Cervical Masses
Synonyms/Description
None
Etiology
Cervical cancer accounts for the majority of cervical malignancies and is second to breast cancer in incidence worldwide. Approximately 85% to 95% of cervical cancers are squamous cell carcinomas and develop at the squamous-columnar junction.
Adenocarcinomas represent only 5% of cervical cancers and arise from glandular cells found in the endocervical canal. Squamous cell lesions of the cervix are typically detected early using conventional cytologic screening methods (Pap test) because they are easy to sample. The majority of endocervical glands are deep within the cervical canal, so detection usually occurs at more advanced stages of disease; hence they have a poorer prognosis than squamous cell cancers. The survival for stages I, II, and III cervical adenocarcinoma is 60%, 47%, and 8% compared with 90%, 62%, and 36% for squamous cell carcinoma.
Non-Hodgkin’s lymphoma of the cervix is rare, accounting for 1% of all extranodal lymphomas. Clinically it may present as a large lobular vascular solid mass of the cervix. Metastatic disease, such as melanoma and breast, lung, and ovarian cancers, may also involve the cervix.
Malignant mixed Müllerian tumors and leiomyosarcomas occur more frequently in the uterine corpus, but may arise in the cervix in rare cases. Embryonal rhabdomyosarcomas typically occur in the pediatric age group.
Benign masses of the cervix include fibroids and polyps, which are similar in origin and appearance to their counterparts in the uterine corpus. Nabothian cysts are also commonly seen.
Ultrasound Findings
Cervical masses can obstruct the cervical canal and result in a hematometra, which may be the first sonographic sign of a cervical malignancy. Cervical carcinomas, especially squamous, are often subtle or undetectable sonographically as they can be quite small. As they grow, they appear as solid lobulated masses with abundant vascularity. Sarcomas and lymphomas are typically large solid vascular tumors when discovered. The appearance of these malignant tumors is nonspecific, although the excessive and disorganized blood flow within the tumor suggests a malignancy. Epstein and colleagues compared the sonographic characteristics of squamous cell and adenocarcinoma of the cervix. The ultrasound appearances of the tumors were all solid masses; however, 73% of the squamous cell carcinomas were hypoechoic, whereas 68% of the adenocarcinomas were isoechoic (p = 0.03). Mixed echogenicity was a nonspecific finding, and Doppler color flow was abundant in almost all the tumors of both types.
Benign masses of the cervix also tend to be solid sonographically, although the blood flow pattern seen with color Doppler tends to be different from that of the cancers. Polyps typically have a single feeding vessel, and are usually echogenic, sometimes containing a cystic center. Fibroids are solid masses with a similar appearance to those in the uterine corpus. They are well circumscribed, with acoustic shadowing, often with a pattern of stripes or swirls caused by these shadows. The blood flow in fibroids is variable although less abundant than in malignant lesions and more peripheral.
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