Presentation
Per-rectal bleeding.
Patient Data
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
FU after 3 cycles of chemoRx 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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