Rectal tumor (T3)

Case contributed by Ian Bickle
Diagnosis certain


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

Patient Data

Age: 60 years
Gender: Male

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.


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 tumor 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.


Gross specimen following mesorectal excision.

The tumor is evident (white color) 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 tumor was T3,N2,M1 (liver).

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

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