Rectal adenocarcinoma

Case contributed by Dr Mostafa El-Feky

Presentation

Per-rectal bleeding.

Patient Data

Age: 60 years
Gender: Male
CT

On presentation

Irregular mural thickening of the lower rectum showing:

  • morphology: annular reaching 1.9 cm in thickness at the left anterior wall at 2 o'clock
  • tumor length: about 6.2 cm
  • circumferential location: anteriorly (two quadrants)
  • anal verge to tumor distance: 5.4 cm
  • multiple suspicious locoregional mesorectal lymph nodes are noted, largest averages 1 x 0.8 cm
  • no pelvic visceral invasion

The liver shows few right hepatic lobe hypoenhancing lesions, largest is noted at segment VI measuring 3 x 3.5 cm, suspicious for hepatic deposits.

Few reactive porta-hepatis and portocaval lymph nodes.

Uncomplicated colonic diverticular disease.

Small right renal upper calyceal stone.

Thickened posterior limb of left adrenal gland with a hypoenhancing and hypodense lesion averaging 0.6 x 1 cm, likely fat-rich adrenal adenoma.

Few right renal simple cortical cysts.

Mildly enlarged prostate with concretions.

Sliding hiatal hernia.

The patient underwent endoscopy with biopsy.

Endoscopic data: oblong ulcerated rectal mass with nodular friable mucosa, extending from the anorectal junction up to 8 cm from anus, involving half of the lumen.

Pathology: moderately differentiated glandular structure, lined by pleomorphic pseudostratified epithelium, infiltrating the surrounding stroma with cellular hyperchromasia and moderate mitosis. Besides, there are foci of necrosis.

Conclusion: rectal adenocarcinoma grade II

CT

Follow up after 3 cycles of chemotherapy (after 3.5 months)

As compared to the previous study, the current study revealed:

Rectal mass: tumor size: currently, the rectal wall at the site of the previously noted rectal mass is uniform and measures 5 mm (limited judgment due to catheter balloon), as compared to 1.9 cm in thickness at the left anterior wall at 2 o'clock at previous study … residual minimal thickening versus normalized rectal wall

Nodes: decreased size of mesorectal lymph nodes, largest currently averages 0.6 x 0.6 cm compared to 1 x 0.8 cm at the previous study.

Hepatic deposits: decreased size and number of the previously noted hepatic hypoenhancing lesions, largest is noted at segment VI measuring 1 x 0.8 cm compared to 2.5 x 2 cm at the previous study.

Stationary few reactive porta-hepatis and portocaval lymph nodes.

Stationary left adrenal lesion. 

Case Discussion

Pathologically proved rectal adenocarcinoma grade II with liver metastases, improved on chemotherapy.

The porta-hepatis and portocaval lymph nodesas well as the left adrenal lesion are likely to be incidental and unrelated to rectal malignancy disease spread.

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Case information

rID: 77110
Published: 26th May 2020
Last edited: 27th May 2020
Inclusion in quiz mode: Included
Institution: Dar El Ashaa Center

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