This method only detects the 14 internationally recognized high-risk HPV types. In addition to types 16 and 18, the other 12 types tested include 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. 2. A positive HPV test does not necessarily mean the presence of cervical intraepithelial neoplasia or cervical cancer. However, high-risk HPV positivity increases the risk of cervical lesions or cervical cancer. Please consult a specialist regarding the clinical significance of specific positive types. Report Date: January 16
Gynecologic Color Doppler Ultrasound Report Ultrasound Description: [Transvaginal + Abdominal] Total hysterectomy and bilateral salpingo-oophorectomy performed. Vaginal vault and bilateral iliac fossae: negative Pelvic fluid: deepest depth 27 mm. Ultrasound Impression: Pelvic fluid. Examination End Time: January 19 09:15
Liquid-Based Cytology (LCT) Report Received Date: January 16 Referring Hospital: This hospital Sampling Site: Cervix/Vagina Satisfaction: Satisfactory Cell Count: >5000 Cell Type: Squamous epithelium Interpretation: No intraepithelial lesion or malignant cells Report Date: January 17
* Four years earlier the patient had undergone surgery for cervical cancer. On this occasion she presented with abdominal pain for the past 20 days. PET/CT was performed, which revealed extensive peritoneal seeding metastases in the pelvic peritoneum, right pelvic wall, right iliac fossa, and around retroperitoneal vessels after cervical cancer surgery, accompanied by multiple lymph node metastases. These findings indicated recurrence of cervical cancer. The patient died approximately 12 to 13 months after these examinations.