Presentation
Rectal pain.
Patient Data
There is a thick-walled cavitating mass. There is central ulceration of the rectal mucosa overlying the tumor, and probable resultant secondary infection and necrosis accounting for the mixed density fluid within the tumoral cavity. The mass restricts on high B-value DWI. Note the suppression of the fluid within the tumoral cavity.
The seminal vesicles and prostate are displaced ventrally.
There is a thick-walled enhancing mass centered on the lower rectum. The mass is displacing the bladder anteriorly. There are no enlarged pelvic lymph nodes and no suspicious liver or liver lesions.
Case Discussion
In the large bowel, GISTs are seen almost exclusively at the anorectal junction.
Importantly, GISTs very rarely metastasize to lymph nodes (<5 %) so the lack of localized lymph node enlargement for a tumor of this size, directs diagnosis away from rectal and prostate cancer.
Presented with Professor Marco Novelli MBChB MSc PhD FRCPath and Dr Hameed Rafiee FRCR, University College London Hospitals.
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