Rectal cancer

Case contributed by Azza Elgendy
Diagnosis certain


Bleeding per rectum. CT was performed showed large rectal mass. Sigmoidoscopy and biopsy revealed rectal adenocarcinoma. MRI was obtained for staging.

Patient Data

Age: 60 years
Gender: Male

There is a large near circumferential, ulcerating mass arising 5 cm above the anal verge and extending to the mid rectum. The mass extends > 5 mm beyond the muscularis propria. The mass shows restricted diffusion on ADC. There is also homogenous enhancement of the mass following contrast administration. Additionally,  there is  fistulous tract leading to a chronic presacral abscess that tracking along the left side pelvic wall and superior to the urinary bladder, the abscess also shows restricted diffusion. Inflammatory changes are seen inferior to the coccyx and extending to the perineum. 

The MRI was done for preoperative evaluation. The case was proven to be moderately differentiated  adenocarcinoma. 

Annotated image

Annotated image shows the extension of the tumor beyond the muscularis propria, for more than 5mm, this corresponds to T3.  

Case Discussion

A large ulcerating mass involving the lower rectum and extending to the mid-rectum. The mass extends beyond the muscularis propria. There is 1 cm adenopathy seen left posterior to the lower rectum. There is no distant metastasis consistent with T3N1M0.

There is a chronic pelvic abscess secondary to a fistulous tract connecting the rectal cavity to the presacral space and extending to the left pelvic sidewall. There is a chronic diverticular disease.  

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