EP22.12: A case report of vaginal primary malignant mesonephric mixed tumour by contrast‐enhanced ultrasound

Malignant mesonephric mixed tumour (MMMT) of the female genital tract, also known as mesonephric adenocarcinoma, is a rare tumour originating from mesonephric duct remnants, mostly found in the cervix. The first case of primary vaginal MMMT was reported in 1983, with only five cases known to date. There's limited research on MMMT's ultrasonographic features, including contrast-enhanced ultrasound (CEUS). We report the case of a 43-year-old woman with a one-month history of irregular vaginal bleeding and a suspected cervical lesion. A gynecological exam revealed a neoplastic growth at the vaginal posterior fornix. Cervical cytology and HPV testing were negative. Transvaginal ultrasound showed a 2.6 × 1.8 × 3.1cm hypoechoic mass at the posterior fornix, with indistinct demarcation from the cervix but clear separation from the rectum. It was regular in shape with heterogeneous internal echoes and exhibited a small hypoechoic area. CDFI showed moderately increased blood flow signals within the mass. Conventional ultrasonographic findings were non-specific, posing challenges in differentiating between benign and malignant vaginal lesions. CEUS played a pivotal role in enhancing diagnostic precision. Following the intravenous administration of SonoVue (1.5ml), the mass displayed rapid centripetal enhancement in the early arterial phase (see figure 1a), subsequently showing a progressive decrease in enhancement during the late arterial phase and venous phase (see figure 1b). This pattern of wash-in and wash-out suggested the presence of a malignant vaginal tumour. In presenting this case, our aim is to broaden the knowledge of gynecologic oncologists and ultrasound practitioners about the sonographic and contrast-enhanced characteristics of vaginal MMMT. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.