Detailed Treatment Process
Patient, female, 50 years old. Radiological Diagnostic Report Department: Urology Clinical Diagnosis: Hydronephrosis; low back pain for several days Examining Physician Request: Assist in diagnosis Examination Site and Name: CT urography (CTU) enhanced imaging Radiological Findings: The position and morphology of both kidneys are normal. Several non-enhancing small low-density foci are seen in the left kidney. The right renal pelvis and calyces are dilated with hydronephrosis throughout the right ureter. Suspicious wall thickening is noted in the proximal pelvic segment of the right ureter (excretory phase: im57). The right kidney shows reduced enhancement. No dilatation is seen in the left renal pelvis or calyces, and the left ureter shows no obvious dilatation. The bladder is well filled with no obvious abnormal density shadows in the bladder wall. The morphology is irregular. Adjacent peritoneum is thickened with enhancement, and adjacent liver tissue shows compression. Increased soft tissue shadows are seen beside the abdominal aorta. Within the scanned layers, the liver is normal in size. Several non-enhancing small low-density foci are seen in the liver. Subcapsular non-enhancing low-density shadows with irregular morphology are seen in the right posterior lobe of the liver and at the junction of the right and left lobes. Adjacent peritoneum is thickened with enhancement, and adjacent liver tissue shows compression. The gallbladder shadow is normal in morphology with wall thickening and no obvious abnormal density shadows in the lumen. The spleen and pancreas show no obvious abnormalities in morphology or density. No obviously enlarged lymph nodes are seen in the abdominal cavity. Radiological Diagnosis: In combination with the medical history, peritoneal metastasis and possible formation of pseudomyxoma peritonei are considered (mainly involving the subcapsular region of the liver). Retroperitoneal lymphadenopathy is present. An infiltrative lesion on the right pelvic wall involves the distal right ureter, resulting in right urinary tract dilatation and hydronephrosis with reduced right kidney function. Pelvic effusion is noted; please correlate with other examinations. Small left renal cysts; liver cysts, 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 Medical History: Four years after cervical cancer surgery, recent abdominal pain for over 20 days. Whole-body examination. Findings: After intravenous injection of 18F-FDG in the fasting state and rest, whole-body PET/CT tomographic imaging was performed. Whole-body tomographic images show: Brain morphology and structure are normal. No abnormal density shadows in the brain parenchyma. No abnormal FDG metabolism. The ventricles, sulci, fissures, and cisterns are not widened. Local density and FDG uptake show no abnormalities. Midline structures are not shifted. No obvious abnormalities in skull bone. No increased FDG uptake. Bilateral eyeballs show normal morphology and contour. Retro-orbital structures are clear. Optic nerves are symmetric bilaterally. No abnormal FDG uptake. Mucosal thickening in the left maxillary sinus with no abnormal FDG uptake. No mucosal thickening in the remaining paranasal sinuses. Sinus walls are intact. Nasal septum is not deviated. Nasal mucosa shows no obvious thickening. No abnormal FDG uptake. No thickening of the nasopharyngeal wall. No abnormal FDG uptake. Pharyngeal recesses are symmetric bilaterally. Eustachian tube openings are not narrowed. Infratemporal fossa and pterygopalatine fossa structures are normal. No abnormal FDG uptake. Hypopharynx morphology and structure are normal. Parapharyngeal spaces are clear. Bilateral submandibular and parotid glands show normal size, morphology, and density with physiological FDG uptake. Thyroid morphology and size are normal with homogeneous density. No abnormal FDG uptake. Multiple small lymph nodes are seen in bilateral deep cervical spaces, submandibular and submental regions, with long diameters of approximately 0.3-0.6 cm. No abnormal FDG uptake. Bilateral thoracic cages are symmetric. Lung markings are clear. A few fibrotic strand shadows are seen 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 calcified focus is seen in the lateral segment of the right middle lobe. No abnormal density shadows in the remaining lung fields. No abnormal FDG uptake. No pleural thickening bilaterally. No pleural effusion. No abnormal FDG uptake. The trachea is central. The trachea and lobar/segmental bronchi are patent with no obvious wall narrowing. Multiple small lymph nodes are seen in the pretracheal retrocaval space, aortic arch region, aortopulmonary window, and bilateral axillae, with long diameters of approximately 0.3-0.6 cm. No abnormal FDG uptake. No obviously enlarged lymph nodes at bilateral hila. No obvious increase in FDG uptake. Heart shadow is within normal size range. Myocardial FDG uptake is not obvious. No pericardial thickening. No pericardial effusion. Bilateral breast parenchyma is relatively loose with multiple slightly dense small nodular shadows. No abnormal FDG uptake. A punctate calcified focus is seen in the upper inner quadrant of the right breast. Liver morphology is slightly irregular. Size shows no obvious abnormality. Liver edge is not smooth. No widening of fissures. Multiple flat soft tissue thickenings on