Rectal tumour (T3)

Case contributed by Dr Ian Bickle

Presentation

Rectal bleeding and altered bowel habit. Colonoscopic proven rectal malignancy.

Patient Data

Age: 59
Gender: Male
CT

Diffusely thickened mid and upper rectum.

Multiple enlarged mesorectal lymph nodes and a single left pelvic sidewall nodes, lateral to the mesorectal fascia.

Low attenuation hepatic lesions, consistent with metastases.

MRI

Circumferential thickening of the mid and upper rectum approximately 6 cm from the anal verge.

At several sites, most pronounced at 3-5 o'clock tumour extends beyond the serosa, but doesn't extend up to the mesorectal fascia.

Multiple enlarged mesorectal nodes and a single left pelvic side wall node.

Pathology

Gross specimen following mesorectal excision.

The tumour is evident (white colour) in the cut specimen, with extension beyond the rectal wall into the mesorectal fat (yellow).

Annotated image

Comparative images in the sagittal plane.

Case Discussion

Rectal carcinoma is one of the more common forms of malignancy.

Local staging is typically undertaken with MRI with CT for the assessment of metastatic disease.

Cross sectional imaging is hugely influential in determining the clinical management decision of patients.

In this case the tumour was T3,N2,M1 (liver).

The case illustrates a good example of a T3 tumour and also highlights the superiority of MRI in local (T stage) of the disease.

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Case information

rID: 32623
Case created: 5th Dec 2014
Last edited: 11th Sep 2015
Inclusion in quiz mode: Included

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