Fig. 1

Examination findings at Out-patient Department. a Several hot spots were detected within the esophagus SUVMax 14.2), the left supraclavicular lymph node SUVMax 8.2), and the lesser curvature of the stomach SUVMax 5.5) in positron emission tomography scan. b A high accumulation, SUVMax 39.1, was found in the vagina and the cervix (arrow). c Inspection of the vulva. d The labia majora is completely fused and there is a pinhole opening in the midline. The vaginal introitus and urethral meatus are obliterated. e A transrectal ultrasound revealed the uterus was retroflexed and the endometrium was thin. f The vagina was dilated with fluid retention and a normal cervix was visualized