the liver capsule with small amounts of subcapsular fluid in corresponding areas. Increased FDG uptake, SUVmax=5.6. A small cystic low-density shadow is seen under the capsule of the right posterior lobe of the liver with no abnormal FDG uptake. No obvious abnormal density shadows in the liver parenchyma on plain CT scan. No abnormal FDG metabolism. Hepatic hilum structures are clear. No dilatation of intra- or extrahepatic bile ducts. Gallbladder morphology and size are normal. Gallbladder wall is slightly thickened. No positive stones or obvious masses. Gallbladder fossa is clear. No abnormal local FDG uptake. Pancreas contour is clear. Morphology and size are normal. No obvious abnormal density shadows. Surrounding spaces are clear. Pancreatic duct is not widened. No abnormal FDG uptake. Spleen morphology and size are basically normal. No abnormalities in density or FDG uptake. Right kidney is swollen with reduced cortical density, dilated renal pelvis with hydronephrosis, and dilatation and hydronephrosis of the upper and middle segments of the right ureter. Left kidney shows duplex renal pelvis and duplex ureter malformation. No localized bulge at the renal margin. Plain CT shows no obvious abnormal density shadows in the parenchyma. No obvious abnormal FDG uptake. No widening of bilateral renal pelvis, calyces, or ureters. No positive stone shadows locally. No obvious abnormal FDG uptake. Perirenal spaces are clear. Bilateral adrenal glands show normal morphology, size, and density. No abnormal local FDG uptake. No esophageal dilatation. No increased local wall FDG uptake. Stomach filling is fair. Gastric antrum wall is slightly thickened with mildly increased FDG uptake, SUVmax=2.4. Bowel filling is unsatisfactory. No local masses. No obvious abnormal FDG uptake. Post-cervical cancer surgery, surgical area structures are slightly disorganized. No abnormal density shadows at the surgical stump. No abnormal FDG uptake. Multiple irregular flocculent soft tissue shadows and nodular shadows are seen on the pelvic peritoneum, right pelvic wall, right iliac fossa, around retroperitoneal vessels, right paracolic gutter, and greater omentum, fusing into masses. The lower segment of the right ureter is locally involved with increased FDG uptake, SUVmax=8.5. Lymph node shadows around the abdominal aorta in the retroperitoneum have blurred and irregular contours with increased FDG uptake, SUVmax=3.8. Bladder is not filled. No positive stones or obvious masses locally. Small amount of pelvic fluid. Spinal alignment is normal. Osteophytes at some vertebral margins and facet joints. Disc bulging at L3/4, L4/5, and L5/S1. 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, around retroperitoneal vessels, right paracolic gutter, greater omentum in the mid-lower abdomen, and diaphragmatic peritoneum. Retroperitoneal lymph node metastases. Subcapsular liver fluid. Involvement of the lower segment of the right ureter with dilatation and hydronephrosis of the right renal pelvis and upper-middle right ureter. 2. Small subcapsular cyst in the right posterior lobe of the liver. Chronic cholecystitis. Left kidney duplex renal pelvis and duplex ureter malformation. Slight thickening of the gastric antrum wall with mildly increased FDG uptake, considered gastritis; gastroscopy follow-up is 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 calcified focus in the lateral segment of the right middle lobe. Chronic inflammatory lymph nodes in the mediastinum. 4. Multiple small fibroadenomas likely in bilateral breasts; breast specialist follow-up recommended. Small calcified focus in the upper inner quadrant of the right breast. Chronic inflammatory lymph nodes in bilateral axillae. 5. Degenerative changes in 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 bilateral deep cervical spaces, submandibular, and submental regions. No abnormal 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 Test Results: Subtype\Result\Reference Value 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 HPV types in this test include 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68. 2. A positive HPV test does not necessarily mean the presence of cervical intraepithelial lesions or cervical cancer. However, high-risk HPV positivity increases the risk of cervical lesions or cervical cancer. Please consult a professional physician for the clinical significance of positivity for different types. Report Date: January 16
Gynecological Color Ultrasound Report Ultrasound Description: [Transvaginal + Abdominal] Total hysterectomy with bilateral salpingo-oophorectomy. Vaginal vault and bilateral iliac fossae: (-) Pelvic fluid: deepest 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 cells Cell Type: Squamous epithelium Interpretation: No intraepithelial lesion or malignant cells Report Date: January 17
* Four years ago, the patient underwent surgery for cervical cancer. The current presentation was abdominal pain for the past 20 days. PET/CT was performed, which showed extensive peritoneal seeding metastases in the pelvic peritoneum, right pelvic wall, right iliac fossa, and around retroperitoneal vessels after cervical cancer surgery, along with multiple lymph node metastases. It appears that the above findings indicate cervical cancer recurrence. The patient passed away approximately 12 to 13 months after these examinations.