Presentation
Known patient of ulcerative colitis on treatment for 20 years presenting with rectal mass.
Patient Data
CT enterography done 4 yr ago was reviewed first
Few scattered polypoidal growths seen arising from the mucosa of descending colon and rectum in this study done 4 years ago.
Poorly enhancing transmural eccentric mass lesion is seen arising from 4 to 12 o clock of rectum with serosal breach, involvement of mesorectal fat. There is loss of fat planes with base of prostate and with right seminal vesicles. Multiple poorly enhancing lymph nodes seen in mesorectum and in internal iliac group. Circumferential mural thickening and stratification is seen in left colon with persistence of the previous descending colon polyps.
Case Discussion
Inflammatory bowel disease and in particular ulcerative colitis is a predisposing factor for colorectal carcinoma. Dysplastic changes occur in adenomas in these patients and hence they warrant routine screening with colonoscopy.
The dysplastic nature of a previously innocuous adenomatous rectal polyp in this case is a good example of neoplastic transformation and extensive locoregional spread.
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