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Rectal adenocarcinoma - metastatic

Case contributed by Dr Bruno Di Muzio


Investigation of PR bleed with coloscopy showing a rectal lesion. Biopsy has been performed. Further imaging staging.

Patient Data

Age: 45 years
Gender: Male

Macroscopy: Rectal biopsy - Multiple fragments of friable tan tissue <1-3 mm.​

Microscopy: The sections show fragments of ulcerated, moderately differentiated adenocarcinoma. The tumour is composed of complex cribriform structures and irregular glands of irregular glands and complex cribriform structures lined by severely dysplastic epithelium and set within the desmoplastic stroma. 

Conclusion: Moderately differentiated adenocarcinoma.


MRI Rectum

Distance to the anal verge: 12 cm
Distance to the top of sphincter complex/anorectal junction: 10 cm
Relationship to anterior peritoneal reflection: Above
Craniocaudal length: 6 cm
Circumferential location (o’clock position): circunferential
Morphology: Annular   
Mucinous: No  
MR‐T category:  T3c   (tumor penetrates >5‐15 mm beyond muscularis propria) 
CRM: N/A: (tumor at peritonealized portion of the rectum)
LYMPH NODES: Mesorectal/superior rectal lymph nodes and/or tumor deposits:  N2b (short axis <5 mm AND all 3 morphologic criteria*)
Superior most suspicious lymph node/deposit is located: peritoneal
Extra mesorectal lymph nodes: M1: common iliac and retroperitoneal
Stage: T3c N2b
Suspicious extra mesorectal lymph nodes: Yes


MRI Liver

Extensive liver metastatic disease with lesions involving all the liver segments. 

Case Discussion

Adenocarcinoma involving the upper rectum and with nodal and extensive liver metastatic disease. Disease staging T3c N2b M1c - stage IV. 


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Case information

rID: 59667
Published: 3rd Jul 2018
Last edited: 9th Sep 2020
Inclusion in quiz mode: Excluded

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