Liver metastases due to rectal primary cancer
RUQ pain and deranged LFTs. Alcoholic, weight loss recently.
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Large non-obstructing mass within the rectum and distal sigmoid colon measuring 7 cm in length, the spine is extensive irregular wall thickening and shouldering in keeping with primary rectal malignancy. Peri-rectal fat stranding is extensive suggesting mesorectal involvement and mesorectal fascia is thickened bilaterally. There is 11 mm upper presacral lymph node and more superiorly a 9 mm lymph node along the superior rectal vessels.
Two ill-defined and possibly contiguous hypodense lesions in the right lobe of the liver, measuring 30 and 20 mm are in keeping with metastatic disease. The segment 8 lesion abuts the anterior branch of the right portal vein which is truncated. The remainder of the portal veins are normal.
Left adrenal gland is bulky measuring 9 x 21 mm which may be metastatic. No other metastatic disease is evident. The lung bases are clear. No bony lesion evident.
Large rectal primary malignancy with presacral and superior rectal lymphadenopathy and right hepatic metastasis and possible intrahepatic portal venous invasion.
Classic case for a viva.