Rectal cancer

Case contributed by Bahman Rasuli


Decreased stool caliber mixed with blood.

Patient Data

Age: 40 years
Gender: Female

Large heterogeneous enhancing solid necrotic mass measuring about 100*110*120 mm with marked water restriction occupied the pelvic cavity originated from the lower two-third rectum left posterolateral side with exophytic growing and infiltration with effacement of mesorectal fascia with extensions as followed:

- Posterior: infiltration of presacral space with effacement fat plan, adhesion to the sacrococcygeal region, external obturator, and pyriformis muscle.

- Anterior: adhesion to uterine cervix and vagina causing the anterosuperior displacement of the uterus.

- Inferior: infiltration of the ischiorectal and ischioanal fossa .

- Superior: extension into the pelvic inlet up to the S1 level.

Circumferential thickening of the rectal wall at the upper third portion 

Regional and iliac chains lymphadenopathies

Both ovaries are unremarkable.

Case Discussion

A huge solid necrotic mass involving the lower two-third rectum and extending to the pelvic cavity with invasion to adjacent organs. Imaging findings consistent with locally advanced rectal cancer stage IVbN2b( IIIc). Neoadjuvant chemoradiation has started prior to surgery in order to decrease the bulk of the mass.

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