Metastatic rectal adenocarcinoma

Case contributed by Mohammad Taghi Niknejad
Diagnosis almost certain

Presentation

Work up for chronic constipation.

Patient Data

Age: 50 years
Gender: Male

Asymmetrical increased wall thickness due to tumoral infiltration is present at the mid and distal rectum, measuring about 5 cm in length and 23 mm in maximum thickness. Mild perirectal fat stranding and a few regional lymphadenopathies with SAD less than 15 mm are evident. 

Multiple nodules less than 12 mm are seen in both lung fields inferring metastasis.

Several small soft tissue density masses, less than 15 mm, are seen at the greater omentum and paracolic gutters, inferring tumoral deposits.

Three nodules measuring 16 mm, 12 mm, and 11 mm are seen at the left adrenal gland, which shows progressive enhancement on post-contrast images, and could suggest metastasis. Bilateral retroperitoneal small nodules related to both kidneys are also noted.

An enlarged upper mediastinal lymph node anterior to the aortic arch (not shown) was also seen.

The prostate gland is enlarged. 

Case Discussion

Rectal mass; pathology proved adenocarcinoma with regional and mediastinal lymphadenopathy, peritoneal tumoral deposits, and adrenal and lung metastasis.

